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Trainee burnout: when does the fire start?
  1. David Bryan Thomas Robinson1,2,
  2. Osian Penri James1,3,
  3. Luke Hopkins1,4,
  4. Chris Brown1,
  5. Arfon Powell1,5,
  6. Tarig Abdelrahman1,
  7. Richard John Egan1,4,
  8. Wyn Lewis1
  1. 1 School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
  2. 2 General Surgery, Prince Charles Hospital, Merthyr Tydfil, UK
  3. 3 General Surgery, Royal Gwent Hospital, Newport, UK
  4. 4 General Surgery, Morriston Hospital, Swansea, UK
  5. 5 Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
  1. Correspondence to David Bryan Thomas Robinson, Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cefn Coed, Nantgarw, UK; david.robinson4{at}


Purpose of the study Burnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors.

Study design Post Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift.

Results In a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R2 0.442, p=0.026), and also during On-call shifts (R2 0.564, p=0.012). Higher SGS scores were inversely related to lower SIs (coefficient −32.52, 95% CI −45.881 to 19.154, p=0.001).

Conclusion Stress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.

  • Education & training (see Medical Education & Training)

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  • Collaborators Welsh Surgical Research Initiative Collaborators, Claire-Marie Hughes, Robyn Hackett, Tom Meredith, Robert Parker, Andrew Forrester, Annie, Hoather, Dominic Hayes, Emma Watson-Jones, Francesca Mitchell, Gareth Price, James Cochrane, Oliver Purnell, Patrick Colhoun, Charlotte Sanders.

  • Contributors DR – concept design, data acquisition and analysis, drafting, final approval and submission; OJ – data interpretation, drafting and final approval; LH – data interpretation, drafting and final approval; CB – data interpretation, critical revision and final approval; AP – data interpretation, critical revision and final approval; TA – data interpretation, critical revision and final approval; RE – concept design, data interpretation, critical revision and final approval; WGL – concept design, drafting, final approval prior to submission, content guarantor; Welsh Surgical Research Initiative – data collection. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding OPJ was supported by a Joint Surgical Research Fellowship from the Royal College of Surgeons England and Health Education and Improvement Wale.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the NHS Research Authority and Health and Care Research Wales (IRAS 254658).

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

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the authors. 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 authors 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.

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