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

backgroundBurnout 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 burnout remains a serious problem. Therefore, we analyzed Japanese residents' burnout, training conditions, and associated factors, especially stress coping ability, which could become an evidence base for creating guidelines of programs and working environments.

methodsIn 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' burnout 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.

resultsOverall, 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 h per week, were judged as having burnout, among whom, 33 (53.2%) and 15 (42.9%) had burnout 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 burnout. 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.

conclusionAbout half of the Japanese residents were judged as having burnout as early as the third month of training under regulations of working 40 h per week. Individual stress coping ability and working hours were found to be significant factors for burnout. 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.