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ORIGINAL ARTICLE
Year : 2018  |  Volume : 62  |  Issue : 1  |  Page : 27-31  

Correlation among perceived stress, emotional intelligence, and burnout of resident doctors in a medical college of West Bengal: A mediation analysis


1 Post Graduate Trainee, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
2 Associate Professor, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
3 Professor and Head, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India

Date of Web Publication6-Mar-2018

Correspondence Address:
Dr. Satabdi Mitra
Department of and Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_368_16

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   Abstract 


Background: Perceived stress and burnout are by-products of powerless responsibility imposed on resident doctors. Emotional intelligence (EI) works as an adapting and coping tool. Objective: The objective of this study is to find out the role of work-related perceived stress on burnout and influence of EI on it. Methods: A descriptive cross-sectional study was conducted from February to April 2016 among 63 resident doctors of different departments of Bankura Sammilani Medical College and Hospital. Data were collected through a self-administered questionnaire for background characteristics and work-related variables. Cohen perceived stress scale, Trait EI, and Shirom-Melamed burnout questionnaire were applied for measuring perceived stress, EI, and burnout, respectively. Statistical analysis was done with of SPSS version 22.0, and for mediation analysis, Andrew F. Hyne’s SPSS macro was adopted. Nonparametric bootstrapping was done assuming small sample. Results: Out of complete responses, 67%, 22.9%, and 9.8% were from clinical, paraclinical, and preclinical specialties, respectively. Burnout had a significant positive correlation with perceived stress and in negative correlation with EI-well-being and positive correlation with EI-self-control and sociability. Physical fatigue factor of burnout had a significant positive correlation with EI-emotionality. Perceived stress had a negative correlation with EI-well-being. On mediation analysis, assuming EI as a mediator, total, direct, and indirect effects of perceived stress on burnout were significant (<0.05). Mediation was proved to act with percent mediation of 0.07. Conclusion: There was definite mitigating effect of EI on burnout by perceived stress among resident doctors. This necessitates more attention by decision-makers toward this burning problem for the sake of care of caregivers.

Keywords: Burnout, emotional intelligence, mediation analysis, perceived stress, resident doctors


How to cite this article:
Mitra S, Sarkar AP, Haldar D, Saren AB, Lo S, Sarkar GN. Correlation among perceived stress, emotional intelligence, and burnout of resident doctors in a medical college of West Bengal: A mediation analysis. Indian J Public Health 2018;62:27-31

How to cite this URL:
Mitra S, Sarkar AP, Haldar D, Saren AB, Lo S, Sarkar GN. Correlation among perceived stress, emotional intelligence, and burnout of resident doctors in a medical college of West Bengal: A mediation analysis. Indian J Public Health [serial online] 2018 [cited 2019 Dec 16];62:27-31. Available from: http://www.ijph.in/text.asp?2018/62/1/27/226622




   Introduction Top


Residency is stressful, overwhelming periods, during which residents work long hours, undertake heavy academic pressure and lives of others depend on them as they increase their knowledge exponentially. Residents carry tremendous responsibilities in their workplace yet with little autonomy besides high degree of personal, interpersonal, and work-home interference. These arrangements set this stage for residents to develop perceived stress and progressive accelerating burnout. In the present day, rising stress among the first-level caregivers in tertiary care settings, being residents, giving rise to stress-induced morbidities and dissatisfaction, for the caregivers for their jobs and in turn, lack of patient satisfaction.[1]

Perceived stress, in literature, is called as a degree to which situation in one’s life is appraised as stressful.[1] Burnout is an effective state of emotional, mental, and physical exhaustion caused by excessive and/or prolonged stress and having three components, namely, physical fatigue, cognitive weariness, and emotional exhaustion.[2] Besides temperament and personality trait, burnout may produce detrimental effect on performance and patient care. The self-efficiency of a person to perceive, understand, and manage emotions in oneself and others, while adapting and coping with surroundings to successfully deal with internal and external environmental demands is called as emotional intelligence (EI).[3] This construct was first developed by research psychologists in early 1990s who have since continued to refine and empirically validate EI models. A systemic review suggests that high-EI predicts academic success, empathy, and improved patient care, optimism, social skill, and ability to solve problems efficiently.[3]

Breaking news frequently covers for encounters between resident doctors and patients’ attendants often leading to unwanted incidents even inside institutional premises and continuous underlying apprehension in the minds of both the sides. The oft-stated reason behind it is pointed toward resource and infrastructure-poor settings to shoulder with excessive workload.

