“RESIDENTS

BURNOUT DUE TO
PATIENT
OVERLOAD, LONG
WORKING HOURS Gujranwala Medical

AND College; DHQ Teaching

Hospital

PERFORMANCE
ANXIETY AND ITS
CORRELATION
WITH PATIENT
CARE.”
To determine the fact and figures of prevailing burnout among
doctors of various departments of DHQ Gujranwala
RESEARCH SUPERVISOR:
Dr. Rabia
SUBMITTED TO:
Dr. Sumair Anwar
SUBMITTED BY:
Rumaiha Sadia(63) ,Sara Shahid(66), Rohma Ahmed(62), Sahrish Manzoor(64), Rameesha
Shams(59).

DEPARTMENT OF COMMUINITY MEDICINE

 APPROVAL PERFORMA

It is certified that Rumaiha Sadia(63),Sara Shahid(66),Rohma Ahmed(62),Sahrish

Manzoor(64),Rameesha Shams(59) have carried out and completed their research on “Residents
burnout due to patient overload, long working hours and performance anxiety and its
correlation with patient care “ under my supervision.

Research supervisor:
Dr. Rabia
Approved By:
Dr. Sumair Anwar
 DEDICATION

This project is dedicated to our Parents who have never failed to give us financial and moral
support, for giving all our needs during the time we developed our system and for teaching us that
even the largest task can be accomplished if it is done one step at a time.
This research is dedicated to our Adviser Dr. Rabia, without her continued support and counsel
we could not have completed this process.
We dedicate this Capstone Project to all of the healthcare providers who work so hard just to
provide the quality medical care to their patients.
 ACKNOWLEDGEMENT

First and foremost, the researchers offer our sincerest gratitude to our adviser, Dr Rabia, whose
encouragement, guidance and support from the initial to the final level enabled us to develop an
understanding of the subject. Without her guidance and persistent help this project would not have
been possible.
The staff of DHQ Gujranwala for being cooperative and assisting and guiding us through all that
was to be done.
To our parents, we would like to thank to them for supporting us in our daily lives, for educating us,
and having them by our sides to guide us always, their prosperity and love for us.
To our HOD Community Medicine, Professor Dr. Sumair Anwar, for always reminding what
professional ethics is that made us a better individual, for the advices that he has given to us and
his support to us to be global competitive students.
Last but not the least, to the one above all of us, the omnipresent God, for answering our prayers
for giving us the strength to plod on despite our constitution wanting to give up and throw in the
towel, thank you so much Allah.
 · ABSTRACT
AIM:
The experience of burnout has been focus of much research during the past few decades.
Measures have been developed, as have various theoretical models and research studies from
many countries have contributed to a better understanding of the causes and consequences of
this occupationally-specific dysphoria. The majority of this work has focused on human service
occupations and particularly health care. This research is meant to determine the fact and figures
of prevailing burnout among doctors of various departments of DHQ Gujranwala and comparison
between departments to realize workload of each department.
MATERIALS & METHODS:
An online self-administered questionnaire was sent via email to all residents (150) at our institute
with and a response rate of 116 was achieved. Out of these 100 residents consented and
completely filled the questionnaires and were included in the analysis. The questionnaire
comprised of demographic variables, the Maslach burnout inventory and occupational risk factors.
RESULTS:
High levels of burnout on at least one subscale were reported by 53% residents, in 2 components
by 9% whereas an alarming 35% residents scored high on all three subscales. Among the
individual subscales emotional exhaustion was most frequent in 48%. Among the departments
surgery reported the highest levels (100%) of burnout and low levels were reported by Pediatrics
(40%). There was more burnout among residents who were longer on duty in hours and in
years.Dissatisfaction with workload, length of work hours, less sleep and number f patients were
significantly associated with high level of burnout.
CONCLUSION:
High levels of burnout are prevalent among doctors in DHQ Gujranwala which are comparable
with international literature. Efforts to improve the work environment of residents may significantly
reduce levels of burnout.
 · INTRODUCTION:
Burnout is a condition of physical or emotional exhaustion due to over work and frustration. It is a
condition of being unable to perform a certain task which a person is performing continuously. [1 ]
Burnout is more commonly used in case of residents than any profession else, so when a
physician gets tired of doing his duty as a result of long working hours or hectic schedule in his
routine it gets difficult for him to provide a quality service to his patients eventually, and hence
patient care is compromised such way. Probably the most distinct characteristic of burnout is the
loss interest in one’s work or personal life a feeling of just going through motions[2]

