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Original article
DOI: 10.1016/j.acci.2020.11.004
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Disponible online el 25 de Diciembre de 2020
Prevalence of burnout syndrome in trainee specialists and teachers of intensive care
Prevalencia del síndrome de Burnout en residentes y docentes de cuidados intensivos
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Alejandro Rivera Palaciosa,
Autor para correspondencia
riveralejo1124@gmail.com

Corresponding author.
, Jhoana Andrea España-Chamorroa, David Ricardo Echeverry-Piedrahitab,c, Paula Andrea Moreno-Gutiérrezd
a Programa Especialización Medicina Crítica y Cuidados Intensivos Universidad Tecnológica de Pereira, Colombia
b Grupo de Investigación Medicina Crítica y Cuidados Intensivos GIMCCI Universidad Tecnológica de Pereira, Colombia
c Médico Intensivista, Docente y coordinador académico del programa de especialización de Medicina Crítica y Cuidados Intensivos, Universidad Tecnológica de Pereira, Colombia
d Docente Fundación Universitaria Autónoma de las Américas, Colombia
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Table 1. Characteristics and scores of the Maslach Burnout inventory in 17 intensive care physicians and intensive care residents and professionals from the city of Pereira, Risaralda during 2019. p values obtained using Mann–Whitney's U test.
Table 2. Average scores of the Burnout scales of the Maslach inventory according to the characteristics of the subject in 17 intensive care physicians and intensive care residents of the city of Pereira, Risaralda during 2019. p values obtained using Mann–Whitney's U test.
Table 3. Classification of the Burnout scales of the Maslach inventory according to the characteristics of the subject in 17 intensive care physicians and intensive care residents of the city of Pereira, Risaralda during 2019.
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Abstract
Objective

To determine the prevalence of Burnout syndrome in trainee specialists and teachers of the critical medicine and intensive care program (CMIC), of the Universidad Tecnológica de Pereira (UTP), for November 2019.

Materials and methods

A cross-sectional study carried out on trainee specialists and teachers of the PMIC program. The information was obtained using a questionnaire that included sociodemographic aspects and the Maslach Burnout Inventory (MBI) questionnaire, for the diagnosis of the syndrome. These were sent institutional e-mail addresses to be completed between November 7 and 14. The STROBE strategy for observational studies was applied.

Results

The questionnaire was completed by 15 out of 21 (71%) trainees, and 2 out 4 (50%) teachers. The mean age was 33±4 years (range 28–45 years), and 76% were male. In the results of the MBI questionnaire, a high score was found in emotional exhaustion (76%, n=13) and depersonalisation (35%, n=6). Personal achievement (23%, n=4) had a low score. The alteration in the three scales was present in 18% (n=3), confirming a Burnout diagnosis. A significantly higher score (p<.05) was found on the depersonalisation and personal achievement scale among those who had children compared to those who did not. Likewise, there was a significant difference (p<.05) in the depersonalization scores between teachers and students, being greater in the teachers.

Discussion

Despite finding high percentages of emotional exhaustion and depersonalization, the prevalence of Burnout syndrome is low among trainees and teachers of the UTP's CMIC program, of November 2019.

Keywords:
Burnout professional
Emotional stress
Personal satisfaction
Job satisfaction
Critical care
Resumen
Objetivo

Determinar la prevalencia del síndrome de Burnout en residentes y docentes del programa de medicina crítica y cuidados intensivos (MCCI), de la Universidad Tecnológica de Pereira (UTP) en noviembre deln año 2019.

Materiales y métodos

Estudio de corte trasversal realizado con residentes y docentes de planta del programa. La información se obtuvo mediante una encuesta con aspectos sociodemográficos y el cuestionario Maslach Burnout Inventory (MBI), para diagnóstico del síndrome, la cual fue enviada a los correos electrónicos institucionales para completarse entre el 7 y el 14 de noviembre. Se aplicó la estrategia STROBE para estudios observacionales.

