What a Shame: Increased Rates of OMS Resident Burnout May Be Related to the Frequency of Shamed Events During Training.
OBJECTIVE
Shame is an ineffective tool in residency education that often results in depression, isolation, and worse patient care. This study aimed to assess burnout, depersonalization, and personal achievement levels in current oral and maxillofacial surgery (OMS) residents, to assess the prevalence of the use of shame in OMS residency training, and to determine whether there is a relation between shame exposure and resident burnout, depersonalization, and personal achievement levels.


METHODS
An anonymous 20-question cross-sectional survey was developed incorporating the Maslach Burnout Index and a previously validated shame questionnaire and sent to all OMS program directors affiliated with the American Association of Oral and Maxillofacial Surgeons for distribution among their respective residents in 2016. Univariate analyses were used to determine the distribution of the predictor (shame) and outcome (burnout) by gender and by frequency of shaming events. Multivariable logistic regression analysis was used to assess the relation of shame to burnout. A 2-sided P value less than .05 was considered statistically significant.


RESULTS
Two hundred seventeen responses were received; 82% of respondents were men (n = 178), 95% were 25 to 34 years old (n = 206), and 58% (n = 126) were enrolled in a 4-year program. Frequently shamed residents were more likely to have depression (58 vs 22%; P < .0001), isolation (55 vs 22%; P < .0001), and poor job performance (50 vs 30%; P < .0001). Residents who were frequently shamed were more likely to experience moderate to severe burnout (odds ratio = 4.6; 95% confidence interval, 2.1-10.0; P < .001) and severe depersonalization (odds ratio = 5.1; 95% confidence interval, 2.1-12.0; P < .0001) than residents who had never or infrequently been shamed.


CONCLUSIONS
There is a clear relation between the number of shame events and burnout and depersonalization levels. It is important to understand the negative impact that the experience of shame has on residents, including its unintended consequences.
Resident, Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University School of Dental Medicine, Boston, MA. Electronic address: Michael.Shapiro@bmc.org.
Michael C
MC
Shapiro
Senior Statistician, Department of Surgery, Boston University Medical Center, and MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA.
Sowmya R
SR
Rao
Resident, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Jason
J
Dean
Residency Director, Department of Oral and Maxillofacial Surgery, Boston Medical Center; Assistant Professor, Boston University School of Dental Medicine, Boston, MA.
Andrew R
AR
Salama
D000328:Adult; D002055:Burnout, Professional / Q000453:epidemiology*; D003861:Depersonalization / Q000453:epidemiology*; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D015995:Prevalence; D012752:Shame; D013515:Surgery, Oral / Q000193:education*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology