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Ann. psychophysiol. 
ISSN 2412-3188 (Online) | 2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v8.i1.2021.43-48 
 

 
 
Original Article                                                                                  

Burnout among emergency  
medicine residents 
Abdullah1, Lal Shehbaz1, Shua Nasir1, Sami Jataoi1,  
Syed Jehanzeb Asim1 & Aatir H. Rajput2 
1Department of Emergency Medicine, Dr. Ziauddin Hospital, Karachi-Pakistan.  
2Department of Psychiatry & Behavioral Sciences, Liaquat University, Jamshoro-Pakistan. 
     

Abstract 
Background: The emergency medicine department is the hub of most activity in 
any healthcare institution, with the most critical patients present and demand the 
most urgent care. However, dealing with that working day in and day out, 
throughout the extensive training period, has many adverse bodily and mental 
effects on the emergency medicine residents, the most problematic among which 
is burnout. The aim was to study the prevalence of burnout among emergency 
medicine residents. 
Methodology: This observational, cross-sectional analysis was conducted upon a 
sample of 54 emergency medicine residents selected via non-probability 
convenience sampling from 3 different tertiary care teaching hospitals at Karachi. 
After taking written informed consent, the Maslach Burnout Inventory (MBI) was 
used to assess burnout and its sub-components (depersonalization, emotional 
exhaustion and personal accomplishment). Additionally, basic biodata, 
sociodemographic details, distress at work were inquired and recorded onto a self-
administered questionnaire. Data were analyzed using SPSS version 22.0. 
Results: Among the 54 residents enrolled in the study, 68.52% were males, while 
31.48% were females. The mean age of the sample stood at 29.0±2.0 years. The 
mean duration of working in the emergency department was 2.0±1.0 years. Mean 
burnout scores were 28.4 for emotional exhaustion (high), 9.3 for 
depersonalization (moderate), and 31.47 for personal accomplishment (moderate). 
The most commonly reported stressors at work included unruly patients and 
attendants, lack of timely cooperation by healthcare professionals from other 
departments, breaking bad news, and work overload. 
Conclusion: After careful consideration, it can be concluded that burnout is 
prevalent among emergency medicine residents, and steps must be taken to 
prevent the already distraught and scarce emergency medicine personnel from 
falling into dysfunction due to burnout. 
 

Keywords 
Burnout, Emergency Medicine, Critical Care, Acute Medicine, Trauma, Causality 

 

 

Citation: Abdullah, Shehbaz L, Nasir S, 
Jataoi S, Asim SJ,  Rajput AH. Burnout 
among emergency medicine residents. 
APP.2021; 8(1):43-48 
 
Corresponding Author Email: 
aatirh.rajput@gmail.com 
 
DOI: 10.29052/2412-3188.v8.i1.2021.43-48 
 
Received 20/11/2020 
 
Accepted 07/05/2021 
 
Published 01/06/2021 
 
Copyright © The Author(s). 2021 This  
 is an open access article distributed  
under the terms of the Creative Commons 
Attribution 4.0 International License, 
which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author 
and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 
 

https://doi.org/10.29052/2412-3188.v8.i1.2021.
http://creativecommons.org/licenses/by/4.0/)
http://creativecommons.org/licenses/by/4.0/)


 
 
 

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Introduction  
Professional life is an essential part of a 
person's daily life, with many of the effects 
of professional/occupational stressors 
encountered during the job spilling over to 
other parts of life and affecting general 
health and well-being. Few professions can 
boast of being more demanding (in terms of 
work hours) and stressful than the 
healthcare profession. Be it doctors, nurses 
or paramedical staff, all are subjected to 
extensive duty hours, extreme work 
conditions and an unparalleled stress level1.  
 
Occupational stress is among the most 
discussed health and safety challenges in the 
modern era. Stress is known to be associated 
with numerous adverse health outcomes 
and poor work performance. At the same 
time, acute exposures to stress can manifest 
as easy fatigability, disturbed sleep, and 
gastrointestinal dysfunctions2. Chronic 
stress exposures manifest as more severe 
conditions including early onset of bodily 
(cardiovascular, musculoskeletal and 
metabolic diseases), mental (depression and 
anxiety) or both disorders; and often 
culminating in burnout3.  
 
