2017 HSC Section 2 - Practice Management
Fletcher et al
cutoff point at which a subject is considered ‘‘burned out.’’ Rather, scores are compared to normative data and grouped into low, average, and high degrees of EE, DP, and PA, reflecting a continuum of potential responses to work-related stress. Although the syndrome of burnout is readily identified with the MBI-HSS, the value of the survey is its ability to assess a subject’s place along a spectrum of responses to stress ranging from low to high degrees of burnout, in con- trast to a dichotomous characterization of burnout as either ‘‘present’’ or ‘‘absent.’’ In the present study, we measured burnout in alumni of the University of Iowa Hospitals and Clinics (UIHC) resi- dency program in otolaryngology using the MBI-HSS. In conjunction with the survey, we also collected demographic information from survey participants, and correlation between demographic data and burnout was assessed. The design of this investigation was a questionnaire-based study of alumni of the UIHC otolaryngology program who were registered with our alumni relations office as of 2008. The survey was distributed to a total of 236 alumni. Survey Administration A single postal mailing containing the MBI-HSS and a demo- graphic data sheet was sent. Each mailing included the survey, the demographic data sheet, a postage-paid return envelope, an instruction sheet, and a cover letter broadly explaining the study’s purpose. To maintain confidentiality, survey partici- pants were instructed not to mark any identifying information on the survey or return envelope. Participation in the study was completely voluntary. Completed surveys were returned by mail and stored anonymously by secretarial staff otherwise uninvolved with the study. The study protocol, survey instru- ment, and demographic survey were reviewed and approved by the University of Iowa Institutional Review Board. MBI-HSS The MBI-HSS evaluates the 3 subjective components of burnout—namely, PA, EE, and DP—through a brief 22-item inventory. We administered the full MBI-HSS, including all 22 questions, among 3 subscales: 9 questions assess emo- tional exhaustion, 8 evaluate personal accomplishment, and 5 score depersonalization. Questions regarding emotional exhaustion include ‘‘I feel like I am at the end of my rope,’’ and ‘‘I feel burned out from my work.’’ Questions such as ‘‘I have accomplished many worthwhile things in this job’’ assess personal accomplishment, whereas questions such as ‘‘I feel I treat some of my faculty and residents as if they were impersonal objects’’ measure depersonalization. The items are listed in no particular order, and respondents are instructed to assign a frequency to these feelings on a scale ranging from never to once a day . Survey respondents link each statement to a score on a 6-point Likert scale (0 = never; 1 = a few times a year or less; 2 = once a month or less; 3 = a few times a month; 4 = once a week; 5 = a few Materials and Methods Study Design and Participants
Table 1. Maslach Burnout Inventory Subscale Stratification (% of Subjects in Each Stratum)
Low Moderate
High
Emotional exhaustion Depersonalization Personal accomplishment
71 56 10
15 17 24
19 21 57
times a week; 6 = every day ), relating the statement or feeling to the incidence of its perception. In scoring the survey, responses were grouped according to category (EE, DP, and PA) based on a key and added together to generate a score for each category. Demographic Data Survey The demographic data survey consisted of a total of 8 ques- tions. The survey was designed to collect basic demographic information, including age (by decade), marital status, length of time married, and number of children in the home. It also collected information about the survey participants’ practice, including type of practice (academic vs private, group vs solo, single vs multispecialty group), number of hours worked per week, and number of years in practice. One ques- tion addressed spirituality by asking respondents to indicate how religious they are on a 7-point Likert scale (1 = very religious; 7 = not at all religious ). Statistical Analysis Statistical analysis was performed using SAS version 9.1 for Windows (SAS Institute, Cary, North Carolina). Pearson correlation coefficients were used to summarize associations between continuous variables. Univariate and multivariate linear regression was used to measure crude and adjusted associations for categorical and continuous risk factors for burnout. Associations and comparisons of means were con- sidered statistically significant if P .05. Of 236 surveys distributed, 115 were returned completed (49% participation rate). Of note, 94% of the study popula- tion indicated that they were married, with the average number of years married being 16.3 (range, 1-57 years), and 56% (64/115) of participants indicated that they had chil- dren living with them. Only 14% (16/115) were younger than age 40, and equal proportions of respondents were in their fourth and fifth decades: 23% (27/115) aged 41 to 50 years and 23% (26/115) aged 51 to 60 years. The majority of the study population was in private practice 56% (64/ 115) with 34% (39/115) in academic medicine. MBI-HSS Percentages of subjects stratified into low, moderate, and high levels for each subscale are listed in Table 1 . Levels Results Demographic Information
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