Background
Resident burnout
The EWTD in Greece and its potential impact on residency training
Objectives
Methods
Participants and data collection
Sample size
Survey measures
Statistical analysis
Results
Demographic data
1. Age | Median: 32 years | 2. Sexa
| Male | Female | ||
---|---|---|---|---|---|---|
Range: 26-45 years
| 172 (55.3%) | 139 (44.7%) | ||||
3. Hospital
b
| Achillopouleio General Hospital of Volos | Agios Savvas Hospital | General Hospital of Athens "Ippokrateio" | General Hospital of Athens "Laiko" | Metaxa Hospital | Nikaia General Hospital |
38 (56.7%) | 42 (31.3%) | 45 (22.1%) | 10 (3.9%) | 44 (31.2%) | 33 (13.6%) | |
Tzaneio Hospital | Venizeleio General Hospital | |||||
51 (25%) | 48 (30.2%) | |||||
4. Marital Status
a
| Married or partnered | Single |
5. Have children
a
| Yes | No | |
107 (34.4%) | 204 (65.6%) | 50 (16.1%) | 10 (83.9%) | |||
6. Resident
| Anaesthesiology | Cardiology | Cytology | Endocrinology | Gastroenterology | General Practice |
speciality
c
| 13 (2.8%) | 14 (2.5%) | 4 (4.9%) | 4 (4.6%) | 8 (6.5%) | 23 (3.3%) |
General Surgery | Haematology | Internal Medicine | Medical Microbiology | Nephrology | Neurology | |
50 (4.4%) | 4 (3.2%) | 39 (2.7%) | 12 (1.7%) | 4 (2.6%) | 6 (2.6%) | |
Neurosurgery | Nuclear Medicine | Obstetrics and gynaecology | Oncology | Ophthalmology | Orthopaedics | |
8 (8.6%) | 4 (6%) | 10 (2.3%) | 7 (13.2%) | 8 (2.6%) | 14 (2.5%) | |
Otolaryngology | Pathology | Paediatric Surgery | Paediatrics | Plastic Surgery | Psychiatry | |
11 (4.8%) | 5 (3.1%) | 3 (5.0%) | 14 (2.5%) | 5 (8.6%) | 5 (1.6%) | |
Pulmonary Medicine | Radiation Oncology | Radiology | Thoracic Surgery | Urology | Vascular Surgery | |
7 (2.3%) | 5 (9.4%) | 11 (1.9%) | 3 (3.9%) | 5 (2.4%) | 5 (10.6%) |
Resident burnout
Future outlooka
| |||||
---|---|---|---|---|---|
Do you believe it will be hard finding/keeping a job as a physician in the future? | Yes | No | I don't Know | ||
145 (46.6%) | 73 (23.5%) | 93 (29.9%) | |||
Opinion on medical residency training
a, b
| Disagree (scores of 1 or 2) | Neither agree nor disagree (score of 3) | Agree (scores of 4 or 5) | Average Score | Range |
My supervisors care about my residency training | 131 (42.1%) | 87 (28%) | 93 (30%) | 2.75 | 1-5 |
I am satisfied with the overall quality of CME I have participated in during my residency training | 130 (41.8%) | 110 (35.4%) | 71 (22.8%) | 2.67 | 1-5 |
I do too much scutwork/paperwork during my residency | 63 (20.3%) | 56 (18%) | 192 (61.7%) | 3.69 | 1-5 |
I dedicate considerable time on patient care | 93 (29.9%) | 79 (25.4%) | 139 (44.7%) | 3.16 | 1-5 |
I am satisfied with the responsibilities and time given to me for patient care | 115 (37%) | 110 (35.4%) | 86 (27.7%) | 2.82 | 1-5 |
I am satisfied with the level of teamwork and support from my peers | 55 (17.7%) | 79 (25.4%) | 177 (56.9%) | 3.5 | 1-5 |
I am satisfied with the overall quality of training in my clinic | 113 (36.3%) | 124 (39.9%) | 74 (23.8%) | 2.76 | 1-5 |
Opinion on the European Work Time Directive (EWTD)
a
| Yes | No | I don't Know | ||
Implementing the EWTD is necessary | 233 (74.9%) | 39 (12.5%) | 39 (12.5%) | ||
The EWTD will be beneficial to my personal and social life | 231 (74.3%) | 44 (14.1%) | 36 (11.6%) | ||
The EWTD will have positive effects on the quality of my residency training | 174 (55.9%) | 55 (17.7%) | 82 (26.4%) | ||
Categorization | |||||
Maslach Burnout Inventory Scores
c
| High | Moderate | Low | Average Score | Range |
Emotional Exhaustion | 176 (56.6%) | 76 (24.4%) | 59 (19%) | 27.9 | 0-54 |
Depersonalization | 206 (66.2%) | 39 (12.5%) | 66 (21.2%) | 12.2 | 0-30 |
Personal Accomplishment | 55 (17.7%) | 74 (23.8%) | 182 (58.5%) | 31.6 | 7-48 |
Future outlook
Training satisfaction
Opinion on the EWTD
Factors related to resident burnout
Emotional exhaustionb
| Depersonalizationb
| Personal accomplishmentb
