We read with great interest the recent articles on ‘Psychological distress, burnout and personality traits in Dutch anaesthesiologists’,1 and ‘High rate of burnout among anaesthesiologists in Belgrade teaching hospitals’.2 Both manuscripts demonstrated a high prevalence of burnout in residents and consultant anaesthesiologists.
In an attempt to compare with these recent reports, we conducted a multicentre observational study to determine the prevalence of burnout among French anaesthesiology residents and compared it with that observed in French psychiatry residents. Following approval from our institutional ethics committee to waive consent [Thursday, 27 March 2014 (chairperson Dr Conil)], the French validated version of the Maslach Burnout Inventory (MBI)3 questionnaires was sent via email to psychiatric and anaesthesia specialists in four cities: Toulouse, Bordeaux, Nantes, Clermont-Ferrand. There were no incentives and all residents were invited to complete the questionnaire anonymously Three dimensions of burnout have been described: emotional exhaustion, depersonalisation and a lack of accomplishment. These three dimensions are included in the measurement tool that is most frequently used to evaluate professional burnout, that is, the MBI. The MBI is a self-administered questionnaire that consists of 22 items. The responses are coded from 0 to 6. The MBI is composed of three factors: emotional exhaustion, depersonalisation and personal accomplishment. Comparisons of the averages of the subgroups were performed between the two courses. We considered the responses to the MBI as continuous variables. We used Student's t-tests. In total, 271 residents completed the MBI. There were 123 anaesthesiology residents and 148 psychiatry residents’. Psychiatric residents were mainly women (67%) with an average age of 27.7 ± 2.0 years, whereas anaesthesiology residents were mainly men (55%) with an average age of 28.8 ± 2.4 years.
Table 1 summarises the prevalence and the degree of burnout in terms of low, moderate and high intensity in the three dimensions (emotional exhaustion, depersonalisation and accomplishment). In both specialities, a little less than half of the residents presented symptoms of burnout.
There was a difference between the subgroups in the ‘depersonalisation’ dimension of burnout; the average score of the anaesthesiologists was 10.18, and that of the psychiatrists was 6.79 (P < 0.001; Table 2).
The study revealed that more than 10% of the participants exhibited moderate to high degrees of internal burnout in both of the resident populations. This exhaustion is of importance not only regarding the safety of medical procedures but also concerning the risks of the residents developing anxiety, depressive disorders or addictions.4 This burnout can have several causes that include the high number of on-calls, setting liabilities, life-threatening situations, level of supervision, encounters with psychological suffering and suicidal risk management. The emotions that arise are aggressiveness, delirium and hallucinations. It appears that each of these specialties can generate a risk known to develop signs of burnout
The prevalence of depersonalisation observed in the present study is similar to that found by Milenovic et al.2 Encounters with life-threatening emergencies and situations of imminent death may explain these findings. Regarding physical fatigue, there seemed to be a difference between the two specialities. The anaesthaesiologists experienced approximately 4 to 5 on-calls per month, whereas the psychiatric residents experienced approximately 1 to 2 per month. There are a number of limitations of this study. The sample may only be partially representative of all anaesthesiology and psychiatry residents in France. The responses were obtained on a voluntary basis. Only involved residents could answer. This was an observational study, and we can provide no answers regarding the causes of these effects in this specific population. Additionally, there was a difference distribution between men and women in both specialties, which may explain in part the difference in the prevalence between the two.
The results of the present study question the decisions to be taken to prevent the occurrence of burnout in this population. Some risk factors have been highlighted in previous studies, such as working conditions, the imbalance between personal and professional lives and states of transient embrittlement (familial and professional).5 Some factors seem difficult to change; others can be regulated with working time. The role of supervision by seniors seems also important to reduce symptoms of burnout (particulary depersonalisation). The kind of supervision seems important for residents. Indeed, Milenovic et al.2 suggest that anaesthesiologists with shorter work experience are far more exposed to depersonalisation than experienced anaesthesiologists. Nevertheless, van der Wal et al.1 explain that practitioners experiencing symptoms of burnout keep on working and potentially pose a threat to their own mental and physical health as well as to patient safety. This seems also true for residents because of fear of repercussions that could influence their subsequent careers. Burnout is a very sensitive subject in the medical population, in general, particularly among residents. This is the clinical reality. These signs of exhaustion are also found in many early courses, and they ultimately remain generally undervalued. This underevaluation can be linked to ignorance of the syndrome and to the difficult, ‘blameless’ nature of this situation for other professionals in personal service.
Acknowledgements relating to this article:
Assistance with the study: we would like to thank Dr Y. Esquirol for her assistance with the study.
Financial support and sponsorship: none.
Conflicts of interest: none.
1. van der Wal RAB, Bucx MJL, Hendriks JCM, et al. Psychological distress, burnout and personality traits in Dutch anaesthesiologists: a survey. Eur J Anaesthesiol
2. Milenović M, Matejic B, Vasic V, et al. High rate of burnout among anaesthesiologists in Belgrade teaching hospitals: results of a cross-sectional survey. Eur J Anaesthesiol
3. Dion G, Tessier R. Validation de la traduction de l’Inventaire d’épuisement professionnel de Maslach et Jackson. [Validation of a French translation of the Maslach Burnout Inventory (MBI)]. Can J Behav Sci Can Sci Comport
4. Talih F, Warakian R, Ajaltouni J, et al. Correlates of depression and burnout among residents in a lebanese academic medical center: a cross-sectional study. Acad Psychiatry
5. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet Lond Engl