Effect of stress coping ability and working hours on burnout among residents

doi:10.21203/rs.2.12215/v1

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Research article

Effect of stress coping ability and working hours on burnout among residents

https://doi.org/10.21203/rs.2.12215/v1

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published 13 Jul, 2020

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Background

Burnout (BO) among residents leads to interruptions in training and even to exit from programs. Despite the implementation of working hour restrictions in the U.S. in 2013, the high rate of BO remains a serious problem. Therefore, we analyzed Japanese residents’ BO, training conditions, and associated factors, especially stress coping ability, with the aim of providing support for residents and evidence-based guidelines for working environments.

Methods

In total, 37 teaching hospitals were randomly selected, and all residents in the third and fifteenth months of a residency program at these hospitals were targeted for this research. We analyzed the residents’ BO rates, associated factors, and interactions using response data from a self-administered questionnaire consisting of the Japanese versions of the Maslach Burnout Inventory (MBI) and the Sense of Coherence (SOC) scale, as well as items asking about their training environments, gender, and age.

Results

Overall, 48 (49.5%) of 97 residents in 18 teaching hospitals (62 and 35 in the third and fifteenth months, respectively) whose average working hours were 63.3 hours per week were judged as having BO, among whom, 33 (53.2%) and 15 (42.9%) had BO in the third and fifteenth months, respectively. Logistic regression analysis indicated that working hours and 10 items on the SOC scale (SOC10) were significant factors of BO.

Two-way analysis of variance revealed that working hours was a significant variable for the MBI-emotional exhaustion score and SOC10 in the third and fifteenth months, respectively. Regarding the MBI-cynicism and professional efficacy scores, the SOC10 was a significant variable in both the third and fifteenth months. In addition, the high SOC group (SOC10>45) showed higher personal efficacy under longer working hours.

Conclusion

About half of the Japanese residents were judged as having BO as early as the third month of training under regulations of working 40 hours per week. Individual stress coping ability and working hours were found to be significant factors for BO. Residents with high stress coping ability exhibited more personal efficacy with more working experiences, which suggests that the SOC scale could be a valuable tool to help foster a suitable training environment.

Educational Psychology

burnout

Maslach Burnout Inventory

sense of coherence

resident

working hours

Postgraduate residency programs in the United States, Canada, and many other countries now aim to foster medical doctors who possess competencies as professionals. To accomplish this goal, qualified residency programs under governmental or professional regulations and guidelines provide residents with opportunities for essential clinical training as well as necessary support and a proper working environment. However, some residents stop training and cannot finish their program. For example, among the 274 internal medicine residency programs in the United States from 1979 to 1984, the training interruption rates due to mental health problems in first- and second-year residents were 1.4 and 0.7%, respectively. These interruptions led to their exit from training programs [1]. According to the 2017 annual report by the Ministry of Health, Labour and Welfare, Japan, 1.2% of residents faced an interruption in training, 37.4% of whom because of medical causes, including mental health problems [2].

Burnout (BO) is defined as a state of extreme physical and mental exhaustion and the depletion of emotions [3]. Medical and health professionals, among others, might easily fall into BO because of excessive demand for mental energy in the process of assisting patients [4]. Maslach and Jackson developed the Maslach Burnout Inventory (MBI) [3], which is a scale for judging BO composed of 16 items rated on a seven-point Likert scale that evaluates a respondent’s emotional exhaustion, cynicism, and professional efficacy.

Previous studies using the MBI reported that 76% of internal medicine residents in the United States in 2001 [5] and 61% of residents in Australia in 2001 [6] were judged as having BO.

Maslach et al. analyzed the cause of BO based on interviews with company administrators and workers, and reported that BO was the result of factors such as social environmental problems, overtime working, a lack of discretionary power, inadequate remuneration, dissatisfaction with work, and poor human relations [7]. As for residents’ BO, several studies have reported that inadequate remuneration [8] and frequent calls [9] are promoting (or worsening) factors for BO and that 80 or fewer hours of work per week [10], counselling [11,12], mentoring programs [13], and mindfulness-based skills programs [14] were preventive (or relieving) factors for BO.

In addition to the training environment, individual factors such as marriage [15] and childcare [16] have been reported to reduce the factors of BO. Women are more resistant [17] or liable [18] to BO. In addition, Tsele et al. and Cliiers reported that individual stress coping ability affected BO among health professionals [19,20].

