Is the solution to resident burnout decreasing the total hours? Recently residencies have attempted to decrease the burden of residency by reducing resident hours and sometimes changing how those hours are spent, as with a night float. Is this the solution to burnout? This is a hard question to answer without longitudinal data, which sadly is lacking.
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An article on burnout in resident physicians by Busireddy, et al. (2017) looks at the value of different interventions, such as reducing work hours, on the degree of burnout as measured by the Maslach Burnout Inventory (MBI). Reducing work hours did reduce burnout on average, but not consistently across all studies that they reviewed. Results differed by the residency specialty and locations, suggesting that burnout is unlikely to be related to global demands on resident physicians and more likely to be due to components of the specific residency program.
Busireddy Kiran R, Miller Jonathan A, Ellison Kathleen, Ren Vicky, Qayyum Rehan, Panda Mukta. Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review. J Grad Med Educ. June 2017;9(3):294-301. doi:10.4300/JGME-D-16-00372.1.
The impact of a reduction in work hours was seen with surgery residents, a group known to have excruciatingly difficult hours. But this same impact was not observed in internal medicine residents. Thus, the solution may only apply to a small percentage of resident training programs that have extreme amounts of workload and subsequent sleep deprivation.
Or potentially, as I discussed in Burnout & Personal Accomplishment the scale is not assessing the Personal Accomplishment aspect of burnout. So perhaps internal medicine residents are gaining an improved level of Personal Accomplishment but the scales don’t show it.
For programs that want to address burnout, an intervention focused on decreasing total hours spent is attractive due to the fact that is is relatively simple to implement versus a more comprehensive wellness program. Several of the studies reviewed in the article were specifically designed to evaluate the effect of decreased work hours on burnout and showed a positive effect. However, this emphasis has a significant chance of positive reporting bias. It is unlikely that a study that assesses the impact of decreased work hours on burnout that showed no impact would be well received in the peer-reviewed literature. More valuable studies assess the value of interventions on multiple outcomes to avoid the risk of positive reporting bias.
Ongoing evaluations of work hour decrease as an intervention for burnout exposed potential adverse effects that increase burnout instead. Concerns include an effect on decreased preparation and a weakened sense of readiness among residents. Additionally, shifting hours may decrease total hours but cause more work-life chaos. It is likely that a more targeted intervention that specifically focuses on the causes of burnout beyond just reducing the total hours spent will be a more effective strategy.
The other interesting finding from the review was that several studies that assessed the effect of stress management interventions did not find a significant impact. It may be that actual exposure to stress and practice in dealing with stress is more effective than merely teaching tools to manage future stress.