Many occupations (such as education, 
agriculture, fishing and forestry industries) 
incur some stress levels, with a few 
(teaching, policing, social work, prison 
guarding and tending to customer care) 
being affected more than the others4. Recent 
research has brought to the notice that, in 
hospital settings, long work hours, high 
work intensity, and extreme work conditions 
yield the worst levels of stress and, 
consequently, lead to the worst possible of 
the many outcomes mentioned above, 
especially burnout5.  
 
Healthcare professionals catering to 
emergency care needs deal with even higher 
work volume and time pressures (given their 

established relationship with sickness, 
absence, high staff turnover and early 
retirement). Thus professionals employed in 
the healthcare setup are projected to suffer 
from severe burnout6. The duty regimen that 
often requires them to work in different 
alternating shifts leads to additional sleep 
troubles, disturbed circadian rhythms, 
lifestyle problems and most worryingly, 
high blood pressure. Furthermore, overwork 
and sleep debt harm carbohydrate 
metabolism and endocrine function7.  
 
The occurrence of hypertension among 
overworked professionals is reported in 
research8. Satisfactory evidence also points 
out higher mean glycated hemoglobin A1c 
(HbA1c) levels and a greater risk of 
developing diabetes mellitus among 
professionals employed in stressful work 
positions9. Research from Japan even goes as 
far as coining a particular term, Karōshi that 
translates to overwork death10. 
 
Karōshi has claimed hundreds of people 
await this eventual fate since not much has 
done to alleviate the working environment's 
stress and limit the number of hours of work, 
especially for the general staff and 
ambulance drivers that have little or no say 
and influence on policymaking circles. The 
conditions are significantly worse for 
healthcare professionals in the emergency 
department. According to reports, those 
who were being subjected to the worst work 
shifts and forced to face extreme conditions 
in which, according to reports, face 36% 
more verbal violence, 22% more physical 
violence and 24% more stress than all other 
healthcare professionals11.  
 
However, the effect of these working 
conditions among them is left largely 
unexplored in international and national 
pools of evidence-based literature. It is, 
therefore, about time that this gap in the 



 
 
 

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literature is filled by evidence. This research 
serves this very purpose and explores the 
prevalence of burnout among emergency 
medicine residents.  
 

Methodology 
This observational analysis was conducted 
upon a sample of 54 emergency medicine 
residents chosen via non-probability – 
convenience sampling from 3 different 
tertiary care teaching hospitals in Karachi. 
After taking written informed consent, the 
Maslach Burnout Inventory (MBI) was used 
to assess burnout and its sub-components i.e. 
depersonalization, emotional exhaustion 
and personal accomplishment. Additionally, 
basic biodata, sociodemographic details and 

distresses at work were inquired and 
recorded onto a self-administered 
questionnaire. The statistical analysis was 
performed on SPSS version 22.0. 
 
All Consenting individuals and emergency 
medicine residents (employed at the study 
setting for at least one year) were included. 
While those with pre-existing mental health 
conditions, suffered emotionally 
traumatizing events in the past six weeks 
were excluded from the study sample.  
 
The MBI score data were categorized as low, 
moderate and high-risk groups for burnout 
based on the overall 22 items score as 
follows: 

 
Table 1: Categorization of MBI score 

Scale Components Low Moderate High 

Emotional Exhaustion ≤ 18 19 - 26 ≥ 27 

Depersonalization ≤ 5 6 - 9 ≥ 10 

Personal Accomplishment ≥ 40 34 - 39 ≤ 33 

 
Confirmatory factor analysis (at a south-east Asian setting) has revealed all three sub-components to have 
a high internal consistency with Cronbach's α coefficient values of 0.837, 0.869, & 0.881 and report a high 

test-retest reliability. Hence the tool was fit for use in the study setting for the intended purpose12.  

