490
depersonalization, and high fatigue are most common during residency and
fellowship in comparison to medical students and early career physicians with less
than 5 years of practice. They also found that residents and fellows were more likely
to report burnout, high emotional exhaustion, and high depersonalization than the
population control sample [ 3 ].
Resident burnout rates range between 50% and 69% among all medical special-
ties [ 6 , 7 ]. One study examined 665 surgical residents and found that 69% met the
criteria for burnout on at least one subscale. Female surgical residents reported
higher rates of burnout than male residents (73 vs. 65%, respectively, p = 0.02) [ 8 ].
While surgical residents face unique challenges including the physical demands of
operating and the intellectual demands of rapidly learning both surgical procedures
and medical knowledge, several studies have shown no significant difference in
burnout among the different specialties [ 6 , 7 ]. Martini et al. compared burnout rates
among different specialties and found a range between 27% in family medicine and
75% in obstetrics-gynecology, 40% burnout in general surgery residents, and no
significant variation among specialties [ 6 ].
Several studies have examined the timing and persistence of burnout among
internal medicine residents. Ripp et al. surveyed internal medicine residents both at
the start and end of intern year. Burnout prevalence was 36% at the start of training
and increased to 81% by the end of intern year. Of the residents who started free of
burnout, 75% developed burnout by the end of the year [ 9 ]. Campbell et al. studied
86 internal medicine residents through all 3 years of residency and found 78% of
residents were burned out at least once. Of the 58 burned-out interns, 42 (75%)
continued to be burned out through their 3 years of training [ 10 ]. These studies
examined internal medicine residents, and their findings may not be generalizable
to surgical residents. Nonetheless these findings are provocative and suggest that
some residents start residency burned out and that once burnout occurs, it tends to
persist throughout training for a certain group of trainees.
Burnout and Surgical Education
While a certain level of stress can be expected during residency, burnout is patho-
logic and relevant to all involved stakeholders: patients, residents, and medical edu-
cators. Residency programs and surgical educators are in the unique position to
positively or negatively affect patient care and resident wellness because they pro-
vide and supervise the training of residents as they care for patients in a high stress
environment.
The highly publicized and tragic death of Libby Zion at New York Hospital in
1984 drew the public’s attention to resident work hours and the effects on patient
care. Research since then has linked resident burnout with suboptimal care and
increased self-perceived medical errors. Shanafelt et al. found 76% of surveyed
residents (n = 115) met criteria for burnout, and burned-out residents were more
likely to self-report providing suboptimal care at least monthly compared to resi-
dents without burnout (53% vs. 21%, p = 0.004), as well as in multivariate analysis
L.M. Douglass and A.C. North