Antonovsky proposed the concept of salutogenesis, and developed the Sense of Coherence (SOC) scale to evaluate individual stress coping ability [21]. The SOC scale is a self-administered questionnaire with 13 items rated on a seven-point Likert scale, and consists of three subscales: the extents to which a person comprehends the world (comprehensibility), perceives manageability in whatever situation that arises (manageability), and finds meaning in life (meaningfulness). A previous study involving 79 nurses using the SOC, MBI, and Beck’s Depression Inventory indicated that people with a low SOC score were at higher risk of BO and depression [19]. Tartas et al. reported that SOC scores examined prior to medical school admission were significantly correlated with occupational stress and BO among medical doctors after graduation [22].

In the United States, the Accreditation Council for Graduate Medical Education implemented working hours regulations on residency programs to prevent overwork, resulting in an average of 80 working hours per week [23–25]. Although the frequency of BO decreased from 36–77% to 25–69% [23,26–29], BO remains a serious problem. Therefore, residency programs require evidence-based guidelines for fostering effective working environments in addition to uniform restrictions on working hours.

In the present study, we analyzed BO and related environmental and individual factors in Japanese residents from the standpoint of the training phase. We also analyzed the relationships between individual stress coping ability, BO, and feelings of professional efficacy.

Targets and data collection

All postgraduate residency programs in Japan are qualified by the Ministry of Health, Labour and Welfare. It is mandatory for residents to practice internal medicine, general surgery, community medicine, and emergency medicine in a 2-year program. We randomly selected 37 teaching hospitals that operate qualified residency programs (1–6 hospitals/prefecture) from all over Japan. All residents in the third and fifteenth months at these hospitals were targeted for this research. We then created a self-administered questionnaire composed of:

the Japanese version of the MBI [30],
the Japanese version of the SOC [31],
items regarding the training environment, including frequency of night duty, working hours, stress-relieving opportunities, adequate working rewards, and work controllability, and
personal characteristics such as gender and age.

We distributed the printed questionnaire by mail with an exploratory description of this research and its ethical approval, and collected responses from July to September 2014.

Data analysis

We confirmed the independence of the MBI and SOC scales by exploratory factor analysis with promax rotation using item scores of both scales, and then excluded the SOC items that were classified into the same factors as the MBI subscale for the subsequent analysis. We confirmed the internal consistencies of the MBI, MBI subscales, and SOC using Cronbach’s coefficient.

Individual BO was judged according to the definition of the MBI [32,33]: an MBI subscale emotional exhaustion (MBI-EX) score of 16 or higher and/or an MBI subscale cynicism (MBI-CY) score of 11 or higher. The MBI subscale professional efficacy (MBI-PE) score was not used for BO judgments. The MBI-PE threshold was 23; less than 23 was judged as abnormally low professional efficacy.

Next, we analyzed the frequency of BO, MBI-EX, MBI-CY, and MBI-PE scores, influential factors related to these scores, and differences in training phases using the t-test, chi-squared test, and logistic regression analysis. To assess the effects of stress coping ability on BO, the respondents were divided into low and high SOC groups using the average SOC scores. Correlation and two-way analysis of variance was then carried out to analyze the relationship between MBI-EX, MBI-CY, and MBI-PE scores, SOC, and working hours. SPSS (version 21; IBM, New York, NY) was used for all data analyses.

In total, 107 residents (response rate: 28.2%) at 18 teaching hospitals in 11 prefectures responded to the questionnaire. After excluding invalid responses, such as choosing the same options, data from 97 residents (41 residents in hospitals with 500 beds or more, 36 in hospitals with 300–499 beds, and 20 in hospitals with 299 beds or less; 62 in the third month of their residency program and 35 in the fifteenth) were used for the analysis.

Table 1 shows the respondents’ demographic data and working environments. The residents’ average ages in the third and fifteenth months were 26.7 and 27.6 years, respectively, average frequency of night duty was 3.6 times per month, and average number of working hours per day was 11.5, which is equivalent to 63.3 hours per week.

Confirmation of scales

Exploratory factor analysis with promax rotation of the Japanese versions of the MBI and SOC scale using data from the 97 respondents indicated a six-factor structure (Table 2). Factors 1, 2, and 4 had items identical to the MBI-PE, MBI-EX, and MBI-CY detected in the original English version. The three-factor structure of the original version of the SOC scale did not detect these in the present analysis, and two items on the SOC scale were classified into factor 1 (MBI-PE); one item had a loading of over 0.4 for factor 4 (MBI-CY) and factor 6. These three items were excluded, and thus, 10 items of the SOC scale (SOC10) were used for the analysis.

