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Factors influencing burn-out among resident physicians and the solutions they recommend
  1. Mohd Nasir Bin Mohd Ismail1,
  2. Sarah Lindstrom Johnson2,
  3. Sallie J Weaver3,
  4. Albert W Wu4,
  5. Andrea C Gielen1
  1. 1 Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
  3. 3 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  4. 4 Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Mohd Nasir Bin Mohd Ismail, Johns Hopkins University Bloomberg School of Public Health, Baltimore 21205-2103, Maryland, USA; nasir.ismail.research{at}

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Residency is a crucial phase of medical training in which trainees acquire the skills and knowledge needed to practise medicine. It has been described as a challenging rite of passage, and in one survey 74% of resident physicians reported they would not recommend their job to their own friends.1 One explanation for this might be found in studies reporting that 76% of internal medicine (IM) resident physicians2 and 65% of emergency medicine (EM) resident physicians3 experience burn-out.

Burn-out is defined by Maslach and Jackson (p99)4 as having three key components: ‘(1) increased feelings of emotional exhaustion’; (2) ‘the development of negative, cynical attitudes and feelings about one’s clients’ (eg, patients); and (3) ‘the tendency to evaluate oneself negatively’ (eg, perceptions of poor work performance). One important reason to address the high prevalence of burn-out among resident physicians is due to the association between burn-out with suboptimal patient care2 and patient safety.3

Thomas5 found in her review of 67 studies that the factors associated with burn-out among resident physicians could be divided into three major categories: (1) work-related, (2) demographic and (3) personal. However, almost all published studies have relied exclusively on quantitative survey methods to identify factors related to burn-out. Additionally, resident physicians have not been involved in selecting the interventions used to reduce burn-out. Including the perspective of resident physicians might help to …

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  • Contributors MNBMI generated the problem statement, created the focal question, applied and received the IRB approval, created the surveys, recruited the study participants, gathered the data, analysed the data, presented the data for doctoral dissertation defence, and wrote this article and responded to the reviewers. SLJ helped with the focal question, reviewed the concept mapping method used in this study, helped analysed the data, guided the discussion and reviewed the article. SJW helped with the data analyses and reviewed the paper thoroughly. AWW served as the chair of dissertation committee and helped guide the discussion, and also reviewed this article. ACG is the principal investigator of this study and the doctoral advisor to MNBMI. She helped with the generation of the problem statements and focal questions, suggested concept mapping as the method to use in this study, helped with the IRB application, reviewed the surveys, helped with analysing the data, reviewed the article, and provided many suggestions throughout the data collection and analysing phases.

  • Funding The Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Armstrong Institute provided funding for the concept mapping method training. The Johns Hopkins Center for Injury Research and Policy provided funding for the gift cards for resident physicians who participated in this study.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Johns Hopkins Bloomberg School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.