 

Result 
Among the 54 residents enrolled in the study, 68.52% were males, while the remaining 31.48% 

were females. The mean age of the sample stood at 29±2.0 years, and further age distribution is 

tabulated below. 

 

Table 2: Age Distribution 

Age Group (Years) Male Female 

≤ 26 03 01 

27-30 32 15 

≥ 31 02 01 
*Data represents frequencies.  

  

The age ranged from 25 to 33 years. As expected of this age, a majority of the residents were well 

ahead into their residency programs (2nd year and above), and a few had completed their 

training). The mean duration of working in the emergency department was 2±1 years.  

 



 
 
 

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Figure 1: Mean Maslach Burnout inventory Scores 

 

Mean burnout scores were 28.4 for emotional 
exhaustion (high), 9.3 for depersonalization 
(moderate), and 31.47 for personal 
accomplishment (moderate).  As per mean 
values, the sample had a high level of 
emotional exhaustion and a moderate 
(bordering on high) level of 
depersonalization. The burnout pertaining 
to personal accomplishment, too, is noted to 
be high. The most commonly reported 
stressors at work included unruly patients 
and attendants, lack of timely cooperation by 
healthcare professionals from other 
departments, breaking bad news, and work 
overload. However, exploring the individual 
factors in detail was beyond the scope of this 
research. 
 

Discussion 
Since residents handle most of the work at 
the emergency medicine department, these 
post-graduate trainees' physical and mental 
health is a cause for concern. In addition to 
their work-related burdens, they face many 
academic and study-related responsibilities 
and demands. Additionally, since the 
profession is dedicated to safeguarding the 
health of critically ill people needing acute 
attention, there is very little tolerance for 
error, thus requiring the residents to always 
be alert and on their toes, hence all the while 
generating anxiety and stress13.  

The excessive workload, lengthy educational 
curricula, constant workplace-based 
assessment and the very intense professional 
demands coupled with a lack of time for 
leisure, family and friends, take a high toll. 
Furthermore, studying for numerous exams, 
pre-meditating future challenges in the 
highly saturated field and the delayed 
prospects of adequate income also act as 
stressors on the mind of emergency medicine 
residents. In addition to these aspects, 
medical professionals' personality traits, 
including obsessiveness, self-exigency, and 
perfectionism, are likely to add to the mix 
adversely14.  
 
It has been hypothesized that persistent 
exposure to continuous psychosocial 
stressors throughout their education and 
training period can lead to Burnout 
Syndrome15. It is essential to understand that 
burnout is a multifactorial occupational 
syndrome. Thus any solution must address 
the complete triad of symptoms it involves, 
namely: emotional exhaustion, 
depersonalization, professional 
cynicism/disbelief16.  
 
In this research, a high level of emotional 
exhaustion, depersonalization and personal 
accomplishment. This is worrying since 
literature reports that having even one 
symptom of the triad may adversely impact 

28.4

9.3

31.47

Emotional Exhaustion

Depersonalization

Personal Accomplishment



 
 
 

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medical professionals' training/learning 
process and reduce their work efficiency17.  
 
A limitation of this research is that we did 
not delve into the less severe manifestations. 
At the same time, other researchers have 
noted and laid much importance on the self-
reported physical images (such as fatigue, 
drowsiness, disorderly eating, and 
migraine). Emotional effects (instability, 
agitation and even a heightened inclination 
towards illicit drugs use) accompany all sub-
components of burnout18.  
 

Conclusion 
After careful consideration, it can be 

concluded that burnout is prevalent among 

emergency medicine residents. Since the 

student/trainee community in medicine is 

already overwhelmed with the high 

prevalence of suicide, depression, stress and 

use of psychoactive substances, steps must 

be taken to counteract the situation. The fact 

that emergency medical personnel are 

among the scarcest in the medical field, it is 

all the more important to dedicate efforts to 

prevent them from falling into dysfunction 

due to burnout. 

 

Acknowledgment  
The authors are thankful to the study 
participants for their cooperation in the 
study. 
 

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