title: The Toxicity of Self-Blame: Sex Differences in Burnout and Coping in Internal Medicine Trainees.
abstract: Burnout is a significant problem facing internal medicine residents contributing to increased risk of depression and suicidal ideation. Coping mechanisms and burnout may differ based on sex.
  
  
  
  The study was a retrospective cross-sectional study of reported burnout and coping mechanisms used by internal medicine residents in June 2014 at a large academic center and its community affiliate. Two hundred eighty-five postgraduate year (PGY)-1, 2, 3, and 4 and incoming PGY-1 residents were surveyed. The Maslach Burnout Inventory-General Survey and Brief Coping Orientation to Problems Experienced were given to measure levels of burnout and frequency of use of coping mechanisms. Percentages of residents who met criteria for burnout and high levels on each of the subscales of emotional exhaustion, cynicism and professional efficacy, were calculated and stratified by sex. Chi-squared tests were used for statistical significance. Average frequency of use of each coping mechanism by sex was calculated with statistical significance determined by two sided t-tests.
  
  
  
  There was a 69% completion rate (198/285) with 100 men and 98 women. Woman had higher levels of burnout (30% vs. 15%, p = 0.014) and emotional exhaustion (22% vs. 9%, p = 0.005). Women used the adaptive coping mechanisms of emotional support (p = 0.001) and instrumental support (p = 0.018) more frequently but also used the maladaptive coping mechanism of self-blame more frequently (p = 0.022).
  
  
  
  Greater use of self-blame as a coping mechanism may be a major factor in the higher rates of burnout and emotional exhaustion in women resident physicians as compared to men. Educators must pay attention to use of self-blame by female residents and as it may be a red flag for resident distress.
authors.affiliation: 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.|2 The Veteran's Administration Pittsburgh Healthcare System , Pittsburgh, Pennsylvania.
authors.forename: Brielle M
authors.initials: BM
authors.lastname: Spataro
authors.affiliation: 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Tilstra
authors.affiliation: 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Rubio
authors.affiliation: 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: McNeil
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002055:Burnout, Professional / Q000453:epidemiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D010820:Physicians / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012649:Self Concept; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States
keywords: burnout; graduate medical education; mentoring