| |
---|---|---|---|
My supervisors care about my residency training
a
| r = -0.124 | r = -0.133 | r = +0.224 |
P = 0.029c
| P = 0.019c
| P < 0.001c
| |
I am satisfied with the overall quality of CME I have participated in during my residency training
a
| r = -0.060 | r = -0.150 | r = +0.177 |
P = 0.289 | P = 0.008c
| P = 0.002c
| |
I do too much scutwork/paperwork during my residency
a
| r = +0.218 | r = +0.088 | r = -0.252 |
P < 0.001c
| P = 0.122 | P < 0.001c
| |
I spend considerable time on patient care
a
| r = +0.116 | r = -0.031 | r = +0.275 |
P = 0.041c
| P = 0.59 | P < 0.001c
| |
I am satisfied with the responsibilities and time given to me for patient care
a
| r = -0.087 | r = +0.012 | r = +0.173 |
P = 0.127 | P = 0.831 | P = 0.002c
| |
I am satisfied with the level of teamwork and support from my peers
a
| r = -0.113 | r = -0.214 | r = +0.323 |
P = 0.046c
| P < 0.001c
| P < 0.001c
| |
I am satisfied with the overall quality of training in my clinic
a
| r = -0.089 | r = -0.071 | r = +0.147 |
P = 0.118 | P = 0.213 | P = 0.009c
|
Discussion
Studied population | Study authors and publication year | Burnout ratesa
| Comparable data from the present study | Comparisonb
| Comments | ||
---|---|---|---|---|---|---|---|
Internal medicine residents (n = 141) and internal medicine specialists (n = 103) of two Greek public hospitals | Panagopoulou et al, 2006 | Internal medicine residents: High EE in 70 (49.6%) High DP in 86 (61.0%) Internal medicine specialists: High EE in 32 (31.0%) High DP in 9 (8.7%) | All residents (n = 311): High EE in 176 (56.6%) High DP in 206 (66.2%) | Internal medicine residents (n = 39): High EE in 23 (59.0%) High DP in 30 | No significant differences in burnout rates between the present study's residents (both total and internal medicine subgroup) and Panagopoulou et al.'s internal medicine residents were observed (P-values > 0.05). Burnout rates in the present study's residents were significantly higher compared to the internal medicine specialists group (P-values < 0.001) | Panagopoulou et al. did not include data on PA | |
Employees (n = 58) of two Pediatric Oncology Units and a Bone Marrow Transplantation Unit in a Greek children's hospital | Liakopoulou et al, 2008 | High EE in 24 (41.4%) High DP in 5 (8.6%) Low PA in 11 (19%) | High EE in 176 (56.6%) High DP in 155 (49.8%) Low PA in 147 (47.3%) | The present study showed increased rates of high EE (P = 0.033), high DP (P < 0.001) and low PA (P < 0.001) | Liakopoulou et al. used different criteria to define high DP (scores ≥ 13) and low PA (scores ≤ 31). For comparison purposes, we adjusted our data to these criteria. The participants of this study were a heterogeneous group that included doctors, nurses and psychosocial staff | ||
Family doctors of 12 European countries (n = 1393) including Greece (n = 45) | Soler et al, 2008 | All participants High EE in 599 (43%) High DP in 492 (35.3%) Low PA in 445 (32%) Greek general practitioners High EE in 14 (31.1%) High DP in 33 (73.3%) Low PA in 41 (91.1%) | All residents (n = 311): High EE in 176 (56.6%) High DP in 206 (66.2%) Low PA in 182 (58.5%) Greek general practice residents (n = 23) High EE in 11 (47.8%) High DP in 14 (60.9%) Low PA in 13 (56.5%) | Compared to the total number of family doctors surveyed in 12 European countries, Greek residents showed significantly increased rates of high EE (P < 0.001), high DP (P < 0.001) and low PA (P < 0.001) while the Greek general practice residents had similar EE rates (P > 0.05), higher DP rates (P = 0.011) and increased rates of low PA (P = 0.013). Compared to the Greek arm of the study, Greek residents had significantly increased rates of high EE (P = 0.001), similar DP (P > 0.05) reduced rates of low PA scores, while Greek general practice residents had similar rates of EE and DP (P > 0.05) but reduced rates of low PA (P < 0.001) |