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Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study
  1. Ashraf A Gohar1,
  2. Melissa Knauert2,
  3. Mohamad A Kalot3,
  4. Akram Khan4,
  5. Darby Sider5,
  6. Muhammad Ali Javed6,
  7. David Wooldridge1,
  8. Leigh Eck7,
  9. Fred Buckhold8,
  10. Brendon Colaco9,
  11. Abid Bhat1,
  12. Dubier Matos Castillo10,
  13. Ross Newman11,
  14. Reem A Mustafa12
  1. 1 Department of Medicine, University of Missouri, Kansas City, Missouri, USA
  2. 2 Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3 Department of Medicine, State University of New York, Buffalo, New York, USA
  4. 4 Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  5. 5 Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida, USA
  6. 6 Department of Critical Care Medicine, Mercy Hospital St Louis Area, Saint Louis, Missouri, USA
  7. 7 Department of Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
  8. 8 Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
  9. 9 Department of pulmonary, Mayo Clinic, Jacksonville, Florida, USA
  10. 10 Division of Pulmonary Critical Care, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  11. 11 Department of Pediatrics, Children's Mercy, Kansas City, Missouri, USA
  12. 12 Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Dr Reem A Mustafa, University of Kansas Medical Center, Kansas City, KS 66103, USA; rmustafa{at}


Background Medical trainees’ work schedule is designed to cover duties without consideration of differences in circadian rhythms during a 24-hour period (chronotype).

Objective To explore chronotype variation among medical trainees and understand its association with burn-out and schedule satisfaction.

Methods In a multicentre observational study, we conducted two surveys between 1 October 2018 and 1 April 2019. Trainees from nine centres across the USA participated. We measured burn-out using Maslach Burnout Inventory (MBI), and trainee chronotype using the Morningness-Eveningness Questionnaire (MEQ).

Results 324 (32%) out of 1012 responded to our survey. Participants were 51% female and had a mean age of 30.8 years. Most participants had an intermediate MEQ type (65%). A large proportion of participants had burn-out on at least one of three tested MBI scales (62%); 5% of participants had burn-out on all three MBI scales. More participants with evening MEQ type had burn-out (66%) compared with morning MEQ type (55%), however, the results were not statically significant (p=0.294). Overall satisfaction with work shifts was 6.5 (95% CI 6.3 to 6.7), with higher satisfaction with day shift 7.7 (95% CI 7.5 to 7.9) and lowest satisfaction with overnight 24-hour call 3.5 (95% CI 3.2 to 3.9). Satisfaction was lower in trainees with burn-out 6.0 (95% CI 5.7 to 6.4), (p<0.001). In the follow-up survey, burn-out was present in at least one scale in 64% compared with 60% of respondents in the initial survey.

Conclusion Burn-out is prevalent among medical trainees. Improving alignment between trainee preferences may improve performance, reduce human errors and burn-out.

Data availability statement

Data are available in a public, open access repository. Data are available upon request.

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Data availability statement

Data are available in a public, open access repository. Data are available upon request.

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  • Contributors Conception or design of the work: RAM and AAG. Data collection and interpretation: all Authors. Data analysis: MK. Drafting the article: RAM, AAG, MAK, MK and AK. Critical revision of the article: all Authors. Final approval of the version to be published: all authors. AG acts as guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.