It is then necessary for a physician to work a little less but at his optimal level to keep himself easy
to perform his duty in a well manner. All the factors that ultimately are causing this frustration not
only among medical staff but also among patients should be alleviated to ensure a quality health
service within a community.[3 ] Regarding the particular environment of a physician in particular
some stressors that would raise the probability of occurrence of burnout can be highlighted:
excessive demands that would diminish the quality of care, long working hours, large number of
shifts, low pay, requirement to deal with suffering and death, and constant exposure to risks are
several major factors.

It has the detrimental effects on physician – patient relationship. Doctors are exposed to stressors
from emotions and situations that arise outside the doctor–patient relationship too[4 ]They have to
work in an increasingly litigious and unforgiving environment. Bureaucratic requirements imposed
upon them are increasing and keep changing. Medical knowledge is advancing rapidly and
doctors have to constantly keep in touch with it. These changes are often so rapid that by the time
doctors have acclimatized with one change something else may come up or evolve. Healthcare
resources are limited in most countries and the environment is unforgiving of mistakes. A recent
publication by the World Medical Association observed:[5]

“Residents in many countries are experiencing great frustration in practicing their profession,
whether because of limited resources, government and/or corporate micro-management of health
care delivery, sensationalist media reports of medical errors and unethical physician conduct, or
challenges to their authority and skills by patients and other health care providers”[6]

Furthermore, doctors are finding themselves working in an environment or in roles for which they
were not trained. Service delivery is changing from an office-based model to a population-based
health model. Doctors have to fulfil administrative duties, such as dealing effectively with
workforce issues, often in addition to their significant clinical commitments. [7 ]Fulfilling
unaccustomed tasks creates stressors, and constantly changing work environments predispose
doctors to high levels of stress. Not uncommonly, doctors deal with these routine stressors by
engaging in emotional withdrawal, social isolation and by denying the existence of problems.
Some of these strategies may be adaptive but pathological responses to chronic exposure to
stress do occur which are explored further in this paper.
This research defines burnout as it is characterized by feeling extremely overextended and
depleted of one’s physical and emotional resources in response to chronic job stressors.

This research is done among house officers and residents in OPDs and wards of ENT,
ophthalmology, gynecology, medicine, surgery, dermatology, pediatrics & pulmonology of DHQ of
Gujranwala to know the factors causing physician burnout and how it is actually affecting patient
care and also medical man's own life and what are the ways to reduce such factors to ensure
public health as a whole and how duties of medical staff should be assigned in a way that it does
not cause saturation of a single person. This study will definitely help alleviating that causes that
are frequently affecting doctor’s performance and patient care. Also this study will ensure the
correlation between the burnout and long duty hours along with patient load. We will be able to
definitely say that for the optimum working of a physician there should be certain fixed number of
patients one should see daily with breaks in between to ensure maximum patient care.

The major focus of our study will be to point out with certainty that there is an impact of
sociodemographic factors on the physician burnout which leads to detriment of patient care.

LITERATURE REVIEW:
· A study on medical students’ distress proposed that on the professional level, distress
contributes to cynicism and depression and subsequently may leads not only to defective
patient care but also a disturbed relationship with faculty and ultimately the culture of medical
profession. [ 8]

· Another study on causes of physician’s burnout suggests that Disruptive physician’s behavior
may diminish productivity and may leads to professional errors and compromised patient safety
[9]

· A study revealed that residents showed medium to high level of emotional exhaustion and
medium to high levels of Depersonalization. And those residents who attained a job satisfaction
and personal accomplishment used a short and long term copying methods in dealing with
stress [10 ]

· Another study clearly showed that substantial evidence suggests that burnout can impact
quality of care in variety of ways and has potentially profound personal implications for
residents including suicidal ideations.[11]

· A study concluded that it has a pervasive negative effect on all aspects of medical care,
including your career satisfaction. According to one researcher, “Numerous global studies
involving nearly every medical and surgical specialty indicate that one in every three residents
is experiencing burnout at any given time.”[12]

