• Tait D Shanafelt, Katharine A Bradley, Joyce E Wipf, and Anthony L Back.
• University of Washington, Veterans Affairs Northwest Health Services Research and Development Center of Excellence, and Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA.
• Ann. Intern. Med. 2002 Mar 5;136(5):358-67.

BackgroundBurnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care.ObjectiveTo determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices.DesignCross-sectional study using an anonymous, mailed survey.SettingUniversity-based residency program in Seattle, Washington.Participants115 internal medicine residents.MeasurementsBurnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, "I did not fully discuss treatment options or answer a patient's questions" or "I made...errors that were not due to a lack of knowledge or inexperience"). Depression and at-risk alcohol use were assessed by using validated screening questionnaires.ResultsOf 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-burned-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout--but not sex, depression, or at-risk alcohol use--was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% CI, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship).ConclusionBurnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.

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