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Cited by 36Healthcare professionals’ stress and burnoutCOVID-19 and Mental HealthDiversity and Career in Medicine

Burnout among neurology residents during the COVID-19 pandemic: a national cross-sectional study

Open access
Turalde, Christian Wilson R., Espiritu, Adrian I., Macinas, Ian Daniel N., Jamora, Roland Dominic G.·2022·Neurological Sciences
DOI 10.1007/s10072-021-05675-4PMC PMC8630990
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Abstract

Background Neurology residents are particularly vulnerable to burnout because of the novel logistical and clinical challenges brought about by the coronavirus disease 2019 (COVID-19) pandemic. Despite its implications, knowledge on burnout and its predictors among neurology residents is lacking. This study aimed to determine the prevalence of burnout among neurology residents during the pandemic, to compare burnout subscale scores and sociodemographic and work characteristics, and to explore residents' perceptions on how to address burnout. Methods We conducted a cross-sectional survey among all 120 residents from the nine institutions in the Philippines offering neurology residency programs from March to August 2020. We obtained sociodemographic and work characteristics using questionnaire. We measured burnout using the Maslach Burnout Inventory. We performed an inductive thematic analysis to analyze perceptions on how to reduce burnout. Results The response rate was 71.67% (86/120). The mean age was 30.1 ± 3.1 years. Using predefined subscale critical boundaries, the prevalence of burnout was 94% (95% CI 89, 99). The lack of compensation and number of on-duty days influenced emotional exhaustion scores. The number of on-duty days influenced depersonalization scores. Thematic analysis revealed five themes: increasing manpower; self-care; reducing clerical tasks; improving work environment; and adequate compensation. Conclusions The prevalence of burnout among neurology residents during the COVID-19 pandemic was alarmingly high. Reforms in hiring policies, work-hour management, manpower organization, work environment, and logistics may be considered.

Integrity signals

Registry

Crossref · 10.1007/s10072-021-05675-4

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 25 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Interpretationreasoning

    The 94% prevalence estimate may overstate burnout because the study used a sensitive definition requiring only one subscale to reach its critical boundary.

    “This may be an overestimation for the reason that the authors utilized a sensitive approach in defining burnout—at least one alteration reaching the critical boundary in any of the three subscales [5, 16].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [5] Rotenstein LS, Torre M, Ramos MA et al (2018) Prevalence of burnout among physicians: a systematic review. J Am Med Assoc 320:1131–1150. https://doi.org/10.1001/jama.2018.12777 source

      The Qualitative Synthesis reports that permissive definitions requiring a cutoff on either emotional exhaustion or depersonalization produced higher prevalence estimates than definitions requiring all three subscales to meet cutoffs. The Discussion also cautions that some cutoffs may capture symptoms rather than clinically meaningful burnout. The paper does not evaluate the citing study’s 94% estimate or establish that its rule was a cutoff on any one of all three subscales. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [16] Doulougeri K, Georganta K, Montgomery A, Lee A (2016) “Diagnosing” burnout among healthcare professionals: can we find consensus? Cogent Med 3:1. https://doi.org/10.1080/2331205X.2016.1237605 source
  • Premisecitation

    Neurology residents who received off days were those who had worked in critical COVID-19 areas.

    “Neurology residents who were given off days were those who rendered services in critical COVID-19 areas [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Geronimo KC, Maylem GL, Anlacan VM, Sta. Maria MA, Jamora RD (2021) Impact and challenges to the neurology residency training in The Medical City during the COVID-19 pandemic. Acta Med Philipp. https://doi.org/10.47895/amp.vi0.2299 source

      The Abstract (page unavailable) describes active-duty periods followed by mandatory quarantine, and Challenges Adaptations (page unavailable) says residents were assigned to both COVID and non-COVID posts. The paper does not say that off days were given specifically to residents who worked in critical COVID-19 areas. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The difference in prevalence between settings is expected because burnout varies across economies, geographic regions, cultures, and ethnic groups.

    “This disparity was expected given that the burnout experience is understood to be significantly varied across different economies, geographical regions [19], culture, and ethnicity [20].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [19] Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L (2013) Correlates of physician burnout across regions and specialties: a meta-analysis. Hum Resour Health 11:48 source

      The Group differences section (page not provided) reports significant differences between the Americas and Europe in how burnout correlates with several factors, supporting geographic variation. But the paper compares associations, not burnout prevalence, and does not establish that economic differences explain a prevalence disparity. In the citing sentence, culture and ethnicity are attached to a separate citation [20]. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [20] Buck K, Williamson M, Ogbeide S, Norberg B (2019) Family physician burnout and resilience: a cross-sectional analysis. Fam Med 51:657–663. https://doi.org/10.22454/FamMed.2019.424025 source

      The paper describes burnout as particularly high in the Texas–Mexico border region and notes that working in underresourced areas may impose burdens that do not generalize to other areas (Introduction and Limitations; page unavailable). This lends some support to geographic variation, but the paper does not establish differences in burnout prevalence across economies or geographic regions. The citing sentence attaches a separate citation to culture and ethnicity. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Findingown data

    No other comparisons between burnout subscale scores and personal or practice characteristics reached statistical significance.