Cronbach’s coefficients for the MBI-EX, MBI-CY, and MBI-PE were 0.91, 0.88, and 0.89, respectively. Cronbach’s coefficient for the SOC10 was 0.81.

BO frequency and influential factors

Among all respondents, 48 (49.5%) were judged as having BO (Table 3). The frequencies of BO in the third and fifteenth months were 53.2% and 42.9%, respectively, with no significant difference. The frequencies of BO among men and women were 49.2% and 50.0%, respectively; gender was not a significant factor.

Logistic regression analysis of BO using gender, frequency of night duty, working hours, age, work controllability, and the SOC10 as independent variables indicated that working hours (odds ratio [OR]: 1.315, 95% confidence interval [CI]: 1.057–1.636, p = 0.014) and the SOC10 (OR: 0.928, 95% CI: 0.882–0.976, p = 0.004) were significant. The SOC10 (OR: 0.918, 95% CI: 0.854–0.986, p = 0.018) and frequency of night duty (OR: 0.615, 95% CI: 0.388–0.974, p = 0.038) were significant variables for BO for respondents in the third and fifteenth months of the residency program, respectively.

MBI subscale scores at different training phases

At the third month, 32 (51.6%, 97.0% of BO residents), 16 (25.8%, 48.5% of BO residents), and 47 (75.8%) residents were judged as having abnormally high scores on the MBI-EX and MBI-CY, and low scores on the MBI-PE, respectively (Table 4).

At the fifteenth month, 12 (34.3%, 80.0% of BO residents), 9 (25.7%, 60.0% of BO residents), and 30 (85.7%) residents were judged as having abnormally high scores on the MBI-EX and MBI-CY, and low scores on the MBI-PE, respectively.

MBI subscale scores, SOC10 score, and working hours

The average SOC10 score of the 97 residents was 45.0 (standard deviation 10.11). Thirty residents (62.5%) in the low SOC group (SOC1045, n = 48) and 18 (36.7%) in the high SOC group (SOC10>45, n = 49) were judged as having BO (Table 3).

The MBI subscale scores in the low and high SOC groups in the third and fifteenth months are shown in Table 5. All subscale scores in the low and high SOC groups were significantly different, except the MBI-EX score in the fifteenth month.

In the low SOC group, the Pearson correlation coefficients between working hours and all three MBI subscale scores were significant in the third month (MBI-EX: r = 0.47, p = 0.007; MBI-CY: r = 0.39, p = 0.029; MBI-PE: r = –0.44, p = 0.012), but not in the fifteenth. In the high SOC group, working hours was correlated with only MBI-PE in the third month (r = 0.36, p = 0.049).

To analyze the relationship between working hours, SOC scores, and MBI subscale scores, the respondents were divided to four groups: ≤9 hours (19 residents), >9 to 11 hours (29 residents), >11 to 13 hours (32 residents), and >13 hours (17 residents) per day.

As shown in Figure 1, two-way analysis of variance with working hours and SOC scores as factors of the MBI-EX score revealed that working hours and SOC scores were significant variables in the third and fifteen months, respectively. Regarding the MBI-CY and MBI-PE scores, SOC was a significant variable in both the third and fifteenth months. The MBI-PE score in the high SOC group was higher (more professional efficacy) in longer working hour groups, whereas the MBI-PE score of the low SOC group was lower (less professional efficacy) in longer working hour groups.

In the present study, 49.5% of Japanese residents were judged as having BO. Our data proved that working hours are an independent factor of BO. However, the residents in this study, whose average working hours was 63.3 per week, showed a similar high frequency of BO in the United States after working 80 hours per week, which indicates that working hour regulations alone might not be adequate for reducing BO.

Our data also indicated that half of Japanese residents were judged as having BO as early as the third month of training. Among BO residents at the third month, 97.0% had a high MBI-EX score and 48.4% had a high MBI-CY score. The MBI-EX indicates decreased working vitality, that is, a low state of mental, creative, and physical energy levels. Meanwhile, the MBI-CY indicates decreased enthusiasm, that is, a low degree of interest in working.

Problems in this transitional phase from undergraduate education to postgraduate residency training were explained as encountering a new environment [34].

In this study, working hours was correlated with MBI-EX scores for residents in the low SOC group at this early phase of training. Residents were under greater stresses caused by interacting with patients and medical staff, learning new material in a more self-directed way, and bearing many responsibilities that accompany the delivery of patient care and the need to take on increasingly more tasks independently [34]. Residents were mentally fatigued and had restrained emotions during this phase.

