Original Article

Primary Language and Cultural Background as Factors in Resident Burnout in Medical Specialties: A Study in a Bilingual US City

Authors: Khalid I. Afzal, MD, Farhan M. Khan, MD, Zuber Mulla, PhD, Ralista Akins, MD, PhD, Elizabeth Ledger, MT, ASCP, MS, CCRP, Frank L. Giordano, MD

Abstract

Objective: The aim of this study was to identify the degree of burnout among resident physicians enrolled in seven postgraduate training programs at Texas Tech University Health Sciences Center (TTUHSC), Paul L. Foster School of Medicine, El Paso, Texas, as it related to residents' age, gender, marital status, number of hours worked per week, primary language, race/ethnicity, and cultural background.


Method: The Maslach Burnout Inventory Human Service Survey (MBI) was administered to measure the level of burnout according to the prevalence of emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA).


Results: Eighty-one percent of the residents at TTUHSC participated in the study. Residents raised in the United States or Canada comprised 28% and 35% of the study, and all reported English as their primary language. The EE scale was significant for obstetrics/gynecology (OB/GYN) residents (prevalence odds ratio [POR] = 13.55, P = 0.02) and psychiatry (PSY) residents (POR = 6.50, P = 0.03). Emergency medicine (EM) residents (POR = 23.35, P = 0.002), OB/GYN (POR = 10.89, P = 0.02), and general surgery (GS) (POR = 6.24, P = 0.03) residents had high DP. Internal medicine (IM) residents (primarily Spanish-speaking) reported significantly low EE (POR = 0.22, P = 0.03) and PA (POR = 0.09, P = 0.001) scores. Residents from the United States or Canada who reported English as their primary language and noted their race as white, had high EE (POR = 3.06, P = 0.03; POR = 5.61, P = 0.0001; POR = 2.91, P = 0.004), DP (POR = 3.19, P = 0.02; POR = 8.34, P ≤ 0.0001; POR = 4.70,P ≤ 0.0001) and PA (POR = 2.61, P = 0.02; POR = 2.35, P = 0.05, POR 0.29, P = 0.3) scores.


Conclusion: Using valid measures, this pilot study identified a statistically significant relationship between burnout and residents' race/ethnicity, primary language, and cultural background. Larger studies with similar focus would be necessary to generalize these findings. At-risk residents in bilingual locations should be provided with cultural awareness workshops, language assistance programs, as well as senior resident and faculty mentors.


Key Points


* Residency training exposes residents to stressors that range from long work hours to sleep deprivation.


* Resident burnout can lead to an increased rate of serious medical errors and can influence all aspects of a resident's life.


* The roles of primary language, race/ethnicity, and cultural background as protective or aggravating factors for resident burnout have not been emphasized in existing literature.


* Early identification of at-risk residents and participation in cultural awareness workshops and language assistance programs is vital as a preventive strategy in bilingual settings.

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