    “The rest of the comparisons between burnout subscale scores and personal and practice characteristics showed no significant difference.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Thematic analysis identified adequate compensation as a theme for reducing burnout.

    “Some participants highlighted the need for adequate and timely compensation, security of employment with compensation, adequate supplies and equipment, and improved privileges to combat burnout.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 11

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Healthcare workers directly involved in COVID-19 patient care had significantly higher rates of depression, anxiety, insomnia, stress, and burnout.

    “Recent cross-sectional studies involving nurses, physician trainees, and physicians concluded that healthcare professionals who were directly involved in the care of COVID-19 patients had significantly higher rates of depression, anxiety, insomnia, stress, and burnout [9, 10].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [9] Lai J, Ma S, Wang Y et al (2020) Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 3:e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976 source

      The Results and Discussion report more severe depression, anxiety, insomnia, and psychological distress among frontline workers directly caring for COVID-19 patients. Distress broadly supports the reference to stress, but this paper does not report burnout as an outcome. The study describes its participants as physicians and nurses, without a separate finding for physician trainees. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [10] Kannampallil TG, Goss CW, Evanoff BA et al (2020) Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS ONE 15:e0237301. https://doi.org/10.1371/journal.pone.0237301 source

      The Results (General characteristics and Multivariable analysis; page numbers unavailable) find significantly higher stress and burnout among exposed physician trainees. They report no significant difference in anxiety or depression between exposure groups, and the study does not report an insomnia outcome. Thus this source does not support the full list of significantly higher rates attributed to it. (LLM, conf=0.94)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Study design and conductcitation

    Burnout was measured with the full 22-item Maslach Burnout Inventory Human Services Survey for Medical Personnel, a well-validated instrument.

    “we measured burnout using the full 22-item Maslach Burnout Inventory Human Services Survey for Medical Personnel MBI-HSS (MP), a well-validated tool designed to investigate the three burnout dimensions, emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) [1].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [1] Maslach C, Leiter MP (2016) Understanding the burnout experience : recent research and its implications for psychiatry. World Psychiatry 15:103–111. https://doi.org/10.1002/wps.20311 source

      The Assessment of burnout section describes the MBI as a validated, standard research tool designed to assess three burnout dimensions. The Burnout and mental illness section identifies exhaustion, depersonalization, and personal accomplishment as the MBI-HSS dimensions. Our copy does not specify a 22-item version or identify a Medical Personnel variant; the citing authors’ statement that they used it is their own method, not a finding of this source. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    A minimum sample of 55 participants was required for the prevalence estimate, assuming 95% confidence, 10% error, prevalence up to 80.5%, and a population of 136.

    “a minimum of 55 participants should be enrolled assuming 95% confidence and an error rate of 10% in the prevalence estimate, and assuming a prevalence rate of up to 80.5% [5] and a total population of 136”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Rotenstein LS, Torre M, Ramos MA et al (2018) Prevalence of burnout among physicians: a systematic review. J Am Med Assoc 320:1131–1150. https://doi.org/10.1001/jama.2018.12777 source

  • May combine two claims.

    Interpretationown data

    In contrast to prior studies linking more working hours to higher depersonalization, this study found that residents with 0-2 on-duty days had higher depersonalization scores than those with 3-4 on-duty days.

    “Contrary to the findings of the previous studies [19, 25] which showed significant direct correlation between the number of working hours and burnout scores in the DP subscale, our study revealed that participants who had 0–2 on-duty days in a week had significantly higher DP scores than those who had 3–4 on-duty days per week.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [19] Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L (2013) Correlates of physician burnout across regions and specialties: a meta-analysis. Hum Resour Health 11:48 source

      Table 4 (page not provided) reports a significant positive correlation between workload and depersonalization (DP), supporting the general direction attributed to prior studies. It does not establish the more specific claim about number of working hours. The 0–2 versus 3–4 on-duty-day comparison is presented as the citing authors’ own finding, not as a finding of this source. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [25] Wang Z, Xie Z, Dai J et al (2014) Physician burnout and its associated factors: a cross-sectional study in Shanghai. J Occup Heal 56:73–83 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reported burnout prevalence among physicians ranges from 0% to 80.5%.

