Residency as a Social Network: Burnout, Loneliness, and Social Network Centrality

摘要

Background? Burnout is typically viewed as an individual condition, and no link has been identified between burnout and loneliness.;Objective? To investigate the association of burnout with loneliness and social network degree and centrality.;Methods? A survey containing the Maslach Burnout Inventory (MBI), a 3-question loneliness scale, and a social connectivity component was sent to residents in a large urban academic medical center internal medicine residency program.;Results? The response rate was 77% (95 of 124 residents). We defined significant burnout as MBI subscores of ≥ 27 for emotional exhaustion (EE), ≥ 10 for depersonalization (DP), or both. This was met by 43 (45%), 47 (49%), and 31 (33%) out of 95 respondents, respectively. Those with significant burnout had higher loneliness scores: 5.6 versus 4.5 for EE (P = .002; OR = 1.50; 95% CI 1.15–1.95); 5.4 versus 4.6 for DP (P = .024; OR = 1.33; 95% CI 1.03–1.71); and 5.8 versus 4.6 for both EE and DP (P = .001; OR = 1.54; 95% CI 1.17–2.02). Rating a larger number of coresidents as closer connections on a 5-point Likert scale was not associated with lower burnout scores. No measures of centrality were associated with burnout scores for EE and/or DP. High personal accomplishment subscores on the MBI did correlate significantly with several measures of centrality.;Conclusions? Burnout was associated with loneliness in a dose-dependent fashion. Greater sense of personal accomplishment was associated with greater network centrality.;What was known and gap Burnout has been studied as an individual phenomenon, but little is known about the effect of loneliness and the presence of social networks.;What is new A study showed that burnout was associated with loneliness, while a greater sense of personal accomplishment was associated with greater network centrality.;Limitations Single site, single specialty study reduces generalizability; social network tool lacks established validity evidence.;Bottom line The study provides a starting point for research on how group and social network factors affect trainee burnout.;Introduction Burnout syndrome, characterized by emotional exhaustion (EE), depersonalization (DP), and a decreased sense of personal accomplishment (PA), is common within the continuum of medical training and practice.1,2 Burnout is associated with depression; suicidal ideation; lower patient satisfaction; decreased altruism, empathy, and perceived quality of care; and increased unprofessional behavior and self-reported errors.3–9 The majority of internal medicine residents (78%) report symptoms of burnout at least once during residency training, with 23% reporting burnout throughout all 3 years of training.5 In 1 study, 61% of residents reported becoming more cynical, and 23% reported becoming less humanistic during training.10 While burnout often is considered an individual affliction, ties between individuals create social networks and allow individuals to influence each other.11,12 The literature on social networks has demonstrated the spread of emotions, such as happiness and loneliness, as well as the spread of negative afflictions, such as smoking and obesity.11 Residency programs represent unique social networks, and we sought to investigate the relationship between burnout and loneliness. We hypothesized that residents with greater loneliness would have greater burnout, and that residents who are more central within their social network have less burnout.;Methods Setting and Participants We piloted our study of loneliness and burnout in a single internal medicine residency program as a proof of concept prior to conducting a larger study. Categorical internal medicine (IM-C), preliminary year internal medicine (IM-P), and internal medicine-pediatrics (MP) residents from a program set in an urban academic medical center were included. The latter 2 groups had large parts of their training embedded in the internal medicine residency.;Results Response Rates A to