Burnout linked to unprofessional behavior, less altruism among medical students

Dyrbye L. JAMA. 2010;304:1173-1180.

Medical students experiencing burnout were more likely to self-report unprofessional clinical behavior, including cheating and dishonesty, and less considerate professional values, according to data from a multi-institutional study.

To determine the correlation between professionalism and burnout among medical students, researchers conducted a cross-sectional survey of all students attending seven U.S. schools during the spring of 2009. Distress among students was gauged using the Maslach Burnout Inventory, PRIME-MD depression screening instrument and the SF-8 quality-of-life assessment tool. The researchers also collected data on students’ participation in unprofessional conduct, their understanding of appropriate industry relationships and their view of physicians’ responsibility to society.

Sixty-one percent of eligible students responded to the survey (n=2,682), 52.8% of whom were burned out. The rate of unprofessional conduct related to patient care among these students was high (endorsed by up to 43%) compared with cheating or dishonest academic behavior (endorsed by <10%).

Students were given six scenarios to determine their opinion on appropriate relationships with industry; 22.4% thought it appropriate to accept $500 from an industry representative after completing a short survey, whereas only 14% had views consistent with American Medical Association guidelines for conflicts of interest. In addition, students with burnout were more likely to participate in one of the cheating or dishonest clinical behaviors examined — including copying from a crib sheet or peer during an exam — compared with those without burnout.

According to the researchers, burnout was also associated with engaging in one or more unprofessional behaviors (35% with burnout of students vs. 21.9% of students without burnout; OR=1.89; 95% CI, 1.59-2.24), and students with burnout had less interest in treating medically underserved patients compared with those who were not burned out (79.3% vs. 85%; OR=0.68; 95% CI, 0.55-0.83).

Burnout was the only facet of distress independently associated with reporting one or more unprofessional behaviors (OR=1.76; 95% CI, 1.45-2.13) or having at least one altruistic view of physicians’ responsibility to society (OR=1.65; 95% CI, 1.35-2.01), according to a multivariate analysis adjusted for personal and professional characteristics.

“These findings are in keeping with the theoretic framework that burnout primarily affects the professional domain, whereas personal distress (such as a low mental [quality of life]) often has greater initial effect on personal domains (eg, relationship difficulties or substance abuse), with a secondary effect on the professional domain depending on chronicity and severity,” the researchers wrote.

Future studies should explore whether interventions to reduce burnout could help promote professional values and behavior among medical students, they concluded.

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