Context.—

Resident physicians face a higher rate of burnout and depression than the general population. Few studies have examined burnout and depression in Canadian laboratory medicine residents, and none during the COVID-19 pandemic.

Objective.—

To identify the prevalence of burnout and depression, contributing factors, and the impact of COVID-19 in this population.

Design.—

An electronic survey was distributed to Canadian laboratory medicine residents. Burnout was assessed using the Oldenburg Burnout Inventory. Depression was assessed using the Patient Health Questionnaire 9.

Results.—

Seventy-nine responses were collected. The prevalence of burnout was 63% (50 of 79). The prevalence of depression was 47% (37 of 79). Modifiable factors significantly associated with burnout included career dissatisfaction, below average academic performance, lack of time off for illness, stress related to finances, lack of a peer or staff physician mentor, and a high level of fatigue. Modifiable factors significantly associated with depression further included a lack of access to wellness resources, lack of time off for leisure, and fewer hours of sleep. Fifty-five percent (41 of 74) of participants reported direct impacts to their personal circumstances by the COVID-19 pandemic.

Conclusions.—

Burnout and depression are significant issues affecting Canadian laboratory medicine residents. As the COVID-19 pandemic continues, we recommend the institution of flexible work arrangements, protected time off for illness and leisure, ongoing evaluation of career satisfaction, formal and informal wellness programming with trainee input, formal mentorship programming, and a financial literacy curriculum as measures to improve trainee wellness.

Burnout is described in the 11th Revision of the International Classification of Diseases (ICD-11) as a syndrome resulting from chronic occupational stress that has not been successfully managed. The syndrome is characterized by feelings of exhaustion, depersonalization or increased mental distance from one's job, and reduced professional efficacy.1 

Physicians face a higher rate of burnout and depression than the general population.2  Several studies have further demonstrated an even higher risk among resident physicians. A recent survey conducted by the Canadian Medical Association demonstrates that resident physicians report significantly more burnout, depression, and lifetime suicidal ideation than staff physicians.3  In a national survey study, Dyrbye et al4  demonstrated a significantly higher rate of burnout among residents and fellows than medical students, staff physicians, and college graduates of the same age.

There have been several recent efforts to address the emergent issue of trainee burnout. In 2017, the Accreditation Council for Graduate Medical Education introduced trainee “well-being” as a program requirement to be monitored through accreditation review.5  The requirement includes provisions such as adequate administrative support; attention to scheduling and work intensity; and attention to resident burnout, depression, and substance abuse. Similarly, the most recent Royal College of Physicians and Surgeons of Canada Standards of Accreditation require programs to operate in a manner that promotes resident wellness, including providing a safe work environment, ensuring that residents are appropriately supervised, and ensuring that residents are able to access confidential wellness support.6  In response, residency programs across North America have instituted formal wellness curricula and programming. At the University of Toronto (Toronto, Canada), comprehensive wellness guidelines were developed, outlining the responsibilities of both residency programs and learners to promote and maintain trainee health and wellness.7  However, the effectiveness of these wellness interventions is largely unknown.

Although resident burnout and depression rates have been described in many clinical specialties, few studies have evaluated these rates in laboratory medicine residents. Further, the COVID-19 pandemic has undoubtedly impacted not only the delivery of residency program wellness initiatives but also the overall health and wellness of medical trainees. The purpose of the present study is to evaluate the current state of wellness in laboratory medicine residents across Canada; to identify the demographic, academic, and personal factors associated with burnout and depression in this group; and to assess the impact of the COVID-19 pandemic on resident wellness.

Research and Ethics Board approval was obtained from the Sunnybrook Health Sciences Centre (Toronto, Canada). An electronic survey was designed using a focus group composed of 5 residents and 1 staff pathologist from the University of Toronto Anatomical Pathology residency training program (see the supplemental digital content at https://meridian.allenpress.com/aplm in the March 2023 table of contents).