· A study by Tait D.ShanafeltMDaOmarHasanMBBS, MPHeLotte N.DyrbyeMD,

MHPEbChristineSinskyMDeDanielSateleMScJeffSloanPhDcColin P.WestMD, PhDd revealed
that After pooled multivariate analysis adjusting for age, sex, relationship status, and hours
worked per week, residents remained at an increased risk of burnout) and were less likely to
be satisfied with work-life balance [13]
· On 9 January 2014 a study was conducted for comparison of stress in different medical
specialties. MBI inventory was used and the results that were obtained indicated that 50% of
residents in gynae/obs faced burnout and 27% family residents faced burnout. In order to
overcome this issue one should implement strategies such as division of patients as on duty
hours. [14]

· A study was conducted in March 2016 on the prevalence of burnout among pediatricians.
Maslachs burnout inventory was used and patient’s perception was checked using
standardized qualitative survey. Then both the results were compared. The results obtained
indicated that 39% of responders had burnout syndrome and those were the people with
suboptimal patient care. [15]

· A study conducted in June 2006 correlated the burnout with medical errors in residents it was
concluded that 14.7% of the residents suffering from burnout conducted medical errors. The
limiting factor were non responders who were either too burn out to respond or they didn’t
consider it much important. [16]

· A study conducted in December 2013 on the relation of burnout at various career stages stated
that the youngest residents face most of the exhaustion and dissatisfaction with their career
choice. The middle aged residents faced burnout more and have more exhaustion due to duty
hours and being on call and they consider leaving their job for reasons other than retirement.
[17]

· A study published in 17 Feb 2014 indicates that prevalence’s of burnout in medical students
ranges from 31% to 45.7% and 60 to 70% surgeons and internal medicines residents face
burnout in US and they can benefit from certain interventions as stress management coursed
and Balint sessions. [18]

· OBJECTIVE:
The objective of this study is to find out the percentage of residents under study that face burnout
due to job stress by using Maslachs burnout inventory in abbreviated form. And to establish a
correlation of burnout with patient load and other demographic & occupational factors.

· METHODOLGY

STUDY DESIGN:
Observational descriptive cross sectional Study

STUDY DURATION

1 month (1-05-2019 to 1-06-2019)

STUDY SETTING:

DHQ teaching hospital Gujranwala which is attached to Gujrawala medical college

STUDY POPULATION:

House officers and residents working in OPDs and Wards of ENT, ophthalmology, gynecology,
medicine, surgery, dermatology, pediatrics & pulmonology during 9am to 2pm on duty in the
hospital for the duration of study.

SAMPLING TECHNIQUE:

Convenience sample

SAMPLING SIZE:

100 ē anticipated response rate of 90 % (7.5% margin of error)

· DATA COLLECTION PROCEDURE:

A questionnaire was sent online to the participants included in the criteria. It contained 2 parts.
One part consisted of MASLACH scale in modified form and second part consisted of
sociodemographic data such as department, year of training, age, marital status, number of
patients seen on daily basic, hours on duty per day and the longest duration on duty a person has
spent, any family stressor ongoing or in the last 3 months that will aid in burnout. Maximum
participation was ensured and then the data was summarized and the hypothesis was tested in
accordance with the data. At the end of this duration we will know whether there is an impact of
patient load and stress on physician burnout or not.

· DATA COLLECTION TOOL

Maslachs burnout inventory will be used in its abbreviated form. The questionnaire was based on
similar questionnaires used in previous studies on burnout and comprised items with open-ended
and closed-ended questions to obtain information on the study variables: sex, age, marital status,
level of education, years of experience, type of contract, length of time in current position, and
length of time spent working at the company. Given the wide range of variables, this article
focuses on the personal characteristics of the simple members (sex, age, marital status, and level
of education). The MBI consists of 12 items scored on a seven-point frequency rating scale
ranging from 0 (never) to 6 (everyday) that assess the syndrome’s three dimensions: emotional
exhaustion, depersonalization, and personal accomplishment.

ANALYSIS:
Using the SPSS software package, individuals were grouped into three level categories (high,
medium, and low) according to their average scores.

INCLUSION AND EXCLUSION CRITERIA:

INCLUDE:
Will include all residents and house officers working during 9am to 2pm in OPDs and Wards of
ENT, ophthalmology, gynecology, medicine, surgery, dermatology, pediatrics & pulmonology

EXCLUDE

Nursing staff, Paramedical staff, Students.

