PS4 - 07: SHAMING AND BURNOUT IN US GENERAL SURGERY RESIDENTS
Patrick K McGillen, MS1, Joshua Davies, MD2, Myriam Castagne, MD2, Peter J DiPasco, MD, FACS3, Tracey Dechert, MD2, Sabrina E Sanchez, MD, MPH2, Tejal S Brahambatt, MD2; 1Boston University School of Medicine, 2Boston Medical Center, 3University of Kansas Medical Center
Background: Surgical residents have been found to be particularly susceptible to experiencing professional burnout. Anecdotally, many surgical residents also report feelings of shame associated with their training, including feelings of inferiority, humiliation, and self-consciousness. We hypothesized that surgical residents experience high levels of shame during surgical training and that this is associated with resident burnout.
Methods: After approval from the Association of Program Directors in Surgery (APDS), program directors from all U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited general surgery programs were asked to distribute an anonymous online survey to their categorical general surgery residents. The survey included the Maslach Burnout Inventory (MBI), the Experience of Shame Scale (ESS) and questions about demographic, social, and training program characteristics. Univariate linear and logistic regression were used to describe the relationship between various resident and training-program characteristics and an individual’s experience of shame and burnout, respectively. Multivariate logistic regression was utilized to test the association between shame and burnout controlling for individual and program characteristics.
Results: A total of 371 categorical general surgery residents responded to the survey. Mean ESS score was 53.18 (SD=14.6). 258 respondents (69.5%) met the criterion for burnout. Training at a single residency program (p=0.02), identifying as non-heterosexual (p=0.02), and lacking a strong emotional support system (p=0.01) were independently associated with burnout. Identifying as not male (p=0.0003) or non-heterosexual (p=0.006), lacking a strong emotional support system (p=0.02), living alone (p=0.008), being childless (p=0.02), and training at a single program (p=0.004) were independently associated with a higher experience of shame. After controlling for all of these variables, a higher ESS score, signifying a higher experience of shame, was found to independently predict burnout (p < 0.0001).
Conclusions: High levels of shame in categorical general surgery residents contribute to higher rates of burnout. Reducing the burden of shame in high-risk subpopulations of general surgery residents through targeted interventions merits further investigation as a way to reduce burnout. Similarly, mitigation of shame experiences as a way to enhance retention and ensure continued diversity in general surgery programs warrants further study.