Burnout among medical residents; their impressions of its impact on patient care and coping mechanisms
Date of Award
Master of Medicine (MMed)
Dr Dorothy Kamya
Dr Charles Muteshi
Obstetrics and Gynaecology (East Africa)
Introduction: Burnout is a syndrome that occurs as a result of chronic workplace stress that has not been successfully managed. This global definition is given by the International Classification of Diseases; 11th edition. The ICD-11 further characterizes burnout using three dimensions: Emotional exhaustion described as feelings of energy depletion or exhaustion; depersonalization described as; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and low personal accomplishments seen as reduced professional efficacy. Burnout refers specifically to phenomena in the occupational context and is not applied to describe experiences in other areas of life. (World Health Organization, 2020) Studies have found higher burnout levels in medical personnel when compared to the general population (Dyrbye, 2014). This can be attributed to many factors, such as struggles with work life integration and longer working hours. Workplace burnout has been directly linked to lapses in professionalism evidenced by not spending adequate time with patients or not paying attention to the social and emotional needs of the patient, absenteeism, and medical errors shown by writing the wrong prescription or misdiagnosing a patient’s condition (Shanafelt, 2002). Negative coping strategies such as substance abuse, emotional outbursts and avoidance of stressful situations have been linked to high level of burnout while positive coping strategies such as actively problem solving, prayer, physical activity have been linked to reduction of the incidence of burnout because they decrease the negative impact of a stressful situation at the workplace encountered (Benjamim R. Doolittle, 2013). There is limited literature on the burnout syndrome, coping mechanisms and subsequent patient care focused on medical residents in Africa. Wellness has been described as the optimum state of health of individuals and groups. It focuses on the fulfilment of a person’s role in the workplace, family and other settings such as the community. (World Health Organization, 2000) There are also no known formal wellness programs designed to improve the mental state of the employee especially when facing work related stress, specifically created to tackle burn out in medical personnel in Africa. The study will help to inform how wellness programs could be developed for the African setting, and what factors may enhance or impede their set up in this context.
Objectives: The level of burnout in post graduate medical residents at Aga Khan University Teaching Hospital was the primary objective and the secondary objectives were to assess the impact of burnout on patient care by medical residents and evaluate their impressions about coping mechanisms for burnout and stress at work.
Methods: This was a cross sectional survey looking at all post graduate medical residents at Aga Khan University Teaching Hospital. It was a mixed method study. 95 out of 120 residents agreed to fill out the Maslach Burnout Inventory- Human Services Survey which was the study tool used to assess the level of burnout. It is a 22-item questionnaire with each item scored using a 7-point Likert scale. It is a worldwide validated tool meaning it is suitable to measure burnout risk levels in health care workers and can be used in different populations globally. It also has clearer cut off points for burnout risk when compared to other tools used to measure burnout. Each participant received a score after filling out the questionnaire and was grouped into either; low risk of burnout or high risk of burnout. To assess the impressions of patient care and evaluate the coping mechanisms employed in the context of burnout, purposive sampling of residents was done and 37 of these residents participated in four focus group discussions after which thematic saturation was reached and three main themes emerged namely; sources of stress, active and passive coping mechanisms and effects of stress and burnout on patient care.
Results: Of the 95 participants who filled the MBI-HSS questionnaire, 53 (52.67%) respondents had a high risk of burnout while 47 (47.37%) had a low risk of burnout. A significant association was found between gender and burnout risk with more females having high risk of burnout compared to males; 58.0% compared to 35.6% (p value 0.029). The department of pediatrics had a high risk of burnout (8 out of 10 respondents) compared to those with a low risk (2 out of 10 respondents), followed by the departments of surgery and anaesthesia (7 out of 11 respondents for high risk and 4 out of 11 respondents for low risk). This was statistically significant with a p value of 0.01 using Chi square test. Transcription, coding and thematic analysis of the focus group discussions revealed that the major sources of stress that residents experienced included; interdepartmental conflict, negative effect of patients on residents, struggle to balance work and other aspects of life and difficult working environments. All focus group discussions revealed that burnout and stress are associated with negative coping mechanisms such as avoidance. Respondents reported that when under stress, they tended to make medical errors such as prescribing the wrong dosage or failing to see a pathology during a diagnostic test.
Conclusion: This study has reported a high level of high risk of burnout amongst post graduate residents which is consistent with other global studies. The sources of stress cited by residents were mostly related to the work place and many reported sub-optimal patient care as a result of burnout. This highlights a need for preventive measures such as wellness programs needed to alleviate this syndrome. Also, this creates awareness for residents to be better able to recognize burnout and be able to appropriately handle stressful situations without necessarily resorting to passive, emotion based coping mechanisms.
Ochola, E. (2020). Burnout among medical residents; their impressions of its impact on patient care and coping mechanisms (Unpublished master's dissertation). Aga Khan University, East Africa.