The survey included multiple-choice and open-ended questions. A content warning was provided at the beginning of the survey, and a link to region-specific emergency mental health resources was provided at the bottom of each page as well as at the end of the survey.

Burnout was assessed using the Oldenburg Burnout Inventory (OLBI), a 16-item survey with both positively and negatively framed items covering dimensions of exhaustion and disengagement.8  The OLBI has been validated for use in medical trainees.9  A cutoff score of 2.25 was used for exhaustion and 2.1 was used for disengagement.10  Depression was assessed using the validated Patient Health Questionnaire 9 (PHQ-9), a 9-item survey covering each of the 9 Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-V) dimensions of depression.11  Scores of 0 to 4 were categorized as no depression; 5 to 9 were considered mild depression; and 10 to 14 were considered moderate to severe depression.11 

The survey period ran from August 4, 2020, to October 4, 2020. The survey was administered through SurveyMonkey and distributed to program directors of Canadian laboratory medicine residency programs using emails obtained from the Canadian Resident Matching Service (CaRMS) Web site. Program directors were asked to forward the survey link to residents in their program. A reminder email to complete the survey was sent to all program directors 1 month into the survey period. Survey responses were collected in SurveyMonkey without participant identifying information. Survey participants were invited to enter into a drawing to win 1 of 5 Amazon.ca gift cards following survey completion as an incentive for participation.

Preliminary findings of the survey were provided to program directors via email on November 5, 2020.

Comparisons of demographic, personal, and academic factors among residents who met and did not meet criteria for burnout and depression were conducted using Pearson χ2 and 2-tailed t tests of independence with significance levels set at P < .05. Qualitative analyses of open-ended responses were completed using a mixed-methods analysis, including the use of descriptive statistics, inductive coding, and thematic analysis.

Demographic Information

A total of 74 completed surveys were received, representing 37% of the 199 Canadian laboratory medicine residents in 2020 according to CaRMS data. An additional 5 surveys were partially completed with at least the OLBI and PHQ-9 portions completed. Residents across all training levels and demographic categories were represented. A summary of demographic characteristics of the survey respondents is presented in Table 1.

Table 1

Demographics of Survey Participants

Demographics of Survey Participants
Demographics of Survey Participants

Prevalence of Burnout and Depression

Overall, 63% of surveyed residents (50 of 79) met criteria for burnout, with 38 (48%) meeting criteria for disengagement and 47 (59%) meeting criteria for exhaustion. Nearly half of the survey respondents (37 of 79; 47%) met criteria for any depression, whereas 14% (11 of 79) met criteria for moderate to severe depression. High levels of disengagement correlated significantly with any depression (P = .01). High levels of exhaustion correlated significantly with any depression (P < .001) as well as moderate to severe depression (P = .02).

Access to Wellness Resources and Programming

Approximately 75% (58 of 77) of the surveyed residents indicated that they had access to wellness activities through their residency program. A similar proportion (74%; 57 of 77) indicated that they had access to wellness resources through their institution.

Factors Associated With Burnout and Depression

Results of Pearson χ2 analysis and 2-tailed t tests are summarized in Tables 2 through 4.

Table 2

Association of Demographic Factors With Burnout and Depression

Association of Demographic Factors With Burnout and Depression
Association of Demographic Factors With Burnout and Depression
Table 3

Association of Academic Factors With Burnout and Depression

Association of Academic Factors With Burnout and Depression
Association of Academic Factors With Burnout and Depression
Table 4

Association of Personal Factors With Burnout and Depression

Association of Personal Factors With Burnout and Depression
Association of Personal Factors With Burnout and Depression

Residence in Canada for more than 20 years, career dissatisfaction, inability to take time off for physical or mental illness, and stress related to personal finances were significantly associated with disengagement. Below average overall academic performance, career dissatisfaction, lack of peer support for academic issues, lack of a staff pathologist mentor, inability to take time off for physical or mental illness, and a high level of fatigue were significantly associated with exhaustion. Access to residency program wellness activities or institutional wellness resources did not correlate significantly with disengagement or exhaustion.