Resultados

De 21 residentes respondieron la encuesta 15 (71%) y de 4 docentes la respondieron 2 (50%). La edad promedio fue de 33±4 años (rango: 28-45 años), el 76% varones. En los resultados del cuestionario MBI, se encontró puntaje alto en cansancio emocional 76% (n=13) y en despersonalización 35% (n=6). En realización personal el 23% (n=4) tenía un puntaje bajo. La alteración en las 3 escalas se presentó en el 18% (n=3), configurando el diagnóstico de Burnout. Se encontró un puntaje significativamente mayor (p<0,05) en la escala de despersonalización y realización personal entre aquellos que tenían hijos comparados con los que no. Igualmente hubo diferencia significativa (p<0,05) en los puntajes de despersonalización entre docentes y estudiantes, siendo mayor en los primeros.

Discusión

Pese encontrar altos porcentajes de cansancio emocional y de despersonalización, la prevalencia del síndrome de Burnout es baja entre residentes y docentes del programa de MCCI de la UTP, durante noviembre del año 2019.

Palabras clave:
Síndrome de burnout
Estres emocional
Realización personal
Satisfacción labora
Cuidado intensivo
Texto completo
Introduction

Rationale: Burnout syndrome or professional burnout, is an emerging condition that has become a public health problem,1 the WHO considers it as an occupational disease which will appear with the QD85 code in the international statistical classification of diseases and related health problems ICD-11, approved last year and which will take effect from January 2022.2 Characterized by emotional stress, depersonalization and low personal achievement,3 it causes a serious impact on the quality of life of those who suffer from it, also affecting their environment, family, co-workers, and institutions, because those affected by this syndrome are susceptible to work absenteeism and low work performance; finally affecting the recipients of their service, who receive depersonalized treatment, characterized by coldness and indifference.4 The term Burnout was used for the first time in the medical literature by the German American psychoanalyst Herbert Freudenberger in 1974,5 to refer to the situation experienced by social service workers in the United States, who after months or a few years of dedication to the work they end up “burning”, by this he meant the feeling described by them of progressive lack of energy until exhaustion, lack of motivation for work, symptoms of anxiety, depression, and aggressiveness with the recipients of their services. During the rest of that decade and the beginning of the 80s, the American psychologists Cristina Maslach and Susan Jackson developed this concept until they delimited the three dimensions that characterize this syndrome: emotional exhaustion, depersonalization, reflected in a distant relationship with service recipients and lack of personal satisfaction.6 Initially described in workers of social services and health services, it was soon evident that it was not exclusive to these sectors, being experienced by educators, public servants, police, and, finally, any profession or trade that implies attention to the public.7 The 1986 Maslach questionnaire is the most widely used in the world; It is made up of 22 items in the form of statements about the professional's feelings and attitudes in their work and toward patients. Its function is to measure Burnout in the three aspects of the syndrome: emotional fatigue, depersonalization, and personal satisfaction, high scores in the first two subscales and low scores in the third allow diagnosing the syndrome.8 Recognized as an emerging public health problem, studies carried out in different countries of the world show that this syndrome transcends borders and cultures with a prevalence that ranges from 6 to 47%.9 The syndrome is very frequent in intensivists, in some studies, more than 45% of the respondents reported severe symptoms of Burnout.10,11 Studies carried out in the country report a variable prevalence; In Bogota, two studies place the prevalence of Burnout syndrome in general practitioners at 6.6%12 and specifically in intensivists at 3.2% for 2016.13 Currently, there are two postgraduate programs in intensive care in the region, despite which there are few data on the prevalence of Burnout syndrome in residents and teachers, so it was intended to determine the prevalence of the syndrome in the postgraduate intensive care program in Universidad Tecnológica de Pereira for 2019.

Objective: The objective was to determine the prevalence of Burnout syndrome in residents and teachers of the critical medicine and intensive care program (CMIC), of the Universidad Tecnológica de Pereira (UTP), for November 2019.

Materials and methods

The STROBE (Statement—checklist of items that should be included in reports of observational studies) 2007 applied.14

Study design, sertting and participants: We conduced a cross-sectional study on the prevalence of burnout syndrome in residents and teachers of the critical medicine and intensive care program at the Universidad Tecnológica de Pereira between November 7 and 14, 2019. The study population included residents enrolled in the intensive care program for the second period of 2019 and teachers of the program linked to a university employment contract. All eligible subjects were called via telephone and invited to participate in the study and the access link was sent to those who agreed to participate. Non-respondants were not asked for reasons to decline.