At the fifteenth month, 80% of the residents with BO had a high MBI-EX score, and 60% had a high MBI-CY score. At this point, the enthusiasm among residents with BO faded, and they tended to view things cynically in addition to having low interest in working.

BO as judged by the MBI indicates an individual’s state at the time of inquiry. On the other hand, a resident’s stress coping ability as evaluated by the SOC is fixed to some extent in early adulthood, and might be only slightly changeable because of life experiences [21]. As previously reported [19,22], resident groups with high SOC scores showed a low frequency of BO as judged by emotional exhaustion and cynicism. In addition, these residents showed high professional efficacy, regardless of the training phase. Furthermore, longer working hours did not worsen their emotional exhaustion or cynicism; rather, professional efficacy was increased in this group, in contrast to the low SOC group, in which professional efficacy decreased.

Kroninger-Jungaberle et al. reported that the concepts of SOC and self-efficacy foster resilience [35]. Mastery experience has also been reported to increase self-efficacy [36]. Our data indicate that residents with high stress coping ability can increase their self-efficacy by gaining more clinical experience, as indicated by working hours, thereby obtaining resilience.

A previous report pointed out that limiting working hours is obviously effective for the prevention of BO, but there was some discussion that excessive restrictions might hinder professional development [24,37]. We found that appropriate working hours for effective training might vary among individuals, and that in addition to supportive programs for residents, personalized programs compatible with his/her stress coping ability and current BO status would be required.

Residents are in danger of BO at the very early phase of training, and the expression of BO might change as time passes. Teaching staffs and program directors should therefore consider these findings to help prevent and respond early to BO among residents.

Limitations

The hospital targeted in the present study was randomly selected from among those throughout the entire country, but the response rate and number of samples for analysis were low. In addition, we used a cross-sectional survey design. Thus, the relationship between working hours and BO at the later phase of a training program remains somewhat unclear because long working hours could be a cause of BO, and also shortened as a result of BO. To confirm the changes in BO status during the training period, it will be necessary to follow these individuals in a cohort study.

Furthermore, this was a survey of residents in a Japanese training program; additional research in other regions and with different training systems is required before our results can be generalized.

Conclusions

Half of the Japanese residents analyzed in the present study were emotionally restrained and judged as having BO in the third month of training. As previously reported, working hours and stress coping ability as evaluated by the SOC were both independent influential factors for BO. In addition, we found that residents with high stress coping ability maintained their interest and enthusiasm for working and obtained professional efficacy under longer working hours, whereas residents with low stress coping ability were liable to experience BO under the same working conditions. Individual stress coping ability could therefore be valuable information for fostering a suitable training environment.

MBI: Maslach Burnout Inventory general survey

MBI-EX: MBI-emotional exhaustion

MBI-CY: MBI-cynicism

MBI-PE: MBI-professional efficacy

BO: burnout

SOC: Sense of Coherence scale

OR: odds ratio

CI: confidence interval

Ethics approval and consent to participate

This research project was approved by the Graduate School of Medical and Dental Science, Kagoshima University (No. 638, 180122).

All target residents received a written explanation of the study protocol, and the voluntary nature of their participation. Residents who consented to participate were asked to return the completed questionnaire. Informed consent was assumed to be obtained when the participants returned a completed questionnaire.

Consent for publication

All target residents received a written explanation of the possible publication of the research findings. Residents who consented for participation were asked to return the completed questionnaire.

Availability of data and materials

Data except MBI can be disclosed within the scope of ethical codes according to requests.

Competing interests

The authors declare that they have no competing interests.

Funding

None.

Authors’ contributions

SK was responsible for designing the questionnaire, performing the statistical analysis, and drafting the initial manuscript; MT made substantial revisions to the manuscript and supported SK in its development, including the search process; KT was responsible for the methodology of the statistical analysis. All authors have read and approved the final version of this manuscript for submission.

Acknowledgments

We would like to thank the respondents and everyone who supported this research.

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Table 1. Baseline demographics of the survey respondents.

	Third month			Fifteenth month			Total
	n	(%)	n		(%)	n		(%)
Respondent	62	(100)	35		(100)	97		(100)
Male	37	(59.7)	26		(74.3)	63		(64.9)
Female	25	(40.3)	9		(25.7)	34		(35.1)
	Mean	(SD)	Mean		(SD)	Mean		(SD)
Age (years)	26.7	(3.6)	27.6		(3.5)	27.1		(3.6)
Working environment
Night duty (days/month)	3.8	(2.2)	3.3		(2.3)	3.6		(2.3)
Working hours (h/day)	11.9	(2.7)	10.9		(1.7)	11.5		(2.4)

n: number of respondents. SD: standard deviation.

