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2021 Jan-Mar;9 (1): E189-E200.

Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression.

Leen Naji, Brendan Singh, Ajay Shah, Faysal Naji, Brittany Dennis, Owen Kavanagh, Laura Banfield, Akram Alyass, Fahad Razak, Zainab Samaan, Jason Profetto, Lehana Thabane, Zahra N Sohani
Author Information
  1. Leen Naji: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que. zahra.sohani@mail.mcgill.ca leen.naji@medportal.ca.
  2. Brendan Singh: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  3. Ajay Shah: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  4. Faysal Naji: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  5. Brittany Dennis: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  6. Owen Kavanagh: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  7. Laura Banfield: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  8. Akram Alyass: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  9. Fahad Razak: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  10. Zainab Samaan: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  11. Jason Profetto: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  12. Lehana Thabane: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
  13. Zahra N Sohani: Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que. zahra.sohani@mail.mcgill.ca leen.naji@medportal.ca.
PMID: 33688027 DOI: 10.9778/cmajo.20200068

Abstract

BACKGROUND: Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice.
METHODS: We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses.
RESULTS: In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar.
INTERPRETATION: Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout.
STUDY REGISTRATION: PROSPERO no. CRD42018108774.

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MeSH Term

Africa
Asia
Australia
Burnout, Professional
Europe
Humans
Internship and Residency
Job Satisfaction
Middle East
North America
Personnel Staffing and Scheduling
Prevalence
Protective Factors
Risk Factors
South America
Journal Article Meta-Analysis Systematic Review
Article has an altmetric score of 10

Word Cloud

Created with Highcharts 10.0.0burnoutPMTsprevalenceamongmedicalBurnoutfactorstrainingstudiespostgraduateidentifyvariedcountryyearstudyspecialtyobjectivesecondarymeta-analysismeta-regressionpooledpublished47countriesBACKGROUND:traineesincreasinglyrecognizedcrisisprofessionaimedestablishriskprotectiveassesswhetherpracticeMETHODS:systematicallysearchedMEDLINEEmbasePsycINFOCochraneDatabaseSystematicReviewsWebScienceEducationResourcesInformationCenterinceptionAug212018primaryglobalevaluateassociationsociodemographiccommonlythoughtrelatedemployedrandom-effectstechniquesestimateconductanalysesRESULTS:total8505screened196meteligibility114included3%95%confidenceinterval431%515%based20yearsinvolving31210remainedunchangedpast2decadesregionEuropeanexperiencinglowestlevelratessurgicalsimilarINTERPRETATION:CurrentwellnesseffortspolicieschangedworldwideFutureresearchfocusunderstandingsystemicleveragingfindingsdesigninterventionscombatSTUDYREGISTRATION:PROSPEROCRD42018108774Globaltrainees:systematicreview

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