Associate Professor Rush University Medical Center
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Introduction: Burnout is highly prevalent among resident physicians and may be especially common during intensive care unit (ICU) rotations, where emotional stressors such as goals-of-care (GOC) discussions and frequent patient deaths are routine. This study used the Stanford Professional Fulfillment Index (PFI) to assess burnout among internal medicine residents and explore its relationship to GOC exposure and patient deaths during ICU rotations.
Methods: Internal medicine residents at a large academic medical center were administered an anonymous survey immediately following their two-week ICU rotation. The survey included the PFI, which assesses Professional Fulfillment, Work Exhaustion, and Interpersonal Disengagement. Burnout was defined as a composite score of Work Exhaustion and Interpersonal Disengagement ≥1.33. Residents also reported the number of GOC discussions and patient deaths they experienced. Additional items assessed perceived impact of GOC, deaths, and rotation length on burnout. Pearson correlations and t-tests were used for statistical analysis.
Results: Of 56 eligible participants, 31 completed the post-rotation survey. Among these, 61.3% met criteria for burnout. Only 41.9% reported high Professional Fulfillment, while 67.7% had elevated Work Exhaustion and 51.6% had elevated Interpersonal Disengagement. In the full cohort, burnout was not significantly correlated with the number of GOC meetings (r = 0.11, p = 0.57), but showed a moderate correlation with patient deaths (r = 0.34, p = 0.062). Among residents who met burnout criteria (n = 19), patient deaths were correlated with burnout severity (r = 0.45, p = 0.056), while GOC meetings remained unassociated (r = 0.02, p = 0.93). Compared to residents without burnout, those with burnout had significantly lower Professional Fulfillment (mean 2.60 vs 3.18, p = 0.004), higher Work Exhaustion (2.20 vs 1.19, p < 0.00001), and higher Interpersonal Disengagement (1.77 vs 0.58, p < 0.00001). They also more strongly agreed that patient deaths worsened burnout (p = 0.0005).
Conclusions: Burnout is highly prevalent during ICU rotations. While GOC discussions were not associated with burnout, patient deaths may contribute meaningfully. These findings support the need for targeted emotional support and debriefing to reduce burnout in ICU trainees.