    “The prevalence of burnout among physicians ranges from 0 to 80.5% [2–5].”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [2] Shanafelt T, Boone S, Tan L et al (2012) Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 172:1377–1385. https://doi.org/10.1001/archinternmed.2012.3199 source
    • cites [3] Binh NG, Phua J, Zhao MY et al (2018) Professional burnout among physicians and nurses in Asian intensive care units: a multinational survey. Intensive Care Med 44:2079–2090. https://doi.org/10.1007/s00134-018-5432-1 source
    • cites [4] Busis NA, Shanafelt TD, Keran CM et al (2017) Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 88:1–12. https://doi.org/10.1212/wnl.0000000000004526 source
    • cites [5] Rotenstein LS, Torre M, Ramos MA et al (2018) Prevalence of burnout among physicians: a systematic review. J Am Med Assoc 320:1131–1150. https://doi.org/10.1001/jama.2018.12777 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The pandemic impaired the healthcare system's capacity to provide specialized services for stroke and other neurologic conditions.

    “Furthermore, the pandemic hampers the healthcare system’s ability to render specialized services to patients with stroke and other neurologic conditions [15].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Tsivgoulis G, Palaiodimou L, Katsanos AH et al (2020) Neurological manifestations and implications of COVID-19 pandemic. Ther Adv Neurol Disord 13:1–14 source

  • May combine two claims.

    Findingown data

    The mean personal accomplishment score was 24.63 ± 8.15, and 93.0% of participants had low personal accomplishment scores.

    “The mean PA score was 24.63 ± 8.15 with 93.0% (n = 80) having significantly low.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Number of on-duty days per week was significantly associated with depersonalization scores (p = 0.025), with a post hoc difference between the 0-2 and 3-4 on-duty days groups (p = 0.007).

    “There is statistically significant difference between at least two groups in terms of number of on-duty days per week on the depersonalization subscale scores (p = 0.025). Post hoc analysis revealed that the significant difference is between the 0–2 on-duty days and 3–4 on-duty days groups (p = 0.007).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Thematic analysis identified increasing manpower as a theme for reducing burnout.

    “The majority of the participants highlighted that hiring more residents, increasing the physician–patient ratio, and effectively distributing the workload would reduce burnout.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Thematic analysis identified reducing clerical tasks as a theme for reducing burnout.

    “Several participants highlighted that the burden of certain non-clinical tasks such as administrative assignments, clerical duties, lectures, and conferences significantly contributes to burnout.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The mean depersonalization score was 6.58 ± 5.01, and 8.14% of participants had high depersonalization scores.

    “The mean DP score was 6.58 ± 5.01 with 8.14% (n = 7) having significantly high scores.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The mean emotional exhaustion score was 21.63 ± 10.56, and 34.8% of participants had high emotional exhaustion scores.

    “The mean EE score was 21.63 ± 10.56 with a third of the respondents (n = 30, 34.8%) having significantly high scores.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Number of on-duty days per week was significantly associated with emotional exhaustion scores (p = 0.033), with a post hoc difference between the 3-4 and 5-7 on-duty days groups (p = 0.041).

    “There was statistically significant difference between at least two groups in terms of number of on-duty days per week on the emotional subscale scores (p = 0.033). Post hoc analysis revealed that the significant difference was between the 3–4 on-duty days and 5–7 on-duty days groups (p = 0.041).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Thematic analysis identified improving the work environment as a theme for reducing burnout.

    “Many participants described how a nurturing psychosocial work environment may prevent burnout.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The depersonalization finding may be explained by unmeasured variables such as job satisfaction and relationships with colleagues.

    “The reason behind this finding may be due to the presence of unaccounted variables such as job satisfaction and work colleague relationship—the two variables that have a positive correlation with compassion in a study among Filipino nurses [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Balinbin CB, Balatbat KT, Balayan AN et al (2020) Occupational determinants of compassion satisfaction and compassion fatigue among Filipino registered nurses. J Clin Nurs 29:955–963. https://doi.org/10.1111/jocn.15163 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The statistical analyses included only a limited set of personal and practice characteristics.

    “Another limitation was the limited personal and practice characteristics included in the statistical analyses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A strength of the study was its use of qualitative methods to capture participants' perspectives on reducing burnout.

    “The strength of this study lies in its inclusion of qualitative methods of analysis to capture the perspectives of the participants on ways to reduce physician burnout.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among 1,671 American neurologists, 60.1% reported at least one burnout symptom.

    “In a study involving 1,671 American neurologists, 60.1% of the respondents had at least one symptom of burnout (emotional exhaustion, depersonalization, and/or career dissatisfaction) [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Busis NA, Shanafelt TD, Keran CM et al (2017) Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 88:1–12. https://doi.org/10.1212/wnl.0000000000004526 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Residents who did not consent to participate may have been experiencing true burnout, despite the fairly high response rate.

