Letters to the Editor
We agree with Dr. Westerman and his colleagues that uniform use of the construct of burnout is important. Unfortunately, there is variability in the way the construct is applied that makes interpretation across studies challenging. This has previously been an issue of debate in this journal as well. For instance, Gabbe et al1 defined burnout as high levels of burnout in all three domains of the Maslach Burnout Inventory (MBI) in their study of burnout in medical school deans and found a very low burnout rate (2%). However, a total of 56% of the responding deans exhibited high burnout on at least one subscale, and 47% had either high emotional exhaustion (EE) or depersonalization (DP). These are dramatically different interpretations that hinge on the definition of burnout.
The MBI Manual does not report any validity evidence on a single high-burnout outcome but, rather, reports correlations with high burnout in each subscale individually.2 This means that to define high burnout, each subscale must be considered on its own. To convert a three-dimensional definition of burnout into a unidimensional construct in our study,3 residents with burnout were defined as high EE or DP.
Apart from our study of persistent burnout in medical residents, it has become standard to define burnout as high EE or high DP.4 For example, every original contribution to JAMA in the last decade used the high EE or high DP definition of burnout.4–7
Finally, we are unaware of any correction factor for DP scores in men or any studies that validate this practice.
Jessica Campbell, MD, MA
Assistant professor, University of Colorado Denver School of Medicine, Aurora, Colorado, and Division of Hospital Medicine, Denver Health Medical Center, Denver, Colorado; firstname.lastname@example.org.
Allan Prochazka, MD
Professor, University of Colorado Denver School of Medicine, Aurora, Colorado, and Department of Ambulatory Care, Denver VA Medical Center, Denver, Colorado.
Ravi Gopal, MD
Assistant professor, University of Colorado Denver School of Medicine, Aurora, Colorado, and Department of Ambulatory Care, Denver VA Medical Center, Denver, Colorado.
2 Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, Calif: Consulting Psychologists Press; 1996.
4 Thomas NK. Resident burnout. JAMA. 2004;292:2880–2889.
5 Dyrbye LN, Massie FS Jr, Eacker A, et al. Relationship between burnout and professional conduct and attitudes among U.S. medical students. JAMA. 2010;304:1173–1180.
6 West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302:1294–1300.
7 West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA. 2006;296:1071–1078.