The questionnaire contained sociodemographic characteristics (age, sex, education level, children, dependents, hours of paid work per month) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Data was collected using an electronic form designed in Google Forms.

Variables: The MBI-HSS questionnaire is used worldwide to determine the presence of Burnout syndrome or job Burnout in health personnel and was validated in Colombia in 2011 by a study carried out in Cali.15 It is made up of 22 items in the form of statements about the feelings and attitudes of the professional in his work and toward patients and has a scale for each of the dimensions of the syndrome:

Tiredness or emotional exhaustion: it constitutes the first phase of the syndrome, characterized by an increasing disproportion between the work done and the tiredness experienced, at this stage, the person becomes more irritable, constantly complains about the amount of work done and loses the ability to enjoy tasks. This subscale consists of 9 questions, assesses the experience of being emotionally exhausted by the demands of work. The maximum score is 54 and corresponds to questions number 1, 2, 3, 6, 8, 13, 14, 16, and 20.

Depersonalization: it is the way of responding to the feeling of impotence, helplessness, and personal hopelessness, the affected person does not express these feelings or try to resolve them instead shows a hyperactive facade that increases their feeling of exhaustion. This subscale consists of 5 items and assesses the perception that everyone recognizes of attitudes of coldness and distance. Maximum score 30 and corresponds to questions number 5, 10, 11, 15, and 22.

Low personal satisfaction: it is the third phase of the process and consists of a progressive withdrawal of all the activities that are not work related to the activities that generated chronic stress, at this stage there is a loss of ideals and an increasing estrangement from the family, social and recreational activities.

Data sources: This subscale is made up of 8 items. Evaluate feelings of self-efficacy and personal satisfaction at work. Maximum score 48 and corresponds to questions number 4, 7, 9, 12, 17, 18, 19, and 21. Each of the questions is rated according to a frequency on a scale of 0 (never) to 6 (every day). The classification of the scores for each scale is shown in Table 1. A diagnosis of Burnout is made with high scores on the scales of emotional fatigue and depersonalization and low on the scale of personal achievement.

Table 1.

Characteristics and scores of the Maslach Burnout inventory in 17 intensive care physicians and intensive care residents and professionals from the city of Pereira, Risaralda during 2019. p values obtained using Mann–Whitney's U test.

Feature  TotalEmotional tirednessDepersonalizationPersonal satisfaction
  n  Mean+SD  p-Value  Mean+SD  p-Value  Mean+SD  p-Value 
Total  17  100  31±10    9±  39± 
Sex
Male  13  76  30±12  0.412  10±0.245  38±0.245 
Female  24  36±  5±  43± 
Age
≤30 years  41  28±12  0.315  7±0.536  43±0.193 
>30 years  10  59  34±  10±  37± 
Marital status
Single  47  36±  11±  37± 
Married  29  27±0.98  7±0.876  35±0.437 
Free union  18  26±12    7±  42± 
Divorced  39±  12±10    37±14   
Children
No  11  65  29±11  0.301  6±0.015  43±0.001 
Yes  35  36±  16±  32± 
Dependent people
No  10  59  29±12  0.536  8±0.417  41±0.109 
Yes  41  35±  11±  37± 
Remunerated job
No  47  35±0.277  9±0.743  42±0.277 
Yes  53  28±13    10±  37± 
Type
Teacher  12  41±0.132  22±0.015  33±0.132 
Resident  15  88  30±10    8±  40± 
First-year  24  20±12    3±  44± 
Second-year  18  35±  11±  41± 
Third-year  29  34±  8±  41± 
Fourth-year  18  30±12    7±  37±10   

Given that the questionnaire to be applied contains some questions that deal with issues relevant to people's quality of life, an informed consent form had to be completed before obtaining the information, and then the data was collected with anonymous questionnaires to guarantee absolute reserve.

