Date Published: September 20, 2016
Publisher: Springer Netherlands
Author(s): Hanne Verweij, Frank M. M. A. van der Heijden, Madelon L. M. van Hooff, Jelle T. Prins, Antoine L. M. Lagro-Janssen, Hiske van Ravesteijn, Anne E. M. Speckens.
Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work–home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work–home interference. Path analysis was used to examine the associations between job and home characteristics and work–home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents.
Burnout is highly prevalent in medical residents. Depending on the specialty 27–75 % of residents suffer from burnout (Ishak et al. 2009). In the Netherlands, approximately one-fifth of medical residents indicate to have moderate to severe burnout symptoms (Prins et al. 2010). Burnout is defined as a syndrome of emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. Emotional exhaustion refers to the feelings of being exhausted and physically overextended; energy is lacking and mood is low. Depersonalization is characterized by feelings of cynicism and detachment toward patients. Reduced personal accomplishment is marked by a tendency to evaluate oneself negatively, particularly with regard to work with patients (Demerouti et al. 2001; Maslach and Jackson 1986). Burnout may lead to less work satisfaction, disrupted personal relationships, substance abuse, depression, and even suicide (De Valk and Oostrom 2007; van der Heijden et al. 2008). Interventions to decrease burnout in medical residents are scarce and only a few studies have been conducted. Ripp et al. (2015) recently found that the implementation of duty hours restrictions did not change burnout rates in American internal medicine residents.
The study was conducted in the Netherlands, where residency training closely follows undergraduate medical education. The 6 years of undergraduate training lead to the MD degree and a basic qualification to practice medicine. Residency programs are run by university medical centers in close collaboration with affiliated general hospitals and vary in length from 3 to 6 years depending on specialty. Before residency, most doctors work as residents-not-in-training to increase their likelihood of obtaining a post in the residency program of their preference. Residents are allowed to work with a maximum of 48 working hours a week including educational activities, and attendance and accessibility shifts. In the Netherlands, postgraduate medical education reformed in the 2000s focusing on competency-based medical education. Since 2004 these reforms were supported by governmental bodies.
The aim of the present study was to examine the associations of work and home characteristics and work–home interference with burnout in Dutch male and female medical residents.
One of the strengths of this study is the large dataset used to test the model. All medical residents in The Netherlands were invited to participate. This resulted in a large, representative dataset with residents from different parts of the country, different hospital settings and different medical specialties.
When developing possible interventions to address burnout in medical residents we should take account of the above. First of all, it is important to teach residents how do deal with the emotional demands at work as this seemed an important predictor of burnout. It is often the emotionally demanding aspects of medicine that may also be the most meaningful and satisfying. Although there is awareness of the importance of emotional wellbeing in health care workers, there is still little attention for effectively managing emotions in medical education. The informal curriculum (physician role modelling) and the medical culture still advocates emotional detachment, distance and clinical neutrality (Shapiro 2011, 2013). Intervision in peer groups and supervision or coaching programs during residency should specifically include dealing with emotional demands. Furthermore, interventions or educational approaches that incorporate aspects of allowing, acknowledging and regulating emotions, such as mindfulness training and Balint groups should be stimulated as well (Dobkin and Hutchinson 2013; Epstein 1999; Kjeldmand and Holmström 2008; Perry et al. 2013).