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Resident Burnout
- Anthony L. Back, MD;
- Joyce E. Wipf, MD; and
- Tait D. Shanafelt, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We appreciate the interest in our study of burnout in residents. Dr. Nash points out the need for caution in altering residency training and notes the lack of empirical evidence on which changes could be based. We agree that evidence is scant and view our study as an early step in establishing such an evidence base. Drs. Beckman and Fang speculate that our results disproportionately reflect a disaffected group of residents. This seems unlikely to us, since more than three quarters of the residents in the study met criteria for burnout and the participation rate was 76%. Dr. Graham suggests that burnout is a reflection of the dismal state of academic medicine, which our study did not directly address.
Although we understand that some readers may interpret our study as endorsement of changes already under way in internal medicine residencies, such as night float rotations and workload limits, we can only reiterate that our study is a cross-sectional snapshot of burnout. It does not provide longitudinal data that could lead to conclusions about the role of specific stressors or residency program features. Nor does our study provide evidence that simply reducing workload will improve physician training. A certain level of intensity may be important to developing competence in challenging situations. Research on the psychology of optimal performance indicates that maximal learning occurs when the challenge is matched to the learner's ability. Too little challenge is boring for learners; too much challenge is overwhelming (1).
We recognize that changes in residency training create new educational challenges. Improvements in residency training—with the goal of nurturing professionalism (2)—should draw on empirical evidence. Our work suggests that burnout may be an important factor in the professional development of residents. We would take Dr. Graham's call for honest dialogue one step further. We need research that will guide optimal training to develop physicians who are peak performers in every aspect: technically adept, knowledgeable, and compassionate.
Anthony L. Back, MD
Joyce E. Wipf, MD
University of Washington
Seattle, WA 98108
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