Statistical methods: The data was analyzed using Epi info 7.0 for Windows. Descriptive statistics were obtained using frequencies and percentages for categorical variables, as well as measures of central tendency for continuous variables. The means of the scores of each subscale were compared using Mann–Whitney's U. A p<0.05 was considered significant.

Results

Out of a total of 24 teaching physicians and residents of the intensive care program of the Universidad Tecnológica de Pereira, the survey answered a total of 17 people (71%); 15 intensive care residents and two teachers and intensivists. The average age was 33±4 years (range 28–45 years) and 76% were men. More than half (53%, n=9) performed paid work, with an average of 132±94hours per month. The characteristics of the respondents are shown in Table 1.

Burnout scale

The average score of the emotional fatigue scale was 31±10 points, for the depersonalization scale 9±8 points and for performance, it was 39±7 points. The comparison of the scores obtained according to the characteristics of the participants is shown in Table 2. A significantly higher score (p<0.05) was found on the depersonalization and personal satisfaction scale among those who had children compared to those who did not. Likewise, depersonalization scores were higher in teachers than in students (p<0.05).

Table 2.

Average scores of the Burnout scales of the Maslach inventory according to the characteristics of the subject in 17 intensive care physicians and intensive care residents of the city of Pereira, Risaralda during 2019. p values obtained using Mann–Whitney's U test.

Feature  Emotional tirednessDepersonalizationPersonal satisfaction
  Mean±standard deviation  p-Value  Mean±standard deviation  p-Value  Mean±standard deviation  p-Value 
Total  31±10    9±  39± 
Sex
Male  30±12  0.412  10±0.245  38±0.245 
Female  36±  5±  43± 
Age
≤30 years  28±12  0.315  7±0.536  43±0.193 
>30 years  34±  10±  37± 
Marital status
Married  36±0.980  11±0.876  37±0.437 
Divorced  27±  7±  35± 
Single  26±12    7±  42± 
Free union  39±  12±10    37±14   
Children
No  29±11  0.301  6±0.015  43±0.001 
Yes  36±  16±  32± 
Has dependent people
No  29±12  0.536  8±0.417  41±0.109 
Yes  35±  11±  37± 
Remunerated job
No  35±0.277  9±0.743  42±0.277 
Yes  28±13    10±  37± 
Type
Teacher  41±0.132  22±0.015  33±0.132 
Resident  30±10    8±  40± 
First-year  20±12    3±  44± 
Second-year  35±  11±  41± 
Third-year  34±  8±  41± 
Fourth-year  30±12    7±  37±10   

When classifying each of the scales, a high emotional fatigue score was found in 76% (n=13) of the participants, 35% (n=6) had for depersonalization and 23% (n=4) had a low achievement score. None of the scales was altered in 23% of the participants (n=4), one in 35% (n=6), two in 23% (n=4) and the three scales were altered indicating Burnout in 18% (n=3). The classification of the scores by sex is shown in Fig. 1 and the classification of the scores according to the characteristics of the participants is shown in Table 3.

Figure 1.

Classification of the scales of the Maslach Burnout questionnaire in 17 intensive care physicians and intensive care residents of the city of Pereira, Risaralda during 2019. Elaborated with Microsoft Excel 360.

(0,08MB).
Table 3.

Classification of the Burnout scales of the Maslach inventory according to the characteristics of the subject in 17 intensive care physicians and intensive care residents of the city of Pereira, Risaralda during 2019.

Feature  Emotional tirednessDepersonalizationPersonal satisfaction
  LowMediumHighLowMediumHighLowMediumHigh
  n  n  n  n  n  n  n  n  n 
Sex
Male  12  12  53  24  24  29  24  12  41 
Female  24  12  18 
Age
≤30 years  12  24  18  12  12  35 
>30 years  53  18  18  24  24  12  24 
Marital status
Single  29  12  12  12  12 
Married 
Free union  12  12  24  24  12  12  35 
Divorced  18  12  12 
Children
No  12  12  41  35  18  12  12  53 
Yes  35  12  24  24 
Has dependent people
No  12  12  35  24  18  18  12  41 
Yes  41  12  12  18  18  18 
Remunerated job
No  41  18  12  18  12  35 
Yes  12  35  18  18  18  24  24 
Type
Teacher  12  12  12 
Resident  12  12  11  65  35  29  24  12  18  10  59 
First-year  12  18 
Second-year  24  12  18 
Third-year  12  12 
Fourth-year  24  12  12  12  12 
Discussion

The intensive care residents and teachers surveyed in our study showed emotional fatigue as the most frequent trait of burnout, whereas despersonalization low achievement were least common. Intensive care unit workers are used to high workload and perceive it as a expectable part of their work.