Factors identified as significantly associated with any level of depression included female gender, a higher number of research projects, career dissatisfaction, fewer hours of sleep per night, and a high level of fatigue.

Academic factors significantly associated with moderate to severe depression included career dissatisfaction, lack of peer support for academic issues, lack of access to wellness activities from the residency program, lack of access to institutional wellness resources, and an inability to take time off for physical or mental illness or vacation. Personal factors significantly associated with moderate to severe depression included fewer hours of sleep per night, a high level of fatigue, stress from personal finances, access to a primary care provider, and a recent or lifetime diagnosis of severe physical illness.

Barriers to Achieving Wellness in Residency

Qualitative analyses of open-ended responses were completed using a mixed-methods analysis, including the use of descriptive statistics, inductive coding, and thematic analysis.

Using inductive coding and thematic analysis, 20% (14 of 71) of residents indicated that the main barrier to achieving wellness in residency related to a lack of time, both during and after work hours. Twelve participants (17%) indicated that their current wellness programming did not meet their needs, including that the current programming was not of interest to them. A further 11 residents (15%) responded that their training programs did not prioritize wellness, often relating to a lack of funding or lack of protected time to pursue wellness initiatives. Thirteen participants (18%) indicated that the physical distancing restrictions in place due to the COVID-19 pandemic were the main barrier to achieving wellness. Twelve participants (17%) responded that they did not perceive any barriers to implementing wellness in their residency program.

Strategies to Improve Wellness in Residency

Of 71 respondents, 29 (41%) indicated in their open-ended response that wellness could be improved through the implementation and improvement of formal wellness activities initiated by the program, including initiatives such as team-building sessions, protected time to pursue wellness activities, a formal mentorship program, increased access to psychologic services, and the formation of a formal wellness committee. Ten residents (14%) responded that increased informal wellness initiatives, most frequently defined as social gatherings with coresidents outside of work hours, would improve their wellness. A total of 9 of 71 residents (13%) stated that improved working conditions would improve their wellness. Suggestions included improving aspects of call during both on- and off-service rotations, increasing access to healthy food at work, and increasing administrative support.

Impact of COVID-19 on Resident Wellness

When asked about program wellness initiatives during the COVID-19 pandemic, 62% of residents (46 of 74) indicated that these activities were either canceled or postponed. Further, more than half of the survey participants indicated that their personal circumstances were directly impacted by the COVID-19 pandemic (41 of 74; 55%). Of these residents, approximately half (19 of 41; 46%) reported significant impacts relating to the inability to gather and travel. Approximately one-quarter (10 of 41; 24%) reported struggles relating to child care and caring for family members. A small proportion (2 of 41; 5%) reported issues pertaining to their personal health, including acquiring COVID-19 infection. The remainder reported academic issues (7 of 41; 17%), including difficulties with in-person case review, delay of certification examinations, cancellation of electives, and reassignment to other specialties (such as internal medicine and microbiology) to meet the clinical demand of the COVID-19 pandemic (ie, redeployment).

