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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 192-196

Burnout of resident doctors in a teaching hospital in Jordan


1 Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
2 Department of Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
3 Department of Pharmacy, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
4 Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan

Date of Submission10-Jul-2020
Date of Decision09-Sep-2020
Date of Acceptance17-Sep-2020
Date of Web Publication06-Nov-2020

Correspondence Address:
Dr. Mohamad E Mahseeri
Department of General Surgery, The University of Jordan, Amman
Jordan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_81_20

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  Abstract 


Background: Burnout syndrome in the medical field recently gained much attention, becoming an essential factor in specialty selection and job satisfaction. In this study, we focus on evaluating the emotional distress among residents of various specialties at a tertiary hospital and associated factors. Methods: This is a cross-sectional study which was done using a sociodemographic questionnaire among residents of various specialties. The collected answers were assessed using Student's t-test and Chi-square test for continuous variables and categorical ones respectively. Results: A total of 250 out of 382 registered residents took the survey with a response rate of 65%, 48% were female, 67.1% single, mean age 27.5 ± 2.2, and mean weekly duty work was 71.8 ± 22.6. 53.6% of residents reported a high grade of emotional exhaustion. Furthermore, 82.4% of the residents exceeded the 24-shift length, reaching a maximum of 56 h straight in-house duty. Male residents reported a higher rate of feeling pressured to work, while female residents reported that they would learn more effectively and commit fewer errors if they slept more. Conclusion: This is the first Jordanian study to measure elements leading to resident emotional distress and its effect on personal achievement. The prompt recognition of risk factors is essential for the achievement of prophylactic actions against resident emotional distress, which can be minimized by a well-defined regulation for residency working hours.

Keywords: Burnout, gender disparities, job satisfaction, Jordan, occupational diseases


How to cite this article:
Al-Taher RN, Mahseeri ME, Al Habashneh RA, Alsmadi M, Harb AI, Bustami NB, Shahait AD, Alghanem L, Alhalasa F, Mutlaq Al Muhtaseb FM, Subhi Qirem MM, Rahman Yaghi SM. Burnout of resident doctors in a teaching hospital in Jordan. Indian J Med Spec 2020;11:192-6

How to cite this URL:
Al-Taher RN, Mahseeri ME, Al Habashneh RA, Alsmadi M, Harb AI, Bustami NB, Shahait AD, Alghanem L, Alhalasa F, Mutlaq Al Muhtaseb FM, Subhi Qirem MM, Rahman Yaghi SM. Burnout of resident doctors in a teaching hospital in Jordan. Indian J Med Spec [serial online] 2020 [cited 2021 Oct 24];11:192-6. Available from: http://www.ijms.in/text.asp?2020/11/4/192/300160




  Introduction Top


Burnout is rising among all medical speciality, and it is increasing more noticeably among Arab and Middle Eastern doctors. To our knowledge, this study is the first study in Jordan to investigate burnout among doctors. It aims to find burnout in Jordanian resident doctors and find the best preventive measures for this growing problem.

This study examines the incidence of burnout and investigates the elements interlocked with burnout among residents in the entire surgical and non-surgical residencies at a tertiary Hospital in Jordan.


  Methods Top


Setting and participants

A descriptive (cross-sectional) study conducted at a tertiary Hospital in Jordan in February and March 2019. The sample tested was residents' training in surgical and nonsurgical residency programs.

Interventions

Collection of data was done through answering a questionnaire [Table 1]. Confidentiality was secured. The engagement was voluntary, and answers were anonymous. Consent was obtained from all participants, and they were disguised to any particular study hypothesis. There were 382 recorded residents, of whom 250 answered the survey. Vacation period, busy work at the time of questionnaires, external rotation, and withholding of the questionnaires were the cause of not reaching the whole residents represented by the questionnaire.
Table 1: Questions 13-21 with percentages of responses

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Outcomes measured

The questionnaire contained 21 items, measuring the emotional exhaustion and level of personal achievement and their associated factors. The questionnaire was divided into three parts. The first part asked for demographic information and numerical responses concerning hours worked, hours slept, and the length of the most extended shift. The second part [Table 1] contained questions measuring the amount of personal achievement and emotional exhaustion. The third part [Table 1] asked for feedback responses to statements. Respondents used a rank of 1 to 5, with 1 denoting “strongly disagree,” and 5 demonstrating “Strongly agree.”

To assess the personal and occupational outline, residents' working hours, percentages were calculated, and the frequency distributions of the evaluated factors were constructed.

Analysis of the Outcomes

A Chi-square test was implemented to study all variables. Furthermore, one-way ANOVA test and Student's t-test were used for continuous variables. A value of P < 0.05 was interpreted as statistically significant. The Statistical Package for the Social Sciences software version 24.0 (IBM SPSS Statistics) was used to conduct the analysis.