ETHICAL CONSIDERATION:

This research is approved by the college ethical committee more over every person involved in
this study will sign give consent before hand.

VARIABLES:
INDEPENDENT VARIABLES
Age, gender, marital status, department, designation.

DEPENDENT VARIABLES:
Duty hours, Doctor patient ratio, Paygrade

· RESULTS:
Approximately 116 questionnaires were filled by residents keeping their personal information
anonymous among them 100 responses were complete and according to our criteria following
data was received .74.1% individuals had part time jobs (2). 87.9% were married (2.5).75%
spouses of married people worked outside of home (3). Among those 50% were medical doctors
and 25% worked as other health care professionals and remaining had other jobs (4).
The ratio of work hours among the residents in general were 28.4% worked 60 to 69 hrs. in a
week, 26.7% worked 50-59 hrs,12.9% worked 70-79hrs, 8.6% worked less than 40hrs,
4.3%worked 80-100 hrs. and 1.7% worked more than 100 hrs. (5). Numbers of calls in the last
week of those who worked night duties is shown in graph (7).

Among those who filled the questionnaire 72.4% had one holiday per week,19% had 2 holidays
and rest had variable numbers (8). The percentage of time spent as nonmedical care like research
and others is given in the graph (11). 29.3% spent 11.20% time in their week as non-medical
worker, 28.3% spent 1-10% of their week, 18.1% spent 21 to 30 and 13.8% did not work as non-
medical personnel. 36.2% had 10-14 patients in their care 25.9% had 15-19 patient 19% had 5-9
8.6% had 20 or more 7.8% had 1-4 and 2.6% had 1 patient in their care (12). 55.2% had less than
10 years of practice 33.6% has 10-19 years of practice ,9.5% had 20 to 29 years,1.7% had 40 or
more years (13).

One of the most alarming findings from this study is that more than 53% of the
professionals suffer from high levels of burnout. This finding corroborates the results of previous
studies conducted at national and international level, which show that the prevalence of burnout in
study samples was over 50%.

(2)
 (2.5)

(3)

(4)

(5)
 (7)

(8)

(11)
 (12)

(13)

department total burnout high moderate low

total
pulmonology 1 0 0 0 0
medicine 11 8 6 1 1
dermatology 28 21 14 6 0
ophthalmology 22 15 14 1 0
surgery 3 3 1 2 0
ENT 10 4 2 1 1
pediatrics 10 4 1 1 2
gynaecology 6 3 2 1 0
other 9 8 1 3 4
total population 100 66 41 16 8
 Frequency of burnout among departments

frequency of burnout
total population
other
gynaecology
pediatrics
ENT
surgery
ophthalmology
dermatology
medicine
pulmonology;medicine;medicine
0 20 40 60 80 100 120

total burnout total high moderate low

department Total
%
pulmonology 0
medicine 72
dermatology 75
ophthalmology 68
surgery 100
ENT 40
pediatrics 40
gynaecology 50
other 88

MASLACH'S SCORING AND DESCRIPTION:

· MBI [MASLACH BURNOUT INVENTORY SCORING]
Ø MBI-EE:
· HIGH: [Medicine 95% -Surgery 91% - Gynae 89%]
· MEDIUM: [Paeds 88% - Ophthalmology 81%]
· LOW: [ENT 80% - Derma 79% - Pulmonology 75% - Others 75%]
Ø MBI-DP:
· HIGH: [Gynae 99% - Surgery 95% - Medicine 91%]
· MEDIUM: [Peds 90% - Pulmonology 89%]
· LOW: [ENT 85% - Ophthalmology 85% - Derma 82%- Others 82%]
Ø MBI-PA:
· HIGH: [Derma 98% - Ophthalmology 91% - ENT 90%]
· MEDIUM: [Medicine 88%- Gynae 85% - Surgery 84% ]
 · LOW: [Pulmonology 81%- Pediatrics 80%- Others 80% ]
Ø MBI-SATISFACTION:
· HIGH: [Derma 99% - Ophthalmology 99% - ENT 98%]
· MEDIUM: [Gynecology 95% - Surgery 95%- Medicine 95%]
· LOW: [Pediatrics 94% - Pulmonology 93%- Others 93% ]
(Where EE=Emotional Exhaustion
DP =Depersonalization, PA =Personal Satisfaction
Satisfaction= means satisfaction with the professional service according to maslach's scale
new modification)
Among those who filled the questionnaires 100 individuals fitted the criteria of our research and
those forms were completely filled while rest had some data missing and some did not
qualify the criteria.
The cut off values for burnout were considered as follows