Our study demonstrates the high rate of burnout (63%; 50 of 79) and depression (47%; 37 of 79) among Canadian laboratory medicine trainees. The reported rate of burnout in medical residents in North America varies widely in the literature, ranging from 38% to 69%.3,4,1215  Although the rate of burnout identified in this study is comparable to the overall rate of burnout in medical residents, it is considerably higher than previously identified in laboratory medicine. A recent survey of pathology residents and fellows with a response rate of approximately 7% (145 of approximately 2100) across the United States identified a self-reported burnout rate of 34% (34 of 101) in pathology residents.16  A survey of residents at a tertiary care center in the United States identified a burnout rate of 46% in pathology residents using the Maslach Burnout Inventory (MBI).17  In a multispecialty survey of residents in Alberta, Canada, which identified an overall burnout rate of 69% (498 of 718), pathology and medical microbiology residents scored significantly lower for the personal achievement index of the MBI, a measure of feelings of competence and successful achievement in one's work, than most of the other surveyed specialties.12  Similarly, although rates of burnout and depression did not vary significantly among different medical specialties in the Canadian Medical Association national physician health survey, participants from laboratory medicine had 2.44 higher odds of having low psychological well-being than in all other areas of practice.3  There are many factors that may account for the discordance in the burnout rates identified in this study of laboratory medicine residents and in studies of other medical specialties. First, there is variation in the burnout measurement tools employed by these studies, including the use of validated burnout inventories such as the OLBI or MBI (in both modified and complete forms), as well as reliance on self-assessment. In addition, there is inherent variation in the stressors, demands, workloads, and work environments of different medical specialties. Many burnout inventories assess depersonalization as a key indicator of burnout, a phenomenon that is likely to be much more common in non–patient-facing specialties, such as laboratory medicine.1820  Lastly, this survey was administered in the midst of the second wave of the COVID-19 pandemic in Canada, a time of increased strain on the health care system and overall increased psychological distress among health care workers.21,22  It is likely that the high rates of burnout and depression identified in this study are at least in part reflective of the stressors unique to this time period.

There have been several studies evaluating factors that are associated with burnout and depression in medical residents. A multicenter survey of emergency medicine residents across the United States identified having a significant other, poor global job satisfaction, and a lack of administrative and clinical autonomy as factors correlating to burnout.23  A survey of US neurosurgical residents demonstrated that inadequate operating room exposure, hostile faculty, and social stressors outside of work were associated with burnout.24  A study of internal medicine interns identified poor faculty feedback and inpatient learning experience, long work hours, and low institutional research rankings as associated with depressive symptoms.25  Our survey has identified many factors that are significantly associated with both burnout and depression. Unsurprisingly, the most pervasive factor, with significant associations with disengagement, exhaustion, and depression, was career dissatisfaction. This finding is corroborated by previous studies of burnout in medicine.23,2628  Demographic factors identified as significantly associated with burnout and depression include female gender and residence in Canada for more than 20 years. The significant association of female gender and depression has been well documented in studies of depression in medicine.2931  The finding of residence in Canada for more than 20 years as a factor significantly associated with disengagement may suggest cross-cultural differences in the experience of burnout. Indeed, studies of burnout in medical students and residents have similarly demonstrated differences in burnout rates across countries.3235  Other potentially modifiable factors correlating to burnout and depression identified in our study include participation in a higher number of research projects, stress related to personal finances, lack of peer or staff mentorship and support, and lack of access to wellness resources.

The most common barrier to achieving wellness for laboratory medicine residents identified through qualitative analyses of open-ended survey responses related to a lack of time, both during and outside of work hours. Lack of time to attend to wellness is a complex and multifactorial issue, the solution to which likely extends beyond providing protected time off for wellness activities. Residency training relies on exposure of the trainee to a high number of cases in order to achieve competence. However, in order to protect the health of trainees, programs must ensure an appropriate balance of workload demands with time to pursue wellness, with buy-in at the institutional and hospital levels. Indeed, attention to work intensity and trainee burnout has been advocated for by both the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada.5,6  The second most commonly stated barrier to wellness related to available wellness programming not meeting resident needs, whereas increasing the volume and improving the delivery of wellness activities offered through residency programs was the most commonly cited strategy to improve wellness.

The COVID-19 pandemic has undoubtedly impacted the health and wellness of health care workers, including resident physicians.36  Although typically considered nonfrontline health care workers, our survey nonetheless captures the significant impacts of the first and second waves of COVID-19 on Canadian laboratory medicine residents. More than half of the surveyed residents reported direct impacts to their personal circumstances, including issues with learning relating to redeployment, remote learning, the inability to travel for electives, or delayed certification examinations, as well as issues relating to the inability to socially gather and travel for leisure, caring for sick family members, issues with arranging child care and impacts on personal health. In a recent survey of anatomic pathology residents at our institution, 75% (15 of 20) of survey participants reported a lower educational yield of rotations occurring during the COVID-19 pandemic and further identified high stress and decreased morale during this period.37 