Our study included a narrow sample of both residents and professionals from one university. Thus, results are could not be generalizable to other ICU workers or healthcare workers. Also, it was not possible to make comparison or statistical tests to determine factors related to burnout. The results are valuable as a baseline for further studies.

According to a meta-analysis published in 2016, the prevalence of Burnout in ICU professionals in the included studies ranged from 6% to 47%,9 in this study, it was reported that the following factors were associated with Burnout: age, sex, marital status, personality traits, ICU experience, work environment, workload and shift work, ethical issues, and taking of decisions at the end of life. This review presents important information that suggests that ICU professionals may suffer from a high level of Burnout, potentially threatening ICU patient care.

In Colombia in September 2016, the results of a study on professional exhaustion in intensivists, a case-control study, were published through an electronic survey on the website of the Colombian association of critical medicine and intensive care AMCI,16 which by 2015 had 750 registered specialists, 154 (20.5%), completed the instrument designed for the research that consisted of four parts, socioeconomic, academic, health history survey and the Maslach Burnout Inventory Human Services Survey (MBI – HSS), finding a Burnout prevalence of 3.2% and identifying the following risk factors: male sex, ICU teacher, ideal/real wages ratio, night shifts, noise, location in the Andean region, mistreatment by companions and transportation by car. In conclusion, it points out that the ICU is a place prone to inequality and inequity, stating that it is necessary to further investigate Burnout and question national policies on human resources in health and hospital development.

In Pereira, an investigation was carried out in 2006 in medical teaching specialists from the Universidad Tecnológica de Pereira (UTP) on the prevalence and factors associated with the development of Burnout syndrome,17 which included internists and subspecialists in this area, psychiatrists, radiologists and general and subspecialized surgeons, all of the teachers at the UTP, which resulted in a prevalence of Burnout syndrome of 45.4%, with emotional exhaustion being the most frequent symptom in respondents with 75.7%, depersonalization in a lesser proportion with 60.6% and the least frequent was the lack of personal satisfaction with 12.%, finding a direct relationship of Burnout with symptoms such as number of patients attended, number of surgical procedures, years of experience, lower remuneration, being single and the presence of a non-stable relationship.

In this research, it was evidenced that the postgraduate course in critical medicine and intensive care is mostly carried out by men (76%), that there was high participation in the study by residents (71%) and that 53% of those surveyed carried out Paid work independent of your academic responsibilities. Regarding the Burnout scales assessed by MBI HSS, a high score was found in emotional fatigue in 76% (n=13) of the participants, it is noteworthy that 100% of women (n=4) have high emotional fatigue. 35% (n=6) for depersonalization. 23% (n=4) of the participants had a low achievement score. The teachers who participated in the survey (n=2), presented high scores in emotional exhaustion and depersonalization, in addition to having low levels of personal achievement. A significantly higher score (p<0.05) was found on the depersonalization and personal fulfillment scale among those who had children compared to those who did not. Likewise, there was a significant difference (p<0.05) in the depersonalization scores between teachers and students, being greater in the former.

Finally, the prevalence of Burnout among teachers and residents found was 18% (n=3). The UTP Intensive care postgraduate program students and teachers had high scores for emotional exhaustion and depersonalization but seemed satisfied with their achievement. Intensive care professionals are used to long working hours and high workloads, as they enjoy the profession they have chosen.

Limitations: given that such a specific population was studied, the number of participants is small, which does not allow significant differences to be observed in various aspects.

