Threading the Needle: Competing Contributors to Burnout in Emergency Medicine Residents

Emergency Medicine (EM) residents experience the highest rate of burnout of any specialty. Although there have been many proposed interventions, burnout remains highly prevalent. The purpose of this qualitative study was to explore how EM residents recognize, approach, and recover from burnout in order to inform future efforts to mitigate the burnout epidemic in trainees.

We interviewed 15 PGY 2-4 residents at four American EM residencies in 2023. We applied a grounded theory approach and a constructivist/interpretivist paradigm to explore participants' experiences through interactive dialogue and co-created interpretation. We invited participants to complete an online survey to collect demographics, information about their burnout experiences, and to schedule a virtual 60-min semi-structured interview, which we then transcribed, coded, and analyzed.

Analysis revealed three key tensions in the way EM residents experience burnout susceptibility versus recovery: coping by social connection versus withdrawal, perceiving burnout causes as societal versus individual, and seeing solutions to burnout as individual versus societal. Residents described withdrawing from others when experiencing burnout, yet believed that interpersonal connection could alleviate their symptoms. Viewing burnout primarily as the result of societal/organizational factors was protective. Solutions to burnout that felt most empowering to residents were individual. Perceiving burnout as the result of individual choices or seeing the solutions to burnout as requiring societal change worsened trainee distress.

Resilience to burnout requires residents to connect when they feel like withdrawing, and to take individual initiative when facing systemic obstacles. The difficulty of holding these intersecting views may explain the persistence of burnout and may prompt future studies to explore how residents who demonstrate these behaviors do so in times of stress.