According to an investigation in the September 7 issue of JAMA, a medical education theme issue in a recent academic year, suboptimal quality-of-life, dissatisfaction with work-life balance, and burnout symptoms of emotional exhaustion which were linked with higher levels of educational debt were frequently reported in the study that consisted of almost three-fourths of all internal medicine residents in the U.S.
The researchers write:
“Factors such as physician burnout, depression, job dissatisfaction, and low quality of life (QOL) have been associated with negative effects on patient care, including major medical and medication errors, suboptimal care practices, and decreased patient satisfaction with medical care. Despite the relevance of physician well-being to patient care outcomes, little is known about patterns of distress across demographic factors. To our knowledge, there has not been a nationally representative examination of factors that may be associated with well-being of internal medicine residents.”
A large national cohort of internal medicine residents were surveyed by Colin P. West, M.D., Ph.D., of the Mayo Clinic, Rochester, Minn., and colleagues, in order to completely understand the frequency of resident distress across demographics together with its connection with medical knowledge, speculating that distress would be linked with higher educational debt, lower test scores, and decreased learning.
Data gathered on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores was used in the investigation together with the 2008 IM-ITE survey, a standardize 340-item multiple-choice self-assessment offered annually in order to evaluate training process by identifying areas of deficiency that require further education.
16,394 internal medicine residents (7,746 U.S. graduates and 8,571 international graduates) were included in the investigation, representing 74.1% of all eligible U.S. residents in the 2008-2009 academic year. Quality of life, symptoms of burnout, year of training, sex, medical school location, together with educational debt were analyzed, and IM-ITE score reported as percentage of correct responses.
They discovered that out of the 2,402 of the 16,187 residents who responded (14.8%), overall quality of life was rated as being “as bad as it can be” or “somewhat bad”. 32.9% reported being somewhat or very dissatisfied about work-life balance. 7,394 of 16,154 residents (45.8%) reported having symptoms of emotional exhaustion at least weekly, while 28.9% of residents (4,541 of 15,737) reported symptoms of depersonalization, such as feelings of being detached or unable to feel emotion, at least weekly. Overall, 8,343 of 16,192 internal medicine residents (51.5%) reported having at least one symptom of burnout.
The researchers also discovered as residents’ educational debt rose, emotional exhaustion and depersonalization also increased. Those with a debt of over $200,000 had a 59% increased chance of experiencing emotional exhaustion, 80% increased chance of experiencing depersonalization, and 72% increased chance or experiencing burnout, compared to those without debt.
They also found that as educational debt grew IM-ITE scores decreased; that for international medical graduates the connection of debt with IM-ITE score was stronger compared to U.S. medical graduates; that international graduates were significantly less likely to report high levels of emotional exhaustion or depersonalization in comparison to U.S. graduates; and that reduced quality of life, decreased satisfaction with work-life balance, as well as increased prevalence of burnout symptoms were linked with lower IM-ITE scores.
The investigators explain:
“Regardless of the explanation, internal medicine residents with greater degrees of emotional exhaustion and debt, and lower QOL levels, consistently scored less well on the IM-ITE and did not recover to the level of their colleagues over the course of their training. Additional studies are needed to better understand these relationships and their effect on clinical competency. In particular, as debt relief programs are developed for physicians in training and in practice, their effect on both well-being and patient safety should be assessed.”
Written by Grace Rattue