Subscale High Moderate Low

Emotional
Exhaustion >15 9-14 0-8
Depersonalization
Lack of Personal
Accomplishment
satisfaction

The certain cut off values for Maslach scale are not defined as it depends on the perception of
the patient or physician, these values are just used for reference.
According to these cut off values the following deductions were drawn

Overall burnout Percentage %

High on atleast 1 subscale 53
High on at least 2 subscales 9
High on atleast 3 subscales 35
High on atleast 4 subscales 3
Subscales Percentage%
high moderate low
Emotional Exhaustion 48 39 13
Depersonalization 41 43 16
Lack of personal accomplishment 12 42 46
Satisfaction with being a doctor 16 45 39

Part time job and burnout:

 Total answers Burnout positve
yes 27 13
no 73 53
Total 100 66

Association of burnout with duty hours

less than 40 hrs 7 7

40 to 49 hrs 18 11
50 to 59 hrs 26 14
60 to 69 hrs 31 18
70 to 79 hrs 14 12
80 to 100 hrs 4 4
100 66

Night duties and burnout

average night duty Total individuals burnout frequency

1-2 times in a week 61 35
3-4 times in a week 37 29
5 and above times in a week 2 2
100 66

Patient load and burnout.

patients number burnout frequency
1 2 0
1 to 4 6 2
5 to 9 17 6
10 to 14 38 20
15 to 19 28 25
20 or more 9 8

Years on duty and burnout

years in practice total number burnout frequency

less than 10 years 51 30

 10 to 19 years 39 29

20 to 29 years 8 5

40 or more years 2 2

DATA ANALYSIS:
The data was grouped, tabulated and analyzed using the Statistical Package for the Social
Sciences (SPSS) software package. First, a descriptive analysis was conducted to compare the
sociodemographic characteristics of the respondents. Inferential statistical analysis was then
performed using inductive methods and procedures (sampling, variables, hypothesis testing) to
determine the statistical properties of a population based on a sample data set and using various
statistical tests such as Pearson’s bivariate correlation, the Student’s t-test, single factor ANOVA

 DISCUSSION:

Burnout among our residents is comparable to that reported by Prins et al[19].In their review, they
compared burnout among residents from different specialties from all over the world. Despite the
highly different economical and political environment of our country, there is no detectable
influence on the level of burnout. This further strengthens the hypothesis that this is a job-related
syndrome and has no relation with the external environment.
Working hours are usually held the biggest culprit in association with burnout. Residents in our
study also showing dissatisfaction with their work hours and work load. 66 percent associated
burnout with increased duty hours with 34 percent being burnout positive and having duty times
greater than 60 hours. This finding was consistent with studies previously done in Pakistan [25]
Residents working for longer hours are more likely to be under stress. Taking the 80-hour limit
suggested by the American College of Graduate Medical Education, a lot of individuals were found
to be overworked and were working beyond the (ACGME) limit.
With reference to patient load, it is seen that burnout frequency increases proportionately with
patient load, reaching a peak of 25 with 15 to 19 patients being handled by one resident. Also
noted is the increase in burn out with years of service, reaching a peak at 19 years and then
declining. This may be due to enhanced experience or decreased work load with higher position in
the work force.
Howlett et al. [22] has shown that coping strategies have a direct influence on burnout. Such
strategies may be implemented in our society to reduce burden on residents and increase
occupational satisfaction. Such personal and workplace modifications include cognitive
behavioural training, psychotherapy, counselling and adaptive skill training, along with
organization-directed interventions, like work process restructuring, work performance appraisals
and work shift readjustments, amongst others [23]. Similarly, an increased emphasis on spirituality
has also been seen to have a positive effect and could be encouraged among trainees [24].
The study shows that more than half, i.e 53%, of the sample population showed high burnout on at
least 1 subscale. Among the remaining, 35% showed high burnout in 3 subscales indicating that
the prevalence of burnout is high in the sample under study and therefore, the population of
doctors it represents.
High levels of emotional exhaustion and depersonalization were seen in 48% and 41% of the
individuals respectively. 46% felt a lack of personal accomplishment and only 16% were highly
satisfied with their professional choice to become a doctor. These findings point towards a high
mental toll prevalent in the population under consideration.
Major limitation of this study is the small sample size which may be to blame for some of the
inconsistencies in the results. A number of questionnaires were also missing certain demographic
details. However, such details did not have any negative impact in the deduction of conclusions.
Despite being a cross sectional study, meaningful patterns can still be discerned from this study
with regards to the influence of various sociodemographic variables, working hours, sleep, night
duties and patients in care on burnout in a resident.

