Resident Physician Burnout in the Medical Intensive Care Unit: A Prospective, Mixed-Methods Study

Burnout, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, negatively affects resident physicians and patients. Although burnout is common among intensive care unit (ICU) healthcare workers, data on its impact on resident physicians during their medical ICU (MICU) rotations are limited.

This study aimed to determine the prevalence, key drivers, and mitigating factors for burnout among resident physicians rotating through the MICU.

We conducted a single-center, mixed-methods prospective cohort study in the MICU of an academic quaternary care hospital. Over the course of a 9-month period, we surveyed residents at the end of their MICU rotation and assessed the prevalence of burnout using the Maslach Burnout Inventory, as well as perceived drivers and mitigators of burnout. Focus groups were conducted to further explore internal medicine (IM) residents' perceptions of drivers and mitigators of MICU-related burnout.

Forty-nine residents completed the survey (80% response rate), and 25 IM residents participated in focus groups. The overall burnout prevalence was 88%. Although not statistically significant, higher burnout rates were observed among first-year residents (94% vs. 78%; P = 0.12) and non-IM residents (100% vs. 81%; P = 0.07). Fifty-three percent of residents believed that there was more burnout in the MICU than other ICU rotations. Three themes emerged as drivers of burnout: patient factors (high acuity, adverse outcomes, ethical dilemmas), team and unit dynamics (interdisciplinary tensions, MICU insider-outsider bias), and the clinical learning environment (limited work-life balance, steep learning curve, normalization of burnout). The primary mitigating factors were meaningful patient interactions, supportive team dynamics, structured debriefing, protected time, and focused skill development.

Burnout in residents rotating through the MICU is extremely high, higher than the previously reported baseline resident burnout rate of 50-75%. First-year and non-IM residents may be especially vulnerable because of unfamiliarity with the unique team and unit dynamics and clinical learning environment of the MICU (high acuity, high intensity, frequent exposure to dying patients, and unit insider-outsider bias). This study highlights unique factors, which contribute to burnout among MICU residents, that differ from those affecting other critical care staff and could be addressed through targeted interventions.