Institutional review board statement

The University of Jordan's institutional review board approved the study.


  Results Top


A total of 250 residents responded to the study. The mean age of participants was 27.5 ± 2.2, 43% were between the ages of 26–27. Male: female distribution was almost equal (52% vs. 48%), and most of the residents were single (67.1%). The contributing percentage of specialties is shown in [Figure 1], with the anesthesia residency having the highest number of residents 39 (15.5%). In [Table 2], postgraduate year (PGY) levels were summarized; about 29.1% were first-year residents. Half of the participants had a scheduled call every third or fourth night, as illustrated in [Figure 2].
Figure 1: Percentage of specialties participating in the study

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Table 2: The distribution of the residents' levels

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Figure 2: On-call schedules according to the amount of on calls repetitions

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The reported length of the most extended shift over the past 7 days was 29 ± 10.5 h, while for the weekly working hours, it was 71.8 ± 22.6 h. 24% of residents exceeded the 80 h/week schedule. Moreover, 73.6% of residents exceed the 24 + 4 h long shift, as shown in [Table 3]. About 77.4% of the residents felt overworked, and 69% felt that they were pressured to work more.
Table 3: The amount of worked hours and the longest shift related to the specialty

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There was a significant correlation between being in a surgical specialty and having high emotional exhaustion (P = 0.003). On the other hand, there was no correlation between being in a surgical specialty and low personal achievement (P = 0.10). Furthermore, there was a significant relation between exceeding 24 + 4-h on-call duty and having emotional exhaustion (P = 0.003). In contrast, there was no relation between the duration of the on-call shift and personal achievement (P = 0.9).

Overall responses to questions were summarized in [Table 1]. To explore gender disparities, cross-tabulation was performed, and male residents reported a higher rate feeling “pressured to work more” (71.9% males vs. 66.9% females, P = 0.026), while the majority of female residents reported that they would learn more effectively if they slept more (98% females vs. 86.7% males, P = 0.003), and they will commit fewer medical errors (90.1% female vs. 83.6% male, P = 0.039). Emotional exhaustion and personal achievement were compared between males and females, but overall, about 53.6% reported that they had high emotional exhaustion, and 70% of the participants graded their personal achievement as a medium.


  Discussion Top


Burnout is a syndrome defined by a small perception of personal attainment, displeasure for work (emotional exhaustion), and a sense of doubt (depersonalization).[1]

It is one of the most crucial prognosticators of doctors' gratification about career and specialty preference.[2],[3] Specific levels of stress may be considered desirable for training and may improve performance. However, the continuous chronic stress may predispose these young physicians to burnout syndrome, which is detrimental to the residents themselves and the higher patient population they treat.[4],[5]

Although the consideration is paid to residents' duty hours, the Jordanian data concerning residents' attitudes toward work-hour regulations are considerably small, and evidence reflecting resident burnout is not present. Also, there is still no law to regulate resident work hours. Little data regarding burnout have been published from the middle east area, including Jordan, for which this study is considered the first.

According to the international literature, the incidence of burnout in residents of all departments ranges from 27% to 75%, depending on the specialty,[6],[7] where it is twice as frequent in doctors of surgical departments.[8] 24% of residents at our tertiary center exceeded the 80 h/week schedule, and 73.6% of the residents exceeded the 24-h long shift. 86.1% of residents reported that if they slept more, they would commit fewer medical errors.

The Accreditation Council for Graduate Medical Education insisted on reducing the resident's working time, as it was effective in July 2003. Their recommendations insist on decreasing work hours to <80 h/week, with on-call frequency not exceeding every third night, and an on-site call not greater than (24 + 4) continuous hours.[9]

Meanwhile, in the European Union, the European Working Time Directive, a European drive created to hinder employers requiring their employee to work unreasonably long hours which will affect their physical and mental well-being; changed their policy for duty hours of the residents to a 48-hour work a week starting August 2009.[10]

One study directed by the American college of surgeons reported the frequency of burnout to range from 30.1% for surgeons who work 60 h/week to 50% for surgeons with the duty of 80 h/week and the correlation with the number of nights to call per week.[10] A noticed verge was seen at more than two nights on-call per week, a burnout estimate at 29.7% for one night on call/week in contrast to 44.6%–45.8% for two nights on calls/week.[10] Burnout is common in women, with 73% of female doctors fulfilling the criterion for burnout correlated with 65% of men.[11] Therefore, whether work-hour regulations diminish the surgical experience, the evidence is still conflicting.[12],[13],[14],[15]

Residents are more likely to show signs of burnout, possibly due to different causes, like extended duty hours, increased work stress levels, and lack of sleep.[16] burnout can have many harmful consequences on persons and institutions, like expanded personnel switch in shifts, absence, sick-leaves, injuries and errors, poor performance, and person-to-person and institutional conflicts.[17] Furthermore, residents' sleep loss and fatigue could negatively affect their patients' outcomes.[18]