CONCLUSION:
In conclusion, our study has highlighted that high levels of burnout are prevalent among residents
in our part of the world similar to what is reported for other countries in the literature. Working
hours have been at the center of the burnout epidemic with residents in our study also showing
dissatisfaction with their work hours and work load. That is why there is more burnout among
medicine and surery residents who have more patient load and more interactions.
Personal and institutional based reforms focused on improving the work environment of residents,
may lead to a significant reduction in the levels of burnout. Our study should pave the way for
focused research and interventions to combat burnout among residents in our region.
REFERENCES:
· [1].. Chapter 43 – Burnout Author links open overlay panelC.Maslach1M.P.Leiter2
https://doi.org/10.1016/B978-0-12-800951-2.00044-3

· [2] L Gundersen - Annals of internal medicine, 2001 - Am Coll Residents

· [3] http://dx.doi.org/10.1590/S1516-31802012000500003 Burnout syndrome and weekly

workload of on-call residents: cross-sectional study

· [4] P.BlanchardahD.TruchotbhL.Albiges-
SauvinchS.DewasahY.PointreauahM.RodrigueschA.XhaarddhY.LoriotchP.GiraudehJ.C.Sori
afhG.Kantorgh https://doi.org/10.1016/j.ejca.2010.05.014

· [5] Aiken LH , Clarke SP , Sloane DM , Sochalski JA , Busse R , Clarke H , et al. Nurses’

reports on hospital care in five countries . Health Aff (Millwood) . 2001 ; 20 ( 3 ): 43 – 53 .
Go to the article , Google Scholar

· [6] Health Affairs>Vol. 30, No. 2: Variety IssueNurses’ Widespread Job Dissatisfaction,
Burnout, And Frustration With Health Benefits Signal Problems For Patient Care

· [7] Medical Student Distress: Causes, Consequences, and Proposed Solutions Author links
open overlay panelLiselotte N.DyrbyeMDaMatthew R.ThomasMDaTait D.ShanafeltMDb
https://doi.org/10.4065/80.12.1613

· [8] Beyond Substance Abuse: Stress, Burnout, and Depression as Causes of Physician
Impairment and Disruptive Behavior Author links open overlay panelStephen
D.BrownMDaMarilyn J.GoskeMDbcCraig M.JohnsonDOa

· [9] Management of stress and prevention of burnout in emergency residents Author links
open overlay panelPhD, RN, CSKathleenLahr Keller*MD, FACEPWilliam JKoenig†
https://doi.org/10.1016/S0196-0644(89)80309-9

· [10] Oncologist Burnout: Causes, Consequences, and ResponsesTait Shanafelt , Lotte

Dyrbye

· [11] Physician Burnout: Its Origin, Symptoms, and Five Main Causes Dike Drummond, MD
Fam Pract Manag. 2015 Sep-Oct;22(5):42-47.

· [12] Changes in Burnout and Satisfaction With Work-Life Balance in Residents and the
General US Working Population Between 2011 and 2014

· [13]Author links open overlay panelTait D.ShanafeltMDaOmarHasanMBBS, MPHeLotte

 N.DyrbyeMD, MHPEbChristineSinskyMDeDanielSateleMScJeffSloanPhDcColin P.WestMD,
PhDd

· [14]Martini, S., Arfken, C.L., Churchill, A. et al. Acad Psychiatry (2004) 28: 240.
https://doi.org/10.1176/appi.ap.28.3.240

· [15]Pediatric Resident Burnout and Attitudes Toward Patient Tamara Elizabeth Baer, Angela
M. Feraco, Selin Tuysuzoglu Sagalowsky, David Williams, Heather J. Litman, Robert J.
VinciPediatrics Mar 2017, 139 (3) e20162163; DOI: 10.1542/peds.2016-2163

· [16] Mayo Clinic. "Physician Burnout Associated With Increase In Perceived Medical
Errors." ScienceDaily. ScienceDaily, 8 September 2006.
<www.sciencedaily.com/releases/2006/09/060908001413.htm>.

