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EDITORIAL COMMENTARY
Year : 2018  |  Volume : 64  |  Issue : 3  |  Page : 136-137

Burnout in medical residents: A growing concern


Department of Psychiatry, University College of Medical Sciences and GTB Hospital, New Delhi, India

Date of Web Publication11-Jul-2018

Correspondence Address:
Dr. M S Bhatia
Department of Psychiatry, University College of Medical Sciences and GTB Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_395_17

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How to cite this article:
Bhatia M S, Saha R. Burnout in medical residents: A growing concern. J Postgrad Med 2018;64:136-7

How to cite this URL:
Bhatia M S, Saha R. Burnout in medical residents: A growing concern. J Postgrad Med [serial online] 2018 [cited 2018 Sep 24];64:136-7. Available from: http://www.jpgmonline.com/text.asp?2018/64/3/136/236376




Medicine is an exacting branch of science. This can be attributed to the requirement of dedication and precision on the part of the health-care providers. The need for urgent care and long hours at work further add to the stress. Prolonged exposure to stressful work environment can take a toll on the physical and mental well-being of an individual. This long-standing stress in medical professionals can often lead to burnout. Burnout can be explained as a state of exhaustion, lack of motivation and disillusionment with one's job or career which arises out of poor coping with work-related stress.

Multiple studies in the recent years have tried to understand the clinical features and predisposing factors for this condition. Different authors have tried to explain the concept of burnout using a constellation of behavioral and somatic symptoms. The concept was first introduced by Freudenberger in his 1974 article “Staff burnout.”[1] He described burnout as a consequence of excessive stress leading to chronic fatigue and lack of enthusiasm. Maslach and Jackson were, however, the first to give a detailed description of the burnout syndrome along with formulating the most widely accepted instrument to measure it, Maslach Burnout Inventory.[2] According to Maslach, burnout can present in three dimensions, namely, emotional exhaustion, depersonalization, and lack of personal satisfaction. Emotional exhaustion leads to irritability, low frustration tolerance and excessive fatigue. Depersonalization can be explained as an indifferent attitude towards work and patients. This is an attempt to distance oneself from the patients using an apathetic attitude. The lack of personal accomplishment arises in burnout leading to a constant feeling of being a failure and low self-esteem.[2] This current study evaluated stress and burnout in surgical and anesthesia residents using Perceived Stress Scale and Burnout Clinical Subtype Questionnaire 12-item version.[3] The latter is a comparatively newer and simpler tool to evaluate burnout and classifies the syndrome into three subtypes: frenetic, under-challenged, and worn out. These subtypes correlate with the original three dimensions given by Maslach and Jackson.[2] According to the results, the residents had high levels of perceived stress and burnout.[3] However, these two findings could have been further analyzed to reveal any correlation.

Burnout has also being included in International Classification of Diseases, Tenth Edition under residual category “Z 73, problems related to life management difficulty.”[4] Burnout syndrome has been reported in people-oriented professions such as medicine, nursing, teaching, psychologists, social workers, and even students in demanding courses like medicine. Medical students have been shown to develop burnout as their career advances. This often leads to psychiatric morbidity like depression, sleep disturbances, substance abuse disorders, poor physical health, psychosomatic conditions, relational problems, and social withdrawal.[5] Burnout has repercussions on the professionalism of medical students as well. A recent multicentric study revealed students with burnout having unprofessional clinical behavior and lesser altruistic behavior towards underprivileged patients.[6] The adaptive stress-coping strategies include planning, acceptance, and active coping whereas the maladaptive stress-coping strategies are self-blame, self-distraction, and venting.[7]

The prevalence of burnout in medical profession varies from 10% to more than 50%.[5] This wide range can be attributed to lack of an established objective criteria for defining burnout. Second, burnout being a complex psychological phenomenon, the occurrence depends on personality traits, coping mechanisms, and resilience of an individual. Idealism, perfectionism, anxious, highly committed, and over-ambitious are some of the traits that predispose one to burnout. Neglect of social life and resulting poor social relations further pushes the person to the brink. Occupational factors such as a demanding profession, long work hours, night-shifts, pressure of time, lack of workforce and resources, and lack of time for family, may contribute towards burnout.[8],[9],[10],[11]

Burnout can lead to poor work performance due to exhaustion, low mood, and lack of concentration. However, these symptoms are similar to those in a depressive episode. Therefore, before diagnosing burnout, it is imperative to rule out depression, since both the conditions need different treatment. Other conditions mimicking burnout are chronic fatigue syndrome, physical disorders such as endocrinopathies and autoimmune disorders.[8],[12] In the current study, screening tools could have been used to evaluate for common mental conditions such as depression, anxiety disorders, and substance use disorders in the participants to eliminate these confounding factors.[3]

Management of burnout comprises primarily of preventive measures such as stress management, skill education, improving time-management, and coping skills to optimize the balance between professional and social commitments. Creating a healthy work environment with better communication in the team, appreciation of efforts, motivating leadership, may be essential. If burnout is severe, then psychotherapeutic approaches like cognitive restructuring can be helpful.[12]

Burnout is emerging as a challenge with the potential to affect the healthcare professionals and the patient population at large. Research is needed to both identify the problem using standardized criteria and formulate a management protocol. Institutions and national policy makers should take into cognizance this unsettling issue of burnout in doctors and residents and implement preventive strategies at the earliest.



 
 :: References Top

1.
Freudenberger HJ. Staff burnout. J Soc Issues 1974;30:159-65.  Back to cited text no. 1
    
2.
Maslach C, Jackson SE. The measurement of experienced bumout. J Occup Behav 1981;2:99-113.  Back to cited text no. 2
    
3.
Gandhi K, Sahni N, Padhy SK, Mathew PJ. Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India. J Postgrad Med 2018;64:145-9.  Back to cited text no. 3
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4.
World Health Organisation. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO; 1992.  Back to cited text no. 4
    
5.
Almeida GC, Souza HR, Almeida PC, Almeida BC, Almeida GH. The prevalence of burnout syndrome in medical students. Arch Clin Psychiatry 2016;43:6-10.  Back to cited text no. 5
    
6.
Dyrbye LN, Massie FS Jr., Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA 2010;304:1173-80.  Back to cited text no. 6
    
7.
Alosaimi FD, Almufleh A, Kazim S, Aladwani B. Stress-coping strategies among medical residents in Saudi Arabia: A cross-sectional national study. Pak J Med Sci 2015;31:504-9.  Back to cited text no. 7
    
8.
Kaschka WP, Korczak D, Broich K. Burnout: A fashionable diagnosis. Dtsch Arztebl Int 2011;108:781-7.  Back to cited text no. 8
    
9.
Afana A, Ghannam J, Ho EY, Al-Khal A, Al-Arab B, Bylund CL Burnout and sources of stress among medical residents at Hamad Medical Corporation, Qatar. East Mediterr Health J 2017;23:40-45.  Back to cited text no. 9
    
10.
Zubairi AJ, Noordin S. Factors associated with burnout among residents in a developing country. Ann Med Surg (Lond) 2016;6:60-3.  Back to cited text no. 10
    
11.
Ratnakaran B, Prabhakaran A, Karunakaran V. Prevalence of burnout and its correlates among residents in a tertiary medical center in Kerala, India: A cross-sectional study. J Postgrad Med 2016;62:157-61.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Weber A, Jaekel-Reinhard A. Burnout syndrome: A disease of modern societies? Occup Med (Lond) 2000;50:512-7.  Back to cited text no. 12
    




 

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