Based on the results of our survey, we propose a list of measures that may improve the wellness of laboratory medicine residents during and beyond the COVID-19 pandemic (Table 5). Academic measures include high-quality laboratory medicine education and assistance with career advancement that adequately prepares residents for a career in laboratory medicine, ongoing evaluation of resident career satisfaction, formal mentorship programming (both peer-to-peer and staff-to-resident), flexible work arrangements, promotion of a balanced workload with consideration of clinical and research activities, and adequate time off for illness and leisure, including the promotion of the full use of available vacation time. Wellness curriculum measures include formal and informal wellness activities and resources provided through the institution or residency program with close involvement of residents in decision-making, and the institution of a financial literacy curriculum for trainees. Other wellness interventions that have been successfully implemented for resident physicians include wellness training courses and maintenance activities, psychologic counseling, and incentives to promote physical activity and healthy eating.3840 

Table 5

Proposed Measures to Improve Laboratory Medicine Resident Wellness

Proposed Measures to Improve Laboratory Medicine Resident Wellness
Proposed Measures to Improve Laboratory Medicine Resident Wellness

Our study strengths include the large sample size and relatively high response rate of 37% (74 of 199). In addition, our study used validated scales of depression (PHQ-9) and burnout (OLBI). Strengths of the OLBI include the relatively short and freely accessible nature of the tool as well as the use of both positively and negatively framed items to assess burnout.41  We also included open-ended questions, providing a more accurate analysis that considered the breadth of real-world resident experiences. Further, our study prioritized the wellness and safety of the survey respondents, with the inclusion of content warnings, location-specific emergency mental health resources, and the maintenance of respondent confidentiality. Finally, our survey questions focused on potentially modifiable academic and personal factors, allowing laboratory medicine program directors to create or modify their wellness programming based on the results.

Limitations of our study include the lack of collection of potentially relevant demographic data, including exact training level, geographic location, laboratory medicine specialty type, race, ethnicity, and sexual orientation. Because laboratory medicine programs tend to have fewer trainees, we chose not to include this information in order to maintain trainee anonymity. The study is also subject to nonresponse bias. This was minimized by the involvement of residents in survey creation, the distribution of the survey through residency program directors, and the provision of incentives for participation, all of which yielded a relatively high response rate. In addition, the survey format of multiple-choice and short-answer questions limited the depth of dialogue that might have been captured through other information-gathering methods, such as focus group or individual interviews.

Burnout and depression are significant issues affecting a large proportion of laboratory medicine residents in Canada. The results of this study can be used by residency programs to guide the implementation and delivery of wellness programming, especially in the midst of the COVID-19 pandemic.