· [17]Physician Satisfaction and Burnout at Different Career Stages Dyrbye, Liselotte N.

etal .Mayo Clinic Proceedings , Volume 88 , Issue 12 , 1358 – 1367

· [18]Maya Romani & Khalil Ashkar (2014) Burnout among residents, Libyan Journal of
Medicine, 9:1, DOI: 10.3402/ljm.v9.2355

· [19] Prins, J. T., Gazendam‐Donofrio, S. M., Tubben, B. J., Van Der Heijden, F. M., Van De
Wiel, H. B. and Hoekstra‐Weebers, J. E. (2007), Burnout in medical residents: a review.
Medical Education, 41: 788-800. doi:10.1111/j.1365-2923.2007.02797.x

· [20] S.H. Oakley, et al.Resident burnout after the 2011 accreditation council for
graduate medical education duty-hour restrictions: a cross-sectional survey
studyObstet. Gynecol., 123 (Suppl. 1) (2014)117S-8S

· [21] J.A. Ripp, et al.The Impact of Duty Hours Restrictions on Job Burnout in Internal
Medicine Residents: A Three-Institution Comparison Study Acad. Med., 90 (4) (2015
Apr), pp. 494-499

· [22] M. Howlett, et al.Burnout in emergency department healthcare professionals is

associated with coping style: a cross-sectional survey Emerg. Med. J., 32 (9) (2015
Sep), pp. 722-727

· [23] W.L. Awa, M. Plaumann, U. Walter Burnout prevention: a review of intervention

programs Patient Educ. Couns., 78 (2) (2010), pp. 184-190

· [24] B.R. Doolittle, D.M. Windish, C.B. SeeligBurnout, coping, and spirituality among
internal medicine resident residentsJ. Grad. Med. Educ., 5 (2) (2013), pp. 257-261

· [25] P.M. Kasi, et al.Studying the association between postgraduate trainees' work hours,
stress and the use of maladaptive coping strategies J. Ayub Med. Coll. Abbottabad, 19 (3)
(2007), pp. 37-41

· [26] A.K. Khuwaja, et al. Comparison of job satisfaction and stress among male and female
doctors in teaching hospitals of Karachi J. Ayub Med. Coll. Abbottabad, 16 (1) (2004), pp.
23-27
· [27] R. Sameer ur, et al.Stress, job satisfaction and work hours in medical and surgical
residency programmes in private sector teaching hospitals of Karachi, Pakistan J. Pak Med.
Assoc., 62 (10) (2012), pp. 1109-1112
Age:
Gender:
DHQ teaching hospital Gujranwala
How often do the following statements describe the way you feel about your patients?
10.I think of giving up medicine for
another career
11.I reflect on the satisfaction I get
1. I deal very effectively with the from being a doctor
problems of my patients 12.I regret my decision to have become
2. I feel I treat some patients as if they a doctor
were impersonal objects Every A few Once a A few Once a A few never
day times a week times a month times a
3. I feel emotionally drained from my week month or less year

work
4. I feel fatigued when I get up in the
morning and have to face another
day on the job
5. I've become more callous towards
people since I took this job
6. I feel I'm positively influencing other
people's lives through my work
7. Working with people all day is really
a strain for me
8. I don't really care what happens to
some patients
9. I feel exhilarated after working
closely with my patients

13. Do you have a part-time job besides a full-time

job?

□ No □ Yes
14. On average, how long do you work in a week?

(Check the appropriate box.)

□ Less than 40 hours □ 40 to 49 hours □ 50 to 59 hours

□ 60 to 69 hours □ 70 to 79 hours □ 80 to 100 hours □ More than 100 hours

15. How many times did you work night-duty last month?

Times of night duty times per month

16. How many times were you called out at night? Please fill in the number of calls in each day of the last week.

Seven Six Five Four Thre Two

days day days days e days
ago s ago ago days ago Yesterday
ago ago

17. On average, how many holidays do you have in a week? Please check the most appropriate number.

□ None □ One □ Two □ Three □ Four or more

18. on average, how many hours of sleep per day do you get at night during weekday? Please fill in the sleep
hours and minutes. This time may be different from the time in which you are in bed.

