493insufficient to identify causal relationships and therefore do not support using
demographic (age, gender, marital status, number of children) or personality char-
acteristics to identify at-risk residents [ 23 ]. New studies have since come out; how-
ever the continued lack of large, prospective studies should be taken into account.
Why are residents burned out? Holmes et al. found that both residents and program
directors agreed that lack of time for self-care, exercise, and/or engagement in enjoy-
able activities outside of work; conflicting responsibilities between work, home, and
family; and feeling underappreciated are the greatest contributors to burnout [ 7 ]. Ishak
et al. reviewed 51 studies and identified time demands, lack of control, work planning,
work organization, inherently difficult job situations, and interpersonal relationships
as possible contributing factors to burnout [ 24 ]. In an exploratory study in which ques-
tionnaires were sent to residents from 13 different specialties, Eckleberry et al. sought
to determine which hypothesized stressors are associated with the presence or absence
of burnout [ 25 ]. Of the 32 hypothesized burnout factors, 11 factors were significantly
associated with at least two of the burnout scales on the MBI. These 11 factors include
perfectionism, lack of stress- coping skills, personal bad habits (smoking, drug use),
lack of control over office processes, lack of control over schedule, poor relationships
with colleagues, lack of time for self-care, difficult and complicated patients, not
enough time in the day, excessive paperwork, and regret over chosen career. Pessimism
was associated with all three subscales of the MBI. Chaukos et al. reported that resi-
dents with burnout had significantly lower levels of mindfulness and coping skills
[ 17 ]. The authors hypothesized that mindfulness may enhance the ability to find
meaning in one’s work through self-awareness and increased coping skills may pro-
tect against depersonalization and emotional exhaustion.
Eckleberry et al. also studied 29 hypothesized wellness factors and a wellness
scale defined as lower emotional exhaustion, lower depersonalization, and higher
personal accomplishment [ 25 ]. Thirteen wellness factors were associated with two
or more wellness scales and include using meditation, relaxation, massage, or other
alternatives; using alcohol or illicit drugs; using support group for physicians; talk-
ing about feelings; using professional counseling; feeling like one has a say in the
training program; feeling like one has some control over one’s schedule; having a
plan for the future; having enough money; having a supportive work environment;
feeling connected to and compassionate toward patients; having good coping skills;
and being happy with child care. The authors concluded that burnout and wellness
factors should be considered when designing burnout interventions with the goal to
minimize factors that cause burnout and promote wellness factors that protect from
burnout. Prins et al. found that highly engaged residents were less likely to self-
report medical errors (p < 0.01) [ 13 ]. They proposed that engagement (a positive,
fulfilling feeling related to one’s work characterized by vigor, dedication, and
absorption) may be a protective factor for burnout. Vigor describes high levels of
energy and willingness to invest in work. Dedication is defined by feelings of enthu-
siasm, pride, and inspiration about one’s job. Absorption means time passes quickly,
and other things do not matter because one is so engrossed with work. Engagement
is essentially the opposite of burnout, and the authors encourage keeping residents
highly engaged in their work.
25 Resident Physician Burnout: Improving the Wellness of Surgical Trainees