1.
World Health Organization.
Burn-out an “occupational phenomenon”: International Classification of Diseases. May 28, 2019.
2.
Shanafelt
TD,
Boone
S,
Tan
L,
et al
Burnout and satisfaction with work-life balance among US physicians relative to the general US population
.
Arch Intern Med
.
2012
;
172
(18)
:
1377
.
3.
CMA National Physician Health Survey. October 2018.
4.
Dyrbye
LN,
West
CP,
Satele
D,
et al
Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population
.
Acad Med
.
2014
;
89
(3)
:
443
451
.
5.
Accreditation Council for Graduate Medical Education.
The program directors' guide to the common program requirements (residency). January 31, 2020.
6.
Royal College of Physicians and Surgeons of Canada.
Standards of accreditation for residency programs in anatomical pathology. July 2020.
7.
University of Toronto Faculty of Medicine, Postgraduate Medical Education.
Wellness guidelines for postgraduate trainees. October 2019.
8.
Demerouti
E,
Bakker
A,
Vardakou
I,
Kantas
A.
The convergent validity of two burnout instruments: a multitrait-multimethod analysis
.
Eur J Psychol Assess
.
2003
;
19
(1)
:
12
23
.
9.
Dahlin
M,
Fjell
J,
Runeson
B.
Factors at medical school and work related to exhaustion among physicians in their first postgraduate year
.
Nord J Psychiatry
.
2010
;
64
(6)
:
402
408
.
10.
Peterson
U,
Demerouti
E,
Bergström
G,
Samuelsson
M,
Åsberg
M,
Nygren
Å.
Burnout and physical and mental health among Swedish healthcare workers
.
J Adv Nurs
.
2008
;
62
(1)
:
84
95
.
11.
Kroenke
K,
Spitzer
RL,
Williams
JBW.
The PHQ-9: validity of a brief depression severity measure
.
J Gen Intern Med
.
2001
;
16
(9)
:
606
613
.
12.
Ferguson
C,
Low
G,
Shiau
G.
Resident physician burnout: insights from a Canadian multispecialty survey
.
Postgrad Med J
.
2020
;
96
(1136)
:
331
338
.
13.
Kealy
D,
Halli
P,
Ogrodniczuk
JS,
Hadjipavlou
G.
Burnout among Canadian psychiatry residents: a national survey
.
Can J Psychiatry
.
2016
;
61
(11)
:
732
736
.
14.
Dahn
H,
McGibbon
A,
Bowes
D.
Burnout and resiliency in Canadian oncology residents: a nationwide resident and program director survey
.
Pract Radiat Oncol
.
2019
;
9
(1)
:
e118
e125
.
15.
Lindeman
B,
Petrusa
E,
McKinley
S,
et al
Association of burnout with emotional intelligence and personality in surgical residents: can we predict who is most at risk?
J Surg Educ
.
2017
;
74
(6)
:
e22
e30
.
16.
Kelly
M,
Soles
R,
Garcia
E,
Kundu
I.
Job stress, burnout, work-life balance, well-being, and job satisfaction among pathology residents and fellows
.
Am J Clin Pathol
.
2020
;
153
(4)
:
449
469
.
17.
Holmes
EG,
Connolly
A,
Putnam
KT,
et al
Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions
.
Acad Psychiatry
.
2017
;
41
(2)
:
159
166
.
18.
McCloskey
CB,
Johnson
K,
Brissette
M,
et al
Factors influencing US allopathic medical students to choose pathology as a specialty
.
Acad Pathol
.
2020
;
7
:
237428952095192
.
19.
Maslach
C,
Jackson
S,
Leiter
M.
Maslach Burnout Inventory Manual. 3rd ed.
Palo Alto, CA
:
Consulting Psychologists Press
;
1996
.
20.
Trockel
M,
Bohman
B,
Lesure
E,
et al
A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians
.
Acad Psychiatry
.
2018
;
42
(1)
:
11
24
.
21.
Shaukat
N,
Ali
DM,
Razzak
J.
Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review
.
Int J Emerg Med
.
2020
;
13
(1)
:
40
.
22.
Vizheh
M,
Qorbani
M,
Arzaghi
SM,
Muhidin
S,
Javanmard
Z,
Esmaeili
M.
The mental health of healthcare workers in the COVID-19 pandemic: a systematic review
.
J Diabetes Metab Disord
.
2020
;
19
(2)
:
1967
1978
.
23.
Takayesu
JK,
Ramoska
EA,
Clark
TR,
et al
Factors associated with burnout during emergency medicine residency
