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Original Investigation
August 2018

Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training

Author Affiliations
  • 1Department of Surgery, University of North Carolina at Chapel Hill
  • 2Department of Biostatistics, University of North Carolina at Chapel Hill
  • 3Department of Surgery, East Carolina Brody School of Medicine, Greenville, North Carolina
  • 4Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
  • 5Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
  • 6Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  • 7Department of Psychiatry, University of North Carolina at Chapel Hill
JAMA Surg. 2018;153(8):705-711. doi:10.1001/jamasurg.2018.0974
Key Points

Questions  What is the prevalence of burnout and depression among general surgery trainees in North Carolina, and do residents’ and attendings’ perceptions of these conditions differ?

Findings  In this cross-sectional survey of 92 general residents and 55 attendings, the prevalence of burnout and risk of depression among general surgery residents were high (58 of 77 [75%] and 30 of 76 [39%], respectively). Residents and faculty members significantly underestimated the prevalence of burnout and depression but identified the same barriers to seeking treatment.

Meaning  Discrepancies exist in actual and perceived levels of burnout and depression among residents and attendings, but a common understanding of barriers to care provides an opportunity for the development of practical interventions.


Importance  Prior studies demonstrate a high prevalence of burnout and depression among surgeons. Limited data exist regarding how these conditions are perceived by the surgical community.

Objectives  To measure prevalence of burnout and depression among general surgery trainees and to characterize how residents and attendings perceive these conditions.

Design, Setting, and Participants  This cross-sectional study used unique, anonymous surveys for residents and attendings that were administered via a web-based platform from November 1, 2016, through March 31, 2017. All residents and attendings in the 6 general surgery training programs in North Carolina were invited to participate.

Main Outcomes and Measures  The prevalence of burnout and depression among residents was assessed using validated tools. Burnout was defined by high emotional exhaustion or depersonalization on the Maslach Burnout Inventory. Depression was defined by a score of 10 or greater on the Patient Health Questionnaire–9. Linear and logistic regression models were used to assess predictive factors for burnout and depression. Residents’ and attendings’ perceptions of these conditions were analyzed for significant similarities and differences.

Results  In this study, a total of 92 residents and 55 attendings responded. Fifty-eight of 77 residents with complete responses (75%) met criteria for burnout, and 30 of 76 (39%) met criteria for depression. Of those with burnout, 28 of 58 (48%) were at elevated risk of depression (P = .03). Nine of 77 residents (12%) had suicidal ideation in the past 2 weeks. Most residents (40 of 76 [53%]) correctly estimated that more than 50% of residents had burnout, whereas only 13 of 56 attendings (23%) correctly estimated this prevalence (P < .001). Forty-two of 83 residents (51%) and 42 of 56 attendings (75%) underestimated the true prevalence of depression (P = .002). Sixty-six of 73 residents (90%) and 40 of 51 attendings (78%) identified the same top 3 barriers to seeking care for burnout: inability to take time off to seek treatment, avoidance or denial of the problem, and negative stigma toward those seeking care.

Conclusions and Relevance  The prevalence of burnout and depression was high among general surgery residents in this study. Attendings and residents underestimated the prevalence of these conditions but acknowledged common barriers to seeking care. Discrepancies in actual and perceived levels of burnout and depression may hinder wellness interventions. Increasing understanding of these perceptions offers an opportunity to develop practical solutions.

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