Table 2. Promax-rotated pattern/structure coefficients for each factor, extracted communalities (h²), and eigenvalues for SOC and MBI factor analysis of scores from 97 residents.

Item	Factor
Item	1	2	3	4	5	6	h²
MBI16	0.880	–0.087	–0.012	0.086	0.090	–0.027	0.757
MBI10	0.873	–0.181	–0.004	0.164	0.041	–0.102	0.735
MBI11	0.768	0.038	–0.154	–0.068	–0.011	0.080	0.552
MBI7	0.757	0.079	0.054	–0.052	0.025	0.002	0.639
MBI12	0.683	0.137	–0.103	–0.218	0.056	0.272	0.625
MBI5	0.561	0.163	0.076	–0.205	–0.180	–0.092	0.487
SOC4	0.298	0.162	0.157	–0.070	0.056	0.189	0.209
XSOC10	0.271	–0.198	0.018	–0.061	0.017	–0.202	0.187

MBI2	–0.026	0.906	–0.063	–0.089	0.044	0.036	0.774
MBI1	0.013	0.821	–0.069	0.001	0.000	0.084	0.686
MBI6	0.047	0.781	0.207	0.194	–0.019	0.195	0.619
MBI3	–0.049	0.746	–0.009	0.094	–0.009	–0.138	0.728
MBI4	–0.004	0.645	–0.054	0.253	0.009	–0.109	0.720

SOC12	–0.027	0.144	0.783	–0.245	–0.048	0.109	0.767
SOC9	–0.031	–0.067	0.769	0.088	0.078	–0.089	0.575
SOC8	0.118	–0.048	0.718	0.007	–0.031	–0.352	0.663
SOC5	–0.239	–0.126	0.645	0.069	0.009	0.106	0.427
SOC13	0.001	0.176	0.624	–0.194	–0.008	–0.061	0.463
SOC6	0.301	–0.284	0.421	0.265	–0.203	0.077	0.375
SOC11	0.095	–0.036	0.365	–0.078	0.212	–0.315	0.370

MBI15	–0.108	0.014	–0.067	0.787	0.087	0.035	0.728
MBI8	–0.019	0.246	0.043	0.762	0.044	–0.112	0.810
MBI14	–0.049	–0.035	–0.143	0.717	0.018	0.187	0.624
MBI9	–0.001	0.157	0.017	0.716	–0.051	–0.142	0.720
MBI13	0.212	0.38	0.010	0.421	–0.090	–0.064	0.473

XSOC2	0.147	0.020	–0.153	0.047	0.815	–0.133	0.633
XSOC3	–0.122	–0.009	0.162	0.037	0.735	0.044	0.604
XSOC1	0.057	0.001	0.264	–0.076	0.410	0.080	0.387

XSOC7	0.123	–0.130	–0.048	–0.420	0.005	0.468	0.593
Rotated sums of squared loadings	5.375	5.328	5.490	6.320	2.461	1.324

MBI: Maslach Burnout Inventory; SOC: Sense of Coherence scale; XSOC: reverse coding item of SOC; MBIx: MBI item number x; SOCy: SOC item number y.

We used the main factor method to extract factors.

We defined a high factor loading as ³0.4. Factor analysis was performed by exploratory analyses.

Table 3. Number and percentage of burnout according to the participants’ gender and working environment.

