SLR - September 2020 - Jacob Carmichael

What is the Prevalence of Burnout, Depression, and Substance Use Among Orthopaedic Surgery Residents and What Are the Risk Factors? A Collaborative Orthopaedic Educational Research Group Survey Study

Reference: Lichstein PM, He JK, Estok D, et al. What Is the Prevalence of Burnout, Depression, and Substance Use Among Orthopaedic Surgery Residents and What Are the Risk Factors? A Collaborative Orthopaedic Educational Research Group Survey Study [published online ahead of print, 2020 May 22]. Clin Orthop Relat Res. 2020;10.1097/CORR.0000000000001310. doi:10.1097/CORR.0000000000001310

Reviewed By: Jacob Carmichael, DPM
Residency Program: East Liverpool City Hospital - East Liverpool, OH

Podiatric Relevance: Resident burnout is a serious issue that is not uncommon among all residencies. By looking at how orthopedic surgery residents are affected by it, we will get a better understanding of how it may be affecting podiatric surgery residents, many of whom operate under a very similar schedule as their orthopedic counterparts.

Methods: Six hundred sixty-one residents from 46 orthopedic surgery programs agreed to fill out a 34-question internet-based, anonymous survey. The survey asked about demographics, educational debt, sleep and work habits, perceived peer or program support and substance abuse. Validated units were used to assess burnout (abbreviate Maslach Burnout Inventory), depression (Patient Health Questionnaire-2) and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption).

Results: Burnout was reported in 52 percent of residents, 13 percent of residents had a positive screen for depression, and 61 percent of residents met the criteria for hazardous alcohol use with 7 percent reporting the use of recreational drugs. Factors associated with high emotional exhaustion scores included early training year, unmanageable work volume, inability to attend health maintenance appointments, lack of exercise and lack of program support. Factors associated with depersonalization included early training year, inability to attend health maintenance appointments and lack of co-resident support. Low personal accomplishment was associated with lack of co-resident support and lack of program support. Factors associated with depression included exceeding duty hour restrictions and lack of program support. Factors associated with hazardous alcohol use included male gender, Asian ethnicity, single or divorced marital status and more sleep per night. Single or divorced status was also associated with illicit drug use.     

Conclusions: This paper shines a light on how common burnout and related issues are among orthopedic surgical residents, which can be taken into consideration for all residency programs. Some of these influencing factors are modifiable from an external standpoint. Duty hour violation, workload, lack of program support, and inability to attend health maintenance appointments, are easy modifications residency programs should try to make an active effort to improve. Other factors need to be addressed from an internal standpoint. Lack of co-resident support was one of the factors associated with burnout . A big contributor to that are programs where a large workload is given to early year residents, who are then left to fend for themselves without support from their co-residents. These are all things we should keep in mind when creating a healthy environment for training residents.  

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