Hours minutes per day

19. on average, how many hours of sleep per day do you get at night during weekend? Please fill in the sleep
hours and minutes. This time may be different from the time in which you are in bed.

Hours minutes per day

20. On average, what percentage in a week do you spend as a non-medical care such as research or education?
Please check the most appropriate box.

□ None □ One to 10% □ 11 to 20%

□ 21 to 30% □ 31 to 50% □ 51% or more

21. On average, how many patients do you have in charge? Please check the most appropriate box

□ None □ One to four patients □ Five to Nine patients

□ 10 to 14 patients □ 15 to 19 patients □ 20 or more patients

22. How many years are you in practice? Please choose the appropriate number

□ Less than 10 years □ 10 to 19 years □ 20 to 29 patients

□ 30 to 39 patients □ 40 or more years

23. What is your specialty? Please choose the appropriate box

□ ENT □ Ophthalmology □ Gynecology □ Medicine

□ Surgery □Dermatology □ Pediatrics

24. What is your relationship status? Please choose the appropriate box
□ Single □ Divorced

□ Widowed or widower □ Married

If you choose “Married” in question 24, please answer the following question.

25.Does your spouse work outside of home?

□ No □ Yes

If you choose “Yes” in question 25, please answer the following question.

26.What kind of professional field does your spouse work? Please check the box below.

□ Medical doctor □ Other health care professionals

□ Other

27.Do you have any children under 22 years old? Please check the box below.

□ No □ Yes
 Informed Consent
Research Description
Title of the Study A cross sectional study of work load and burnout among doctors
working In DHQ hospital Gujranwala
Name of the Investigator Sara, Rumaiha, Rohma,Sahrish , Rameesha
Name of Organization Gujranwala Medical College
Source of Funding None
Duration of the Study 1 month (1-05-2019 to 1-06-2019)
Purpose of the study
The objective of this study is to find out the percentage of residents under study that face burnout due to job stress
by using Maslachs burnout inventory in abbreviated form. And then proving the statement that there is a correlation
of burnout with patient load long working hours and job stress
Methodology
This is an observational cross sectional study. Conducted in DHQ Gujranwala for a duration of One month from (1-
05-2019 to 1-06-2019) study population will be 100 and sampling will be convenience sampling. Data will be
collected under 3 headings i.e. demographic variables, work load assessment and Maslach abbreviated
questionnaire. The collected data will be analyzed using SPSS version 22.
Confidentiality
The information that we collect from this research project will be kept confidential. Information about you that will
be collected during the research will be put away and no-one but the researchers will be able to see it. Any
information about you will have a number on it instead of your name. Only the researchers will know what your
number is. It will not be shared with or given to anyone except our colleagues and teachers and other doctors and
professors for a cross sectional analysis or review.
Possible Benefits to the Research Participants
There may not be any benefit for you but your participation is likely to help us find the answer to the research
question. There may not be any benefit to the society at this stage of the research, but future generations are likely
to benefit
Possible Risks to the Research Participants
The only risk is that you will be giving us 10 to 20 minutes of your valuable paid time. You may not be able to
check a patient during that time period.

Right to Refuse to Participate and Withdrawal

Participation in this research study is voluntary and you may refuse to participate without any loss of benefits,
which you are entitled. You have full right to withdraw anytime during the study.
For Further Information
For further details about the research study and the rights of the participants, please contact
Name: Contact No.:

UNDERTAKING: I have read this consent form and fully understood it. I volunteer to participate in this research study.
I understand that I will receive a copy of this form. I voluntarily choose to participate, but I understand that my consent
does not take away any legal rights in the case of negligence or other legal fault of anyone who is involved in this
study. I further understand that nothing in this consent form is intended to replace any applicable Federal/Provincial
laws.

_______________________________ _________________________________
Participant’s Name & Signatures/ Signatures of the witness in case of
Thumb impression. Thumb impression

______________________________
Signatures of the Investigator and Date