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High burnout, low empathy levels among SG medical residents

Pearl Toh
09 Jan 2018

Medical residents ─ young doctors training to be specialists ─ in Singapore are feeling more burnt out with lower levels of empathy than their counterparts in the US, a recent study found.

“[T]his issue is alarming, as empathy decline and high burnout can have serious repercussions on physicians’ well-being and adversely affect quality of patient care,” said the researchers led by Dr Lee Phong Teck from the National Heart Centre Singapore.

The cross-sectional study involved 446 medical residents (mean age 29.4 years) from the Singhealth Residency programme spanning across three general hospitals, five National Specialty Centres, and nine clinics in the community. [Singapore Med J 2017;doi:10.11622/smedj.2017096]

“US literature was used as comparison because the majority of empathy and burnout literature on residents were based in the US. We also felt that our training systems, that is the local residency programme and the strict guidelines from Accreditation Council for Graduate Medical Education in the US, were similar,” explained the investigators.

The overall empathy levels, as assessed with JSPE*, were lower among Singapore medical residents at a mean score of 104.9, compared with 120 for their counterparts in the US. [Am J Psychiatry 2002; 159:1563-1569]

Furthermore, burnout rates were higher in the Singapore cohort than those in the US (80.7 percent vs 47–70 percent), indicating that eight out of 10 residents in Singapore felt burnt out. [Acad Med 2010;85:1630-1634; Arch Surg 2004;139:933-940; Acad Med 2011;86:1304-1310]

Specifically, higher burnout score in each domain in the MBI** ─ namely emotional exhaustion (34.1 vs 21.0), depersonalization (15.2 vs 5.0), coupled with a lower sense of personal accomplishment (39.4 vs 42.0) was observed among young doctors in Singapore compared with their US counterparts.

“There is evidence that burnout hampers empathy. Physicians who experience exhaustion and burnout are often depersonalized in social interactions and less capable of demonstrating empathy … On the other hand, empathy is often associated with job satisfaction and this protects physicians from emotional exhaustion,” according to Lee and co-authors.

“Our findings also suggest that physician empathy was correlated with burnout,” they added.

Residents who were more empathetic felt less exhausted emotionally and depersonalized, but a higher sense of personal accomplishment (p-value for correlation <0.001 for all).

“Empathy was positively correlated with personal accomplishment, but inversely associated with other indicators of burnout,” observed the researchers. “For every unit increase in JSPE, there was a 0.158- and 0.149-point decrease in emotional exhaustion and depersonalization, respectively, and 0.26-point increase in personal accomplishment.”

Nonetheless, noting that the r2 values in the regression analyses were small (≤0.2 for all three components), the researchers said “this suggests that while both empathy and burnout are certainly related, there remains a large undefined component in their combined construct that is yet to be elucidated.” 

According to Lee and co-authors, the higher burnout rates and lower empathy levels among residents in Singapore vs the US “is likely a reflection of multiple factors, ranging from medical education to work factors, such as hospital work-hours and policies as well as societal expectations on physicians.”

“Further research into the underlying cause of this association is necessary in order to plan protective interventions,” they suggested.

 

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