Most assessments of physician functioning focus on burnout and use measures that identify burnout. To get a more comprehensive understanding of how someone is doing, assessing parameters other than burnout is necessary. A group of investigators that has contributed significantly to the burnout literature has filled this gap by producing a professional fulfillment index PFI. That index measured burnout indicators as well as expanding the measure to items that might associate with quality of life, depression, anxiety, and sleep-related impairment. They investigated this scale, along with another novel scale, to assess self-reported medical errors.
Trockel Mickey, Bohman Bryan, Lesure Emi, et al. A Brief Instrument to Assess Both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians. Acad Psychiatry. 2018;42(1):11-24. doi:10.1007/s40596-017-0849-3.
Another scale, the Maslach Burnout Inventory (MBI), has several weaknesses. The MBI asks the respondent to look back over a long time period. It is thus less able to determine the impact of interventions (or a lack of intervention) in more brief intervals. The PFI fills this gap by including a shorter time marker (just the past two weeks), yielding a scale that is more amenable for the following change over time than the original Maslach Burnout Inventory.
Although the MBI has elements to track personal accomplishment, this measure is more task-focused and typically does not correlate well with burnout in the health professional population. The “accomplishment” aspect of the scale is often not assessed for that reason. The PFI fills this gap with questions to assess fulfillment. The questions are rated using the following scoring strategy: Not at all true=0, Somewhat true=1, Moderately true=2, Very true=3, Completely true=4
- I feel happy at work
- I feel worthwhile at work
- My work is satisfying to me
- I feel in control when dealing with difficult problems at work
- My work is meaningful to me
- I’m contributing professionally (e.g. patient care, teaching, research, and leadership) in the ways I value most
Lodewijk et al. identified other components of job satisfaction including opportunities for personal development, perceived cooperation and support, work-life balance, patient appreciation, and income.
Schmit Jongbloed Lodewijk J, Cohen-Schotanus Janke, Borleffs Jan CC, Stewart Roy E, Schönrock-Adema Johanna. Physician job satisfaction related to actual and preferred job size. BMC Med Educ. May 11, 2017;17. doi:10.1186/s12909-017-0911-6.
The elements to track “work exhaustion” measures physical exhaustion as well emotional and include a slightly different rating scale: Not at all=0, Very little=1, Moderately=2, A lot=3, Extremely=4
- A sense of dread when I think about work I have to do
- Physically exhausted at work
- Lacking in enthusiasm at work
- Emotionally exhausted at work
Depersonalization measures are expanded to cover colleagues and are rephrased as ” interpersonal disengagement.” They continue the use of the above scale: Not at all=0, Very little=1, Moderately=2, A lot=3, Extremely=4
- Less empathetic with my patients
- Less empathetic with my colleagues
- Less sensitive to others’ feelings/emotions
- Less interested in talking with my patients
- Less connected with my patients
- Less connected with my colleagues
Most importantly the PFI, unlike the MBI, is not proprietary (and does not incur a cost to administer it), thus making it more likely to be utilized outside of a research-funded context. Validation was originally done in 2017 with a small population of physicians, mostly residents, at a single institution not named in the study, but likely to be Stanford. Thus, the findings may not translate to the larger audience. Nonetheless, this moves the field forward and offers a non-proprietary scale to assess a broader range of coping over a shorter time period. We just need additional data to demonstrate its value.
The self-reported error scale was a significant part of the article and the research effort. Unfortunately, moderate and low correlations and low consistency raise doubt of the utility the self-reported error scale at this point. Since the literature connecting burnout with medical errors is unclear, the performance issues may reflect that disconnect. One possible explanation is that errors are only seen in the most severe situation of burnout, by which time the problem has been identified by other physicians and compensatory changes such as increased supervision or altered workload have been put in place.
Addressing the issues that lead to burnout is important in overcoming this persistent issue among medical students. We seek to educate medical students about the issue of burnout through game-based learning. In BurntOut, medical students are immersed in a virtual reality environment where they practice coping strategies to improve resilience. The BurntOut role-playing experience delivers targeted, realistic narratives and hands-on scenarios to deepen medical student understanding of how to address and overcome burnout during game-play and beyond.