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Quality & safety in the literature: May 2019
  1. Nathan Houchens1,2,
  2. Ashwin Gupta1,2,
  3. Jennifer Meddings1,2,3
  1. 1 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Nathan Houchens, Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; nathanho{at}

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Key points

  • In a systematic review exploring burnout in practicing physicians, marked variability in study quality and definitions of and methods used to assess burnout precluded the ability to accurately determine the prevalence of this condition. A consensus definition of burnout and uniform methods to assess it are needed. JAMA. 18 Sept 2018

  • A meta-analysis identified that physician burnout is associated with twofold increased odds of unsafe care, unprofessional behaviours and lower patient satisfaction. This results in inefficient and costly care delivery for healthcare systems. JAMA Internal Medicine. 1 Oct 2018

  • In a pilot randomised clinical trial, integration of formal stress resilience and mindfulness training into surgical residency appeared feasible and acceptable to surgical interns. Mindfulness skills appeared to be lasting, as evidenced by continued independent practice over 12 months of follow-up. JAMA Surgery. 17 Oct 2018


Burnout, a term first coined in 1974 used to describe ‘the state of mental and physical exhaustion caused by one’s profession’,1 has more recently been characterised by Maslach and Jackson as a construct consisting of emotional exhaustion, depersonalisation, and reduced personal accomplishment.2 Maslach is well known in this field, particularly because of the self-named Maslach Burnout Inventory (MBI), a well-validated tool which many consider to be the gold standard for measuring burnout in medical professionals.2 Emotional exhaustion is used to describe a state of somatic symptoms, compassion fatigue, and diminished emotional reserve. Depersonalisation denotes negative, cynical attitudes and impersonal feelings towards customers. Reduced personal accomplishment indicates feelings of incompetence, inefficiency, and inadequacy.3

Burnout arises from high levels and protracted periods of stress. While this condition was originally used to describe those working in human services,1 it has also been used for individuals experiencing any repeatedly stressful stimuli. Healthcare providers are particularly prone to burnout, as they routinely …

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  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.