		Third month			Fifteenth month			Total
		Respondents	BO		Respondents	BO		Respondents	BO
Variable		n	n	(%)	n	n	(%)	n	n	(%)
	All	62	33	(53.2)	35	15	(42.9)	97	48	(49.5)
	Male	37	22	(59.5)	26	9	(34.6)	63	31	(49.2)
	Female	25	11	(44.0)	9	6	(66.7)	34	17	(50.0)
Night duty (days/month)	£2	15	5	(33.3)	10	6	(60.0)	25	11	(44.0)
	£4	23	13	(56.5)	16	8	(50.0)	39	21	(53.8)
	£6	17	10	(58.8)	7	1	(14.3)	24	11	(45.8)
	>6	5	4	(80.0)	2	0	(0)	7	4	(57.1)
Working hours (h/day)	£9	11	4	(36.4)	8	1	(12.5)	19	5	(26.3)
	£11	18	8	(44.4)	11	5	(45.5)	29	13	(44.8)
	£13	19	10	(52.6)	13	7	(53.8)	32	17	(53.1)
	>13	14	11	(78.6)	3	2	(66.7)	17	13	(76.5)
Existence of somebody	Yes	57	30	(52.6)	33	14	(42.4)	90	44	(48.9)
to consult	No	5	3	(60.0)	2	1	(50.0)	7	4	(57.1)
Has ways to release one’s stress	Yes	57	30	(52.6)	31	11	(35.5)	88	41	(46.6)
Has ways to release one’s stress	No	4	3	(75.0)	3	3	(100.0)	7	6	(85.7)
Feels adequate reward for own work	Yes	56	28	(50.0)	30	13	(43.3)	86	41	(47.7)
	No	6	5	(83.3)	5	2	(40.0)	11	7	(63.6)
	Can	46	20	(43.5)	24	10	(41.7)	70	30	(42.9)
	Cannot	16	13	(81.3)	11	5	(45.5)	27	18	(66.7)
	£45	32	20	(62.5)	16	10	(62.5)	48	30	(62.5)
	>45	30	13	(43.3)	19	5	(26.3)	49	18	(36.7)

BO: respondents who were diagnosed as burnout by the Maslach Burnout Inventory (emotional exhaustion ³16 and/or cynicism ³11).

n: number of respondents. SOC10: scores on the Sense of Coherence scale, excluding three items that were classified into the Maslach Burnout Inventory subscales.

Table 4. Number of respondents who had abnormal MBI subscale scores in the third and fifteenth months of their residency program.

	Third month		Fifteenth month		Total
	n	(%)	n	(%)	n	(%)
High MBI-EX	32	(51.6)	12	(34.3)	44	(45.4)
High MBI-CY	16	(25.8)	9	(25.7)	25	(25.8)
Low MBI-PE	47	(75.8)	30	(85.7)	77	(79.4)
BO	33	(53.2)	15	(42.9)	48	(49.5)
Total	62	(100)	35	(100)	97	(100)

High MBI-EX: residents whose Maslach Burnout Inventory (MBI) emotional exhaustion score was ≥16.

High MBI-CY: residents whose MBI cynicism score was ≥11.

Low MBI-PE: residents whose MBI professional efficacy score was ≤25.

BO: respondents who were diagnosed as having burnout by High MBI-EX and/or High MBI-CY.

n: number of respondents.

Table 5. Average MBI subscale scores in the low and high SOC groups.

		Third month				Fifteenth month				Total
		n	Mean	SD	P	n	Mean	SD	P	n	Mean	SD	P
MBI-EX	Low SOC	32	17.7	6.83	0.048^*	16	15.9	6.84	0.083	48	17.0	6.81	0.007^**
	High SOC	30	14.2	6.89		19	11.7	6.81		49	13.2	6.89
MBI-CY	Low SOC	32	9.9	7.15	0.001^**	16	12.9	8.64	0.000^**	48	10.9	7.73	0.000^**
	High SOC	30	4.6	4.42		19	4.4	3.06		49	4.5	3.92
MBI-PE	Low SOC	32	14.3	7.07	0.008^**	16	12.9	6.41	0.049^*	48	13.9	6.83	0.001^**
	High SOC	30	19.7	8.09		19	17.5	6.79		49	18.8	7.62

MBI-EX: Maslach Burnout Inventory-emotional exhaustion. MBI-CY: Maslach Burnout Inventory-cynicism. MBI-PE: Maslach Burnout Inventory-professional efficacy.

Low SOC: Respondents whose score on the 10-item Sense of Coherence Scale was ≤45.

High SOC: Respondents whose score on the 10-item Sense of Coherence Scale was >45.

n: number of respondents. SD: standard deviation.

*P<0.05; **P<0.01: Significant difference in average MBI subscale scores based on a t-test.

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published 13 Jul, 2020

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Effect of stress coping ability and working hours on burnout among residents

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Abstract

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Background

Methods

Targets and data collection

Data analysis

Results

Confirmation of scales

BO frequency and influential factors

MBI subscale scores at different training phases

MBI subscale scores, SOC10 score, and working hours

Discussion

Limitations

Conclusions

List of Abbreviations

Declarations

Ethics approval and consent to participate

Consent for publication

Availability of data and materials

Competing interests

Funding

Authors’ contributions

Acknowledgments

References

Tables

Status:

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