.
Acad Emerg Med
.
2014
;
21
(9)
:
1031
1035
.
24.
Attenello
FJ,
Buchanan
IA,
Wen
T,
et al
Factors associated with burnout among US neurosurgery residents: a nationwide survey
.
J Neurosurg
.
2018
;
129
(5)
:
1349
1363
.
25.
Pereira-Lima
K,
Gupta
RR,
Guille
C,
Sen
S.
Residency program factors associated with depressive symptoms in internal medicine interns: a prospective cohort study
.
Acad Med
.
2019
;
94
(6)
:
869
875
.
26.
Amoafo
E,
Hanbali
N,
Patel
A,
Singh
P.
What are the significant factors associated with burnout in doctors?
Occup Med
.
2015
;
65
(2)
:
117
121
.
27.
Rao
S,
Ferris
TG,
Hidrue
MK,
et al
Physician burnout, engagement and career satisfaction in a large academic medical practice
.
Clin Med Res
.
2020
;
18
(1)
:
3
10
.
28.
Mehta
LS,
Lewis
SJ,
Duvernoy
CS,
et al
Burnout and career satisfaction among U.S. cardiologists
.
J Am Coll Cardiol
.
2019
;
73
(25)
:
3345
3348
.
29.
Burger
PHM,
Scholz
M.
Gender as an underestimated factor in mental health of medical studies
.
Ann Anat
.
2018
;
218
:
1
6
.
30.
Gobert
D,
Thompson
D,
Takeshita
J,
et al
Depressive symptoms in medical students and residents: a multischool study
.
Acad Med
.
2009
;
84
(2)
:
236
241
.
31.
Hardeman
RR,
Przedworski
JM,
Burke
SE,
et al
Mental well-being in first year medical students: a comparison by race and gender: a report from the medical student CHANGE study
.
J Racial Ethn Health Disparities
.
2015
;
2
(3)
:
403
413
.
32.
Frajerman
A,
Morvan
Y,
Krebs
MO,
Gorwood
P,
Chaumette
B.
Burnout in medical students before residency: a systematic review and meta-analysis
.
Eur Psychiatry
.
2019
;
55
:
36
42
.
33.
Lucchetti
G,
Damiano
RF,
DiLalla
LF,
et al
Cross-cultural differences in mental health, quality of life, empathy, and burnout between US and Brazilian medical students
.
Acad Psychiatry
.
2018
;
42
(1)
:
62
67
.
34.
Molodynski
A,
Lewis
T,
Kadhum
M,
et al
Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries
.
Int Rev Psychiatry
.
2021
;
33
(1–2)
:
37
42
.
35.
Naji
L,
Singh
B,
Shah
A,
et al
Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression
.
CMAJ Open
.
2021
;
9
(1)
:
E189
E200
.
36.
Luo
M,
Guo
L,
Yu
M,
Jiang
W,
Wang
H.
The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public–a systematic review and meta-analysis
.
Psychiatry Res
.
2020
;
291
:
113190
.
37.
Hojilla
C,
Armstrong
S,
Pun
C,
et al
A holistic approach to pathology education during the coronavirus disease 2019 (COVID-19) pandemic
.
Arch Pathol Lab Med
.
2021
;
145
(8)
:
923
924
.
38.
West
CP,
Dyrbye
LN,
Erwin
PJ,
Shanafelt
TD.
Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis
.
Lancet
.
2016
;
388
(10057)
:
2272
2281
.
39.
Busireddy
KR,
Miller
JA,
Ellison
K,
Ren
V,
Qayyum
R,
Panda
M.
Efficacy of interventions to reduce resident physician burnout: a systematic review
.
J Grad Med Educ
.
2017
;
9
(3)
:
294
301
.
40.
Lu
F,
Ratnapalan
S.
Burnout interventions for resident physicians: a scoping
[published online June 10, 2022].
Arch Pathol Lab Med
.
2022
.
41.
Reis
D,
Xanthopoulou
D,
Tsaousis
I.
Measuring job and academic burnout with the Oldenburg Burnout Inventory (OLBI): factorial invariance across samples and countries
.
Burn Res
.
2015
;
2
(1)
:
8
18
.

Author notes

The authors have no relevant financial interest in the products or companies described in this article.

Supplemental digital content is available for this article at https://meridian.allenpress.com/aplm in the March 2023 table of contents.

A portion of the data in this study were presented as abstracts during the virtual 2021 United States and Canadian Academy of Pathology Annual Meeting; March 16, 2021.

Supplementary data