Almost 70% of the residents graded their personal achievement as low, and 8% reported high emotional exhaustion. Hunting for autonomy and self-reliance are struggles common to young trainees; however, residents in their medical profession are experiencing further stress due to their training and educational structure present in their medical profession, which will affect their progress and training. As reported by Maslach et al., the loss of competent performance seems to emerge from the lack of proper resources, while emotional exhaustion results from excessive workload.[19]

Our study has some limitations. Our study depends on resident self-respondent data to evaluate medical errors. However, the current study is the first to describe a reliable relationship between the training atmosphere and burnout among residents in Jordan.


  Conclusion Top


Burnout syndrome is an overwhelming problem that leads to an increased rate of medical error and should be dealt with severely for standard patient care. A strict work hours-duty policy should be applied practically by Jordanian medical counsel and a strong need for well-defined regulations for residency working hours that should be implemented by the Jordanian parliament. We also advise increasing the database and national studies on this subject to involve hospitals all over Jordan other than our tertiary Hospital in a more objective manner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377-85.  Back to cited text no. 1
    
2.
Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg 2009;250:463-71.  Back to cited text no. 2
    
3.
Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: A comparison by sex. Arch Surg 2011;146:211-7.  Back to cited text no. 3
    
4.
Abut YC, Kitapcioglu D, Erkalp K, Toprak N, Boztepe A, Sivrikaya U, et al. Job burnout in 159 anesthesiology trainees. Saudi J Anaesth 2012;6:46-51.  Back to cited text no. 4
    
5.
Rossouw L, Seedat S, Emsley RA, Suliman S, Hagemeister D. The prevalence of burnout and depression in medical doctors working in the Cape Town Metropolitan Municipality community healthcare clinics and district hospitals of the Provincial Government of the Western Cape: A cross-sectional study. S Afr Fam Pract 2013;55:567-73.  Back to cited text no. 5
    
6.
Ishak WW, Lederer S, Mandili C, Nikravesh R, Seligman L, Vasa M, et al. Burnout during residency training: A literature review. J Grad Med Educ 2009;1:236-42.  Back to cited text no. 6
    
7.
Gouveia PA, Ribeiro MH Neta, Aschoff CA, Gomes DP, Silva NA, Cavalcanti HA. Factors associated with burnout syndrome in medical residents of a university hospital. Rev Assoc Med Bras (1992) 2017;63:504-11.  Back to cited text no. 7
    
8.
Basu CB, Chen LM, Hollier LH Jr., Shenaq SM. The effect of the Accreditation Council for Graduate Medical Education Duty Hours Policy on plastic surgery resident education and patient care: An outcomes study. Plast Reconstr Surg 2004;114:1878-86.  Back to cited text no. 8
    
9.
Villaneuva T. European Working Time Directive faces challenges. CMAJ 2010;182:E39-40.  Back to cited text no. 9
    
10.
Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, Bechamps GJ, et al. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg 2010;211:609-19.  Back to cited text no. 10
    
11.
Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. J Am Coll Surg 2016;223:440-51.  Back to cited text no. 11
    
12.
Kairys JC, McGuire K, Crawford AG, Yeo CJ. Cumulative operative experience is decreasing during general surgery residency: A worrisome trend for surgical trainees? J Am Coll Surg 2008;206:804-11.  Back to cited text no. 12
    
13.
Damadi A, Davis AT, Saxe A, Apelgren K. ACGME duty-hour restrictions decrease resident operative volume: A 5-year comparison at an ACGME-accredited university general surgery residency. J Surg Educ 2007;64:256-9.  Back to cited text no. 13
    
14.
Schneider JR, Coyle JJ, Ryan ER, Bell RH Jr, DaRosa DA. Implementation and evaluation of a new surgical residency model. J Am Coll Surg 2007;205:393-404.  Back to cited text no. 14
    
15.
Romanchuk K. The effect of limiting residents' work hours on their surgical training: A Canadian perspective. Acad Med 2004;79:384-5.  Back to cited text no. 15
    
16.
Baer TE, Feraco AM, Tuysuzoglu Sagalowsky S, Williams D, Litman HJ, Vinci RJ. Pediatric Resident Burnout and Attitudes Toward Patients. Pediatrics 2017;139:2016-163.  Back to cited text no. 16
    
17.
Cordes CL, Dougherty TW. A review and an integration of research on job burnout. Acad Manag 1993;18:621.  Back to cited text no. 17
    
18.
Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residency training: A reappraisal. JAMA 2002;288:1116-24.  Back to cited text no. 18
    
19.
Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001;52:397-422.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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