491(odds ratio 8.3 [95% CI, 2.6–26.5]) [ 11 ]. In a prospective longitudinal cohort study,
West et al. found that 139 residents (39%) reported at least one major medical error
during the study period [ 12 ]. Residents reporting a medical error had significantly
higher rates of burnout on all three subscales of the MBI (p < 0.001), greater fatigue
(difference, 0.54; p = 0.006), and significantly lower QOL (difference, 10.41;
p = 0.02). Additionally, residents reporting an error were more likely to screen posi-
tive for depression at least once during the study period (odds ratio, 2.83; p < 0.001).
Similarly, Prins et al. also found that residents with moderate or severe burnout self-
reported more medical errors overall (p < 0.001) and more errors due to lack of time
(p < 0.001) [ 13 ]. It has also been reported that residents who commit self-perceived
medical errors are more likely to subsequently experience burnout (p = 0.002 for all
three subscales of MBI), decreased QOL (p = 0.02), and screen positive for depres-
sion (odds ratio 3.29, 95% CI 1.90–5.64) [ 14 ], suggesting a cycle of burnout with
perceived medical errors. The true incidence of medical errors performed by burned-
out residents vs. non-burned residents is not known, as these studies rely on self-
perceived and self-report medical error.
While much focus has been on the effects of burnout on patient care, there are
real and considerable negative effects on the actual residents delivering that care. In
August 2014, two resident physicians committed suicide in separate incidents in
New York City. While suicide represents the extreme end of the spectrum, it dem-
onstrates the seriousness of burnout in resident physicians. No study to date has
specifically looked at the rate of resident physician suicide; however it is well known
that physicians in general are at increased risk for suicide. A meta-analysis found
male physicians have 40% higher risk of committing suicide and female physicians
have 130% higher risk of committing suicide than the general population [ 15 ]. One
study specifically looked at suicidal ideation in medical residents and found 12% of
residents reported having suicidal thoughts and that suicidal ideation is more preva-
lent in burned-out residents (20.5% vs. 7.6%, P < 0.001) [ 16 ].
Associated with suicide is depression, which multiple studies have found higher
risk for depression in residents with burnout [ 3 , 7 , 10 , 11 , 17 ]. Holmes et al. reported
that of the residents who screened positive for depression (17% total), 96% of them
also met criteria for burnout [ 7 ]. Another study found that residents meeting criteria
for burnout were more likely to both self-report major depression during residency
(315 vs. 11%, p = 0.031) and screen positive on a depression screening (51% vs.
29%, p = 0.042) [ 11 ]. While burnout and depression are associated with each other,
their causal relationship is not well understood. In addition, resident burnout is asso-
ciated with decreased QOL [ 5 ], career dissatisfaction [ 11 ], increased odds of motor
vehicle accidents [ 18 ], and higher levels of stress and worry [ 17 ].
The graduate medical education (GME) community also has a large stake in resi-
dent burnout because patient care and resident wellness reflect upon the training and
learning environment that residency programs provide. In response to concerns
about patient care and resident well-being, the Accreditation Council for Graduate
Medical Education (ACGME) introduced an 80-h workweek restriction, restricted
overnight shift lengths, and mandated minimum time off between shifts in 2003.
The ACGME then revised restrictions in 2011 to include a 16-h shift limit for
25 Resident Physician Burnout: Improving the Wellness of Surgical Trainees