    “Although it had a fairly high responder rate of 71.67%, the residents who did not consent to participate in the study may be experiencing true burnout syndrome.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Residents with more on-duty days may have greater exposure to positive work relationships, which could lower their depersonalization risk.

    “Residents who have more on-duty days might be more exposed to positive work relationships, thereby lowering their risk for DP.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In an Asian multinational survey, 50.3% of intensive care physicians and 52.0% of nurses showed signs of burnout.

    “In a multinational survey among intensive care physicians and nurses in Asia, 50.3% of physicians and 52.0% of nurses have signs of burnout [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Binh NG, Phua J, Zhao MY et al (2018) Professional burnout among physicians and nurses in Asian intensive care units: a multinational survey. Intensive Care Med 44:2079–2090. https://doi.org/10.1007/s00134-018-5432-1 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Physician emotional exhaustion and depersonalization are significantly correlated with longer patient recovery time and patient dissatisfaction.

    “A cross-sectional study on the relationship between physician burnout and patient outcomes concluded that physician’s emotional exhaustion and physician depersonalization are significantly correlated with longer recovery time and patient dissatisfaction [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Halbesleben JRB, Rathert C (2008) Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 33:29–39. https://doi.org/10.1097/01.HMR.0000304493.87898.72 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Emotional exhaustion is significantly associated with reduced professional work effort.

    “Emotional exhaustion is significantly associated with decreased professional work effort [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Shanafelt TD, Mungo M, Schmitgen J et al (2016) Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 91:422–431. https://doi.org/10.1016/j.mayocp.2016.02.001 source

  • May combine two claims.

    Study design and conductnone given

    The study lacked a control group and pre-pandemic baseline burnout scores.

    “Another limitation of this study was the lack of a control group or pre-pandemic baseline scores for burnout.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a US nationwide study, burnout was more common among physicians (37.9%) than in the general workforce (27.8%).

    “In a nationwide study in the United States (USA), the rate of burnout was higher among physicians (37.9%) compared to the general workforce population (27.8%) [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Shanafelt T, Boone S, Tan L et al (2012) Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 172:1377–1385. https://doi.org/10.1001/archinternmed.2012.3199 source
25 of 25

  • The paper relies on this without support.

    The existing literature lacks data on how common and what predicts burnout among neurologists and neurology residents during the COVID-19 pandemic.

    “Despite its implications, the literature on prevalence and predictors of burnout among neurologists and residents in the time of the COVID-19 pandemic is still lacking.”

  • The paper relies on this without support.

    During the pandemic, every neurology resident in the country was mobilized to provide care for COVID-19 patients with neurological conditions.

    “The pandemic mobilized all neurology residents in the country to render medical care to COVID-19 patients with neurological conditions.”

  • The paper relies on this without support.

    Knowledge about burnout prevalence and its correlates among Filipino physicians is very limited.

    “Very little is known about the prevalence of and factors associated with burnout among Filipino physicians”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Outpatient-duty percentage does not match the count

    Minor

    The study reports 86 participants, so 52 participants represent about 60.5%, not 62.5%.

    Reported 62.5 · recomputed 60.465116

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Ruiz RL, Santos-Doctor MA (2007) The epidemiology of stress markers and burnout among resident physician trainees: the Manila Doctors Hospital experience. Filip Fam Physician 45:91–100
  2. Joson MG (2010) Degree of burn-out among family medicine resident trainees: a descriptive study. Filip Fam Physician 48:8–15
  3. Medina M, Modina KA (2016) Compassion fatigue among physicians and nurses in the emergency department, Makati Medical Center. Philipp J Emerg Med 2:22–36

Cited by

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Related

Authors
Turalde, C. W. R., Espiritu, A. I., Macinas, I. D. N., & Jamora, R. D. G.
Affiliations
  • Philippine General Hospital (PH)
  • University of the Philippines Manila (PH)
Corresponding author
Jamora, Roland Dominic G.
ORCID
Venue
Neurological Sciences
Publisher
Springer Science and Business Media LLC
Published
2021-11-30
Volume
43
Issue
3
Pages
1503-1511
ISSN
  • 1590-1874 (ISSN-L)
  • 1590-3478
DOI
10.1007/s10072-021-05675-4
PMC
PMC8630990
OpenAlex
W3216516962
Cited by
36
References
35
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 14 · 2022: 2 · 2015: 1 · 2014: 1
FWCI
5.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Neurological Sciences (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
Keywords
burnout, neurology residents, COVID-19 pandemic, emotional exhaustion, depersonalization, Maslach Burnout Inventory, physician workforce, compensation
MeSH terms
Burnout, Psychological, COVID-19, SARS-CoV-2, Adult, Cross-Sectional Studies, Humans, Internship and Residency, Neurology, Surveys and Questionnaires

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