Emergency Medicine Resident Burnout and Examination Performance.

OBJECTIVES: Burnout afflicts emergency physicians (EPs) to a significant degree. The impact of burnout spans from decreased clinical efficiency to increased medical errors to heightened risk of physician suicide. This large-scale study captures responses from emergency medicine (EM) residents regarding two burnout items and examines the correlation between in-training examination (ITE) scores and burnout risk as well as that between residency year and burnout risk. METHODS: This was a prospective, mixed-methods, cross-sectional cohort study. All residents in U.S. categorical EM residents who took the 2019 ITE were included. At the end of the ITE, residents were invited to complete a voluntary survey that included two items from the Maslach Burnout Inventory (MBI) that have been found to be strongly indicative of burnout: one about self-perception of being burned out and one about feelings of callousness. Responses were on a 7-level Likert scale (1-7), ranging from very low frequency (1) to very high frequency (7). Measurements included the number of residents in each year-level of training (EM1-EM4), the MBI item ratings, and the ABEM ITE score. Performance, as measured by the scaled, equated score, was compared to the MBI item responses. A corrected Spearman's correlation coefficient (ρ) was used to compare continuous data (score) against a discrete ordinal variable (MBI Likert response). RESULTS: There were 2,501 EM1 residents, 2,389 EM2 residents, 2,206 EM3 residents, and 616 EM4 residents in the study group. There were 7,206 (93.4%) physicians who completed the first MBI question about burnout; 7,172 (93%) completed the second MBI question about callousness. There was no statistically significant association between the burnout item response and ITE performance (ρ = -0.03; p = 0.015). There was a positive, statistically significant association between the callousness item response and higher ITE performance (ρ = 0.07; p < 0.001). There was a statistically significant association between the response to the burnout item and training level (ρ = 0.07; p <0.001). There was also a statistically significant association between the response to the callousness item and training level (ρ = 0.15; p < 0.001). The overall prevalence of burnout risk in various training levels were EM1, 28.2%; EM2, 39%; EM3, 41.1%; and EM4, 43.3%. CONCLUSIONS: Our study found no significant correlation between ITE score and burnout risk. There was a weakly positive correlation between ITE scores and callousness. Based on our study results, ITE scores may not be useful in prognosticating burnout risk for EM residents and, interestingly, higher ITE scores correlated to stronger feelings of callousness. Our study indicates that EM residents at higher levels of training reported stronger self-perceptions of burnout and callousness. Further investigation into why residents at higher levels of training may experience greater burnout risk is warranted.

Curated Collections for Clinician Educators: Five Key Papers on Graduated Responsibility in Residency Education.

Introduction The Accreditation Council for Graduate Medical Education calls graduated responsibility "one of the core tenets of American graduate medical education." However, there is no clear set of resources for programs to implement a system of progressively increasing responsibilities for trainees. This project aimed to identify a set of high-yield papers on graduated responsibility for junior faculty members. Methods A study group of Academic Life in Emergency Medicine Faculty Incubator participants identified relevant literature on graduated responsibility via a comprehensive literature search and a call to the online medical education community; 59 total papers were identified. The most relevant and applicable were selected by the study group via a three-round modified Delphi process. Results Five key articles for junior faculty interested in implementing more robust graduated responsibility at their residency training program were selected and described here. Summaries of key points, along with considerations for faculty developers and relevance to junior faculty, are presented for each article. Conclusions The articles presented here provide a solid theoretical and practical basis for junior faculty to explore graduated responsibility. The five articles presented here provide the junior faculty with a toolkit to examine and improve their systems for assigning responsibilities in a graded fashion at their own institutions.