Relationship between burnout and professional conduct and attitudes among US medical students.
BACKGROUND
The relationship between professionalism and distress among medical students is unknown.


OBJECTIVE
To determine the relationship between measures of professionalism and burnout among US medical students.


METHODS
Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME-MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society.


METHODS
Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL.


RESULTS
Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by <10%) in comparison to unprofessional conduct related to patient care (endorsed by up to 43%). Only 14% (362/2531) of students had opinions on relationships with industry consistent with guidelines for 6 scenarios. Students with burnout were more likely to report engaging in 1 or more unprofessional behaviors than those without burnout (35.0% vs 21.9%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.59-2.24). Students with burnout were also less likely to report holding altruistic views regarding physicians' responsibility to society. For example, students with burnout were less likely to want to provide care for the medically underserved than those without burnout (79.3% vs 85.0%; OR, 0.68; 95% CI, 0.55-0.83). After multivariable analysis adjusting for personal and professional characteristics, burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors (OR, 1.76; 95% CI, 1.45-2.13) or holding at least 1 less altruistic view regarding physicians' responsibility to society (OR, 1.65; 95% CI, 1.35-2.01).


CONCLUSIONS
Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools.
Dyrbye
Liselotte N
LN
Mayo Clinic College of Medicine, Rochester, Minnesota, USA. dyrbye.liselotte@mayo.edu
Massie
F Stanford
FS
Eacker
Anne
A
Harper
William
W
Power
David
D
Durning
Steven J
SJ
Thomas
Matthew R
MR
Moutier
Christine
C
Satele
Daniel
D
Sloan
Jeff
J
Shanafelt
Tait D
TD
D000328:Adult; D000533:Altruism; D001291:Attitude of Health Personnel; D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D003625:Data Collection; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians / Q000941:ethics*; D028743:Professional Misconduct / Q000523:psychology*; D011788:Quality of Life; D012577:Schools, Medical; D012941:Social Responsibility; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology*; D014481:United States; D055815:Young Adult