Letters to the Editor
To the Editor:
Campbell and colleagues'1 findings on predictors of persistent burnout in residents provide medical educators and researchers new information on the process of burnout. We agree with those authors that more insight is needed into the construct of burnout. Toward that end, we feel compelled to comment on their use of that construct.
It is true, as Campbell et al state, that research has not provided a one-dimensional construct of burnout. Maslach et al2 describe burnout as a syndrome characterized by emotional exhaustion (EE), depersonalization (DP), and a reduced sense of personal accomplishment (PA). Their Maslach Burnout Inventory states that burnout exists when an individual has high scores on EE and a high score on DP or a low score on PA. In contrast, Campbell et al state that burnout exists when there is a high score on either EE or DP. In our opinion, this latter description does not do justice to the construct of burnout. Moreover, it leads to inflated percentages of burnout. For example, Prins et al3 recently reported that 21% of the residents they studied met Maslach and colleagues' criteria for burnout (high scores on EE and one other subscale of the subscales mentioned above). However, 38% scored high just on DP, which, according to Campbell et al, could be reported as burnout.
Furthermore, Campbell et al1 report that men have an odds ratio of 3.31 compared with women in their risk of persistent burnout. In the literature on burnout, it is well established that men score higher on DP than do women. Campbell et al do not report whether they used the corrected scores for men and women on the DP subscale. Therefore, it remains unclear what the importance of this finding is.
In conclusion, we plea for a uniform use of the construct of burnout that does justice to its intricate nature, especially since our common purpose is to gain more insight into this important issue.
Michiel Westerman, MD
Physician and PhD student, St. Lucas Andreas Hospital, Amsterdam, The Netherlands; firstname.lastname@example.org.
Joanne P.I. Fokkema, MD
Physician and PhD student, St. Lucas Andreas Hospital, Amsterdam, The Netherlands.
Pim W. Teunissen, MD, PhD
Resident in obstetrics–gynecology and researcher, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands.
1 Campbell J, Prochazka AV, Yamashita T, Gopal R. Predictors of persistent burnout in internal medicine residents: A prospective cohort study. Acad Med. 2010;85:1630–1634.
2 Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, Calif: Consulting Psychologists Press, Inc.; 1996.
3 Prins JT, Hoekstra-Weebers JE, Gazendam-Donofrio SM, et al. Burnout and engagement among resident doctors in the Netherlands: A national study. Med Educ. 2010;44:236–247.