Disengagement, substance use up risk of burnout among orthopaedic surgery residents

Burnout level is high among surgery residents in the Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programme, according to a Singapore study. Stressors that lead to higher burnout include feeling of inadequate sleep, poor work-life balance, poor relationships with fellow residents/faculty, and financial pressures.

“Residents with lower resilience were at risk of burnout,” the researchers said. “Protective coping mechanisms against burnout included planning and positive reframing, while behavioural disengagement and substance use may likely increase the risk of burnout.”

This cross-sectional questionnaire-based study included 44 orthopaedic surgery residents. Burnout was measured using the Maslach Burnout Inventory and resilience using the Short Grit Scale. The Brief Coping Orientation to Problems Experienced scale was used to determine coping mechanisms.

Twenty (45.5 percent) residents met the criteria for burnout. High levels of emotional exhaustion (EE) and depersonalization (DP) were associated with stressors, such as inadequate sleep (EE: r, 0.43; p<0.01; DP: r, 0.33; p<0.05), conflict between family and work (EE: r, 0.40; p<0.01; DP: r, 0.40; p<0.01), financial pressure (DP: r, 0.44; p<0.01), and conflict with residents (EE: r, 0.35; p<0.05; DP: r, 0.34; p<0.05) and faculty (EE: r, 0.44; p<0.01; DP: r, 0.35; p<0.05). [Singapore Med J 2021;doi:10.11622/smedj.2021010]

Stressors associated with burnout in this study were comparable to western ACGME counterparts. [J Bone Joint Surg Am 2004;86:1579-1586]

Severe burnout correlated with lower grit scores (p<0.05). Planning and positive reframing were some of the protective coping mechanisms, whereas behavioural disengagement and substance use could further increase burnout risk.

“Coping mechanisms are employed in times of stress and may contribute to the development of burnout,” the researchers said. “Various coping mechanisms exist but optimal coping mechanisms have yet to be defined.” [Annu Rev Psychol 2001;52:397-422]

Previous studies found that emotion-focused coping among physicians resulted in job stress and burnout. Another study reported that surgeons using self-distraction as a coping strategy were at higher risk of experiencing acute traumatic stress after serious surgical complications. [Br J Psychol 1996;87(Pt 1):3-29; Psychooncology 2008;17:570-576; Am J Surg 2014;208:642-647]

“Planning (eg, thinking about how to confront the stressor or planning one’s active coping efforts) as a coping mechanism appeared to be protective against severe burnout, while positive reframing (making the best of the situation by growing from it or viewing it in a more favourable light) was associated with higher levels of personal accomplishment,” the researchers said.

“Given our findings, we suggest that programmes educate residents on the various coping mechanisms and, in particular, encourage planning as a coping mechanism while highlighting that substance use and behavioural disengagement should be avoided as main coping strategies,” they added.

Burnout is defined as a syndrome of EE, DP, and a reduced sense of personal accomplishment among individuals who work with people in some capacity. [J Organ Behav 1981;2:99-113]

“Given the high demands of medical care, it is unsurprising that medical professionals are at significant risk of burnout,” the researchers said. [Intern Med J 2005;35:272-278]