School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
J Surg Educ. 2020 Nov-Dec;77(6):e86-e93. doi: 10.1016/j.jsurg.2020.09.024. Epub 2020 Oct 17.
Surgical residents have been shown to experience high rates of burnout. Whether this is influenced predominately by intrinsic characteristics, external factors, or is multifactorial has not been well studied. The aim of this study was to explore the relationship between these elements and burnout. We hypothesized that residents with higher emotional intelligence scores, greater resilience and mindfulness, and better work environments would experience lower rates of burnout.
General surgery residents at 7 sites in the US were invited to complete an electronic survey in 2019 that included the 2-item Maslach Burnout Inventory, Brief Emotional Intelligence Scale, Revised Cognitive and Affective Mindfulness Scale, 2-Item Connor-Davidson Resilience Scale, Utrecht Work Engagement Scale, and Job Resources scale of the Job Demands-Resources Questionnaire. Individual constructs were assessed for association with burnout, using multivariable logistic regression models. Residents' scores were evaluated in aggregate, in groups according to demographic characteristics, and by site.
Of 284 residents, 164 completed the survey (response rate 58%). A total of 71% of respondents were at high risk for burnout, with sites ranging from 57% to 85% (p = 0.49). Burnout rates demonstrated no significant difference across gender, PGY level, and respondent age. On bivariate model, no demographic variables were found to be associated with burnout, but the internal characteristics of emotional intelligence, resilience and mindfulness, and the external characteristics of work engagement and job resources were each found to be protective against burnout (p < 0.001 for all). However, multivariable models examining internal and external characteristics found that no internal characteristics were associated with burnout, while job resources (coeff. -1.0, p-value <0.001) and work engagement (coeff. -0.76, p-value 0.032) were significantly protective factors. Rates of engagement overall were high, particularly with respect to work "dedication."
A majority of residents at multiple institutions were at high risk for burnout during the study period. Improved work engagement and job resources were found to be more strongly associated with decreased burnout rates when compared to internal characteristics. Although surgical residents appear to already be highly engaged in their work, programs should continue to explore ways to increase job resources, and further research should be aimed at elucidating the mediating effect of internal characteristics on these external factors.
外科住院医师的 burnout 发生率很高。导致 burnout 的因素主要是内在特征、外在因素还是多因素的，目前尚未得到很好的研究。本研究旨在探讨这些因素之间的关系。我们假设，情绪智力得分较高、韧性和正念更强、工作环境更好的住院医师 burnout 发生率较低。
美国 7 个地点的普通外科住院医师受邀于 2019 年完成一项电子调查，该调查包括 2 项 Maslach 倦怠量表、简要情绪智力量表、修订认知和情感正念量表、2 项 Connor-Davidson 韧性量表、Utrecht 工作投入量表和工作需求-资源问卷的工作资源量表。使用多变量逻辑回归模型评估个体结构与 burnout 的关系。根据人口统计学特征，对住院医师的评分进行了综合评估、分组评估和地点评估。
在 284 名住院医师中，有 164 名完成了调查（应答率为 58%）。共有 71%的受访者有很高的 burnout 风险，各地点的风险范围为 57%至 85%（p=0.49）。性别、PGY 水平和受访者年龄与 burnout 率无显著差异。在单变量模型中，没有发现人口统计学变量与 burnout 相关，但情绪智力、韧性和正念的内在特征以及工作投入和工作资源的外在特征都被发现可以预防 burnout（所有 p 值均<0.001）。然而，检查内在和外在特征的多变量模型发现，没有内在特征与 burnout 相关，而工作资源（系数-1.0，p 值<0.001）和工作投入（系数-0.76，p 值 0.032）是显著的保护因素。总体而言，参与度很高，尤其是在工作“奉献”方面。
在研究期间，多个机构的大多数住院医师都有很高的 burnout 风险。与内在特征相比，工作投入和工作资源的增加与 burnout 发生率的降低更为密切相关。尽管外科住院医师似乎已经非常投入工作，但计划应继续探索增加工作资源的方法，进一步的研究应旨在阐明内在特征对这些外在因素的中介作用。
