Burnout in psychiatry residents: the role of relations with peers, preceptors, and the institution

Physicians have a higher prevalence of mental health problems compared to the general population. The prevalence of burnout in residents has been reported to range between 25 and 75%, and burnout has been associated with increased medical errors, suboptimal care of patients, and reduced empathy.¹,² Despite current knowledge about the problem and several interventions implemented to date, rates are still rising, with some authors now talking of a burnout epidemic.³

The aim of this cross-sectional study was to evaluate the association between burnout and perceived relations with preceptors, peers, and the institution. Approval was obtained from the local ethics committee (protocol 70231617.6.0000.5327). All psychiatry residents from a city in the South of Brazil were invited (n=87), and 66 (76%) agreed to participate. A sociodemographic questionnaire was administered, burnout symptoms were evaluated by means of the Maslach Burnout Inventory (MBI), and relations by means of the Work Environment Evaluation Instrument (WEEI).⁴,⁵

The mean age of the participants was 28.3±3.1 years, and 53% were male. According to the cutoff point most frequently used in the literature, 55 participants (83.3%) would be classified as meeting the burnout criteria: 47% were positive for emotional exhaustion (EE), 62.1% for depersonalization (DP), and 69.7% for personal accomplishment (PA). Relations with preceptors, the institution, and peers all correlated with EE and DP (Table 1). The items most correlated with EE were “I feel that I am always short of what the preceptors expect of me” (r_s = 0.53; p < 0.001), “I feel more pressured than helped by my preceptors” (r_s = 0.43; p < 0.001), and “I feel a collaborative climate in my institution” (r_s = -0.39; p = 0.001). DP correlated more with the items “I feel a collaborative climate in my institution” (r_s = -0.47; p < 0.001), “I feel like I belong to my institution” (r_s = -0.46; p < 0.001), and “I feel more pressured than helped by my preceptors” (r_s = 0.43; p < 0.001). PA correlated with the relationship with peers and the institution (Table 1). The items most correlated with PA were “I feel like I belong to my institution” (r_s = 0.33; p = 0.007), “I feel a collaborative climate in my institution” (r_s = 0.32; p = 0.008), and “My colleagues are not my friends” (r_s = -0.28; p = 0.024).

Table 1
Correlations (Spearman’s rho) between WEEI and burnout dimensions

	WEEI peers	WEEI preceptors	WEEI institution
Emotional exhaustion total	0.337*	0.558*	-0.428*
Depersonalization total	0.327*	0.481*	-0.457*
Personal accomplishment total	-0.280†	-0.180	0.351*

• WEEI = Work Environment Evaluation Instrument.
• ^*
  Significant at p < 0.01.
• ^†
  Significant at p < 0.05.

These findings highlight potentially modifiable institutional factors as a way to face the rising rates of burnout among health professionals and emphasize the need for further investigations on the subject. Interventions aimed at improving the quality of relations within institutions may have great potential for reducing burnout rates and mental health problems in physicians and other health professionals, as well as improving their well-being.

References

• ¹
  West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296:1071-8.
• ²
  Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358-67.
• ³
  Hauck S, Gabbard GO. Institutional factors in the medical burnout epidemic. Braz J Psychiatry. 2019;41:191-2.
• ⁴
  Schaufeli WB, Leiter MP, Maslach C, Jackson SE. Maslach Burnout Inventory - General Survey. In:Maslach C,Jackson SE,Leiter MP. The Maslach Burnout Inventory: test manual 3rd ed. Palo Alto: Consulting Psycologist Press; 1996. p. 19-26.
• ⁵
  Monteiro GM, Hauck S. Work Environment evaluation instrument (WEEI): development, validation and association with Burnout. Trends Psychiatry Psychother. Forthcoming 2020.

Publication Dates

• Publication in this collection
  09 Mar 2020
• Date of issue
  Mar-Apr 2020

History

• Received
  24 Nov 2019
• Accepted
  21 Dec 2019