Authors’ contribution

Study concept and design:. Acquisition of data: ARP, JAEC, DREP. Analysis and interpretation of data: ARP,JAEC,PAM. Drafting of the manuscript: ARP,JAEC. Critical revision of the manuscript for important intellectual content: ARP,JAEC, DREP. Statistical analysis: PAM. Administrative, technical, and material support: All authors. Study supervision: DREP. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding

The authors declare that no external funding was received for the conduct of this study.

Conflicts of interest

No conflicts of interest for all authors.

References
[1]
Y. Molina, F. Vargas, M. Calle.
Prevenir el Burnout como problema de salud pública.
Repositorio Universidad CES de Medellín, (2015), pp. 1-37
[2]
P.A.G. Stavroula Leka, T. Cox.
La O.M.S. reconoce como enfermedad el burnout o “síndrome de estar quemado”. Organización médica colegial de España.
(2019),
[3]
V. Olivares Faúndez.
Laudatio: Dra. Christina Maslach, Comprendiendo el Burnout.
Ciencia & Trabajo, 19 (2017), pp. 59-63
[4]
O. Segura.
Agotamiento profesional: concepciones e implicaciones en la salud pública.
Biomédica, 34 (2014), pp. 535-545
[5]
H.J. Freudenberger.
Staff burn-out.
J Soc Issues, 30 (1974), pp. 159-165
[6]
C. Maslach.
Burnout: a social psychosomatic analysis.
Meeting of American Psychological Association, San Francisco, (1977),
[7]
C. Maslach, S.E. Jackson.
MBI: Maslach Burnout Inventory Manual.
Consulting Psychologists Press, (1981),
[8]
C. Maslach, S.E. Jackson, M.P. Leiter, W.B. Schaufeli, R.L. Schwab.
Maslach burnout inventory. 1986, 21 (1986), pp. 3463-3464
[9]
C.H. Chuang, P.C. Tseng, C.Y. Lin, K.H. Lin, Y.Y. Chen.
Burnout in the intensive care unit professionals: a systematic review.
Medicine (Baltimore), 95 (2016),
[10]
N. Embriaco, E. Azoulay, K. Barrau, N. Kentish, F. Pochard, A. Loundou, et al.
High level of burnout in intensivists: prevalence and associated factors.
Am J Respir Crit Care Med, 175 (2007), pp. 686-692
[11]
M. Moss, V.S. Good, D. Gozal, R. Kleinpell, C.N. Sessler.
A Critical Care Societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action.
Am J Respir Crit Care Med, 194 (2016), pp. 106-113
[12]
A.M.A. Roldán, A.M.Q. Barriga.
Síndrome por quemarse en el trabajo y variables familiares y laborales de los médicos generales de Bogotá. Una estrategia de calidad laboral.
Revista Colombiana de Psiquiatría, 44 (2015), pp. 198-205
[13]
O. Segura, M.G. Duque, C. Enciso, O.C. Porras.
Agotamiento profesional (burnout) en médicos intensivistas: una visión de la unidad de cuidados intensivos desde la teoría fundamentada.
Acta Colombiana de Cuidado Intensivo, 16 (2016), pp. 126-135
[14]
STROBE (Statement—checklist of items that should be included in reports of observational studies) 2007. https://www.strobe-statement.org/index.php?id=available-checklists.
[15]
L. Córdoba, J.A. Tamayo, M.A. González, M.I. Martínez, A. Rosales, S.H. Barbato.
Adaptation and validation of the Maslach Burnout inventory-human services survey in Cali, Colombia.
Colombia Méd, 42 (2011), pp. 286-293
[16]
O. Segura, C. Enciso, M.G. Duque, O.C. Porras.
Agotamiento profesional en médicos intensivistas colombianos: un estudio caso-control.
Acta Colombiana de Cuidado Intensivo, 17 (2017), pp. 4-13
[17]
J.C. Gutiérrez, J.J.P. Saravia, J.Z.M. Muñoz, D.M.O. Vélez, C.M.C. González, Y.K.G. Hincapié.
Prevalencia y factores asociados a “burnout” en médicos especialistas docentes de la Universidad Tecnológica de Pereira. 2006.
Revista Médica de Risaralda, 14 (2008), pp. 3
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