Burnout and association with resident performance as assessed by Pediatric Milestones: An exploratory study

Acad Pediatr. 2020 Aug 11;S1876-2859(20)30479-4. doi: 10.1016/j.acap.2020.08.006. Online ahead of print.

Abstract

Introduction: Prior work demonstrating that burnout is associated with decreased performance in medical trainees has relied on self-report and/or single site studies. We explored the relationship between burnout status and Milestones-based scores in pediatric residents nationally.

Methods: In April-June 2016 we confidentially surveyed residents using the Maslach Burnout Inventory (MBI). Separately, programs submitted resident Milestones scores in June 2016. We examined the relationship between burnout and performance as assessed by Milestones scores for each domain of competence. We performed multivariate analysis to determine which components of burnout (depersonalization (DP), emotional exhaustion (EE), lack of personal accomplishment (PA)) were most impactful.

Results: 1494/2368 (63%) residents at 32 programs completed the MBI and had Milestones scores submitted. Residents who scored positive for burnout scored lower in all Milestones domains. Sub-group analysis demonstrated that this association was only significant (p<0.05) in the Post-Graduate Year 1 (PGY1) categorical pediatric cohort. In the PGY1 residents (n=442), those positive for burnout had lower Milestones scores in patient care (PC) (2.78 vs. 2.98), systems based practice (2.69 vs. 2.87), problem based learning and improvement (2.77 vs. 2.93), professionalism (3.09 vs.3.24), and interpersonal and communication skills (2.95 vs. 3.12), but not medical knowledge. Multivariate analysis demonstrated that, in PGY1 residents, lower PC score was associated with lower PA and higher DP.

Conclusion: Burnout is associated with decreased Milestones performance for pediatric PGY1 residents. DP and low PA were associated with lower PC scores in PGY1 residents. Future research should address whether strategies to mitigate burnout improve PGY1 performance.

Keywords: Burnout; Medical Education; Milestones; Pediatric; Performance; Resident.