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Burned Out or Bummed Out
LETTER TO THE EDITOR J Oral Maxillofac Surg -:1, 2017
BURNED OUT OR BUMMED OUT
incidence of burnout among oral and maxillofacial surgery or other residents is not yet well established. In other words, will the well-rested resident be more resilient and less susceptible to being shamed while on duty, and will this resilience make it less likely that burnout will occur? Or, does one’s personality or self-image, regardless of how much one slept the night before, determine one’s susceptibility to shaming? Many of today’s residents have lifestyle goals that might be unrealistic or at odds with the demands of surgical residency training. Perhaps a better method of evaluation of applicants before admission to a training program might help to improve this situation. Our military uses an extensive physical and psychological evaluation process in the selection of candidates for submarine, ‘‘top gun’’ aviation, Navy SEAL, Army Ranger, and other programs of training that are highly demanding and stressful. Those responsible for the selection and training of resident surgeons should do no less to protect these young men and women from burnout or career dissatisfaction and protect their patients from unsatisfactory surgical care.
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To the Editor:—The recent article by Rosenbluth et al regarding ‘‘burnout’’ among surgical residents caused me to harken back to the days, over 40 years ago, when I was an overworked, sleep-deprived general surgery resident in a major university medical center hospital. We worked hard (up to 120 hours/week); cared for many seriously ill or injured patients; slept ‘‘fast’’ when off duty; strived to maintain relationships with spouses, children, or significant others; and most of all, strained to keep an even keel and a normal perspective on life, despite our chattel-like lifestyle. We followed the teachings of our mentors and endured their constant questioning or ‘‘pimping’’2 (we never considered it shaming; we usually realized that we should be better prepared) mostly with good humor or acceptance as part of our lot. We considered surgery a calling, requiring total dedication when one was on duty. Burnout, which is not recognized by the Diagnostic and Statistical Manual of Mental Disorders, is characterized as consisting of emotional exhaustion, depersonalization, and reduced accomplishment.3 Residents, particularly female residents, may be ‘‘uniquely vulnerable .after being repeatedly shamed by an attending or more senior resident [italics added].’’4 The act of being shamed by a superior may be more in the mind of the person enduring this reaction than in the reality of the situation. Having as well as maintaining a positive self-image in the presence of adversity or stress is an important characteristic of a successful surgeon. Residents are there to learn; most attendings and senior residents take this responsibility seriously. However, the trainee must want to learn, and he or she might require a certain amount of encouragement, cajoling, or even a ‘‘kick in the pants’’ at times to accomplish this. When done in front of one’s peers, such action, although embarrassing to some, often serves as a wake-up call to a resident with a healthy attitude toward hard work. Whether the decreased duty hours for resident physicians mandated in 2011 by the American Council for Graduate Medical Education will result in more sleep and reduce the
ROGER A. MEYER, DDS, MS, MD Greensboro, Georgia
References 1. Rosenbluth SC, Freymiller EG, Hemphill R, et al: Resident wellbeing and patient safety: Recognizing the signs and symptoms of burnout. J Oral Maxillofac Surg 75:657, 2017 2. Carlson ER: Medical pimping versus the Socratic method of teaching. J Oral Maxillofac Surg 75:3, 2017 3. Maslach M: Maslach Burnout Inventory Manual (ed 3). Palo Alto, CA, Consulting Psychologists Press, 1996 4. Shapiro MC, Rao SR, Dean J, et al: What a shame: Increased rates of OMS resident burnout may be related to the frequency of shared events during training. J Oral Maxillofac Surg 75:449, 2017
http://dx.doi.org/10.1016/j.joms.2017.04.047
1
BURNED OUT OR BUMMED OUT
incidence of burnout among oral and maxillofacial surgery or other residents is not yet well established. In other words, will the well-rested resident be more resilient and less susceptible to being shamed while on duty, and will this resilience make it less likely that burnout will occur? Or, does one’s personality or self-image, regardless of how much one slept the night before, determine one’s susceptibility to shaming? Many of today’s residents have lifestyle goals that might be unrealistic or at odds with the demands of surgical residency training. Perhaps a better method of evaluation of applicants before admission to a training program might help to improve this situation. Our military uses an extensive physical and psychological evaluation process in the selection of candidates for submarine, ‘‘top gun’’ aviation, Navy SEAL, Army Ranger, and other programs of training that are highly demanding and stressful. Those responsible for the selection and training of resident surgeons should do no less to protect these young men and women from burnout or career dissatisfaction and protect their patients from unsatisfactory surgical care.
1
To the Editor:—The recent article by Rosenbluth et al regarding ‘‘burnout’’ among surgical residents caused me to harken back to the days, over 40 years ago, when I was an overworked, sleep-deprived general surgery resident in a major university medical center hospital. We worked hard (up to 120 hours/week); cared for many seriously ill or injured patients; slept ‘‘fast’’ when off duty; strived to maintain relationships with spouses, children, or significant others; and most of all, strained to keep an even keel and a normal perspective on life, despite our chattel-like lifestyle. We followed the teachings of our mentors and endured their constant questioning or ‘‘pimping’’2 (we never considered it shaming; we usually realized that we should be better prepared) mostly with good humor or acceptance as part of our lot. We considered surgery a calling, requiring total dedication when one was on duty. Burnout, which is not recognized by the Diagnostic and Statistical Manual of Mental Disorders, is characterized as consisting of emotional exhaustion, depersonalization, and reduced accomplishment.3 Residents, particularly female residents, may be ‘‘uniquely vulnerable .after being repeatedly shamed by an attending or more senior resident [italics added].’’4 The act of being shamed by a superior may be more in the mind of the person enduring this reaction than in the reality of the situation. Having as well as maintaining a positive self-image in the presence of adversity or stress is an important characteristic of a successful surgeon. Residents are there to learn; most attendings and senior residents take this responsibility seriously. However, the trainee must want to learn, and he or she might require a certain amount of encouragement, cajoling, or even a ‘‘kick in the pants’’ at times to accomplish this. When done in front of one’s peers, such action, although embarrassing to some, often serves as a wake-up call to a resident with a healthy attitude toward hard work. Whether the decreased duty hours for resident physicians mandated in 2011 by the American Council for Graduate Medical Education will result in more sleep and reduce the
ROGER A. MEYER, DDS, MS, MD Greensboro, Georgia
References 1. Rosenbluth SC, Freymiller EG, Hemphill R, et al: Resident wellbeing and patient safety: Recognizing the signs and symptoms of burnout. J Oral Maxillofac Surg 75:657, 2017 2. Carlson ER: Medical pimping versus the Socratic method of teaching. J Oral Maxillofac Surg 75:3, 2017 3. Maslach M: Maslach Burnout Inventory Manual (ed 3). Palo Alto, CA, Consulting Psychologists Press, 1996 4. Shapiro MC, Rao SR, Dean J, et al: What a shame: Increased rates of OMS resident burnout may be related to the frequency of shared events during training. J Oral Maxillofac Surg 75:449, 2017
http://dx.doi.org/10.1016/j.joms.2017.04.047
1