Despite doctor-patient unrest is a burning issue today and this often leads to deadly consequences for both, health setting caregivers’ burnout, and their perceived stress play important role behind it. Hence, the current study was conducted in this still almost unexplored field to find out role of work-related perceived stress on burnout and influence of EI on it among resident doctors of Bankura Sammilani Medical College, Bankura, West Bengal, India.


   Materials and Methods Top


An institution-based descriptive study with the cross-sectional design was conducted for 3 months (February to April 2016) in Bankura Sammilani Medical College and Hospital, which is the only teaching hospital with tertiary level of care setting in Bankura running since 1956. This college was affiliated with 46 postgraduate seats per academic year till date against which trainees are posted over a total of fifteen departments. Postgraduate trainees who stay in hostels and posted in different preclinical, paraclinical, and clinical specialty departments were considered as study population. Those having a history of substance abuse and history of psychiatric illness were deliberately excluded from the inclusion as study participants. In the absence of any prevalence study in similar setting, assuming 50% prevalence, sample size calculated, Zα2 xpx (100-p)/l2 (where, Zα =1.96, prevalence P = 50, so, 100-p = 50, absolute precision l = 13%) as 57. Assuming 10% of nonresponse rate, sample size came as 63. Residents were considered arbitrarily as having emergency duty or not having emergency duty and following population proportionate to size they were selected. Data collection was done with the help of:

  1. Self-administered questionnaire filled up by the study participants containing background characteristics such as age, gender, permanent residence, family type of rearing, marital status, discipline and year of posting, working hours, night duties, and emergency duties in the previous month, etc.
  2. Cohen Perceived Stress Scale (PSS)-10 questions asking about feelings and thoughts during the preceding month[4]
  3. Trait EI questionnaire short form (TEIQue-SF)-30-items questionnaire designed to measure Global TEI. These questions are distributed over four regions, namely, well-being, self-control, emotionality, and sociability and each one is responded on a 7-point Likert Scale[5]
  4. Shirom-Melamed Burnout Questionnaire -have 22 items with responses distributed in 7-point Likert Scale, ranging from 1 (almost never) to 7 (almost always). It consists of 3 subscales for physical fatigue factor, cognitive weariness factor, and emotional exhaustion factor.[6]


After obtaining ethical clearance from Institutional Ethics Committee of Bankura Sammilani Medical College, informed verbal and written consent was taken from the study participants after explaining them with the study objectives. Thereafter, the study participants, i.e., resident doctors were approached in their hostel for data collection at their convenient hours for which they were intended beforehand over telephone.

Two datasets were incompletely filled up and hence excluded from the entry and analysis. For the rest sixty-one, statistical analysis was done with SPSS version 22.0 (IBM, New York, USA) and Spearman’s rank correlation coefficient method was used to examine the relationship between variables. Mediation analysis was done with Andrew F. Hynes’s SPSS Macro (indirect) for mediation.[7] As the study sample was small, nonparametric bootstrapping for resampling with replacement was done to test the mediational model.[8]


   Results Top


Baseline characteristics

Out of 61 valid responses from the residents, 41 (67%) were from different clinical specialties, fourteen (22.9%) from paraclinical, and six (9.8%) were from preclinical participants. The mean (±standard deviation) age of the study participants was 31.16 (±4.013) years. Thirty-nine (63.9%) were male, and 22 (36.1%) were female. Thirty-six (59%) belonged to general caste followed by 10 (16.4%) scheduled tribe, 8 (13.1%) scheduled caste, and 7 (11.5%) were from other backward classes. Majority, 42 (68.9%) came from urban and 19 (31.1%) were from rural background, 33 (54.1%) were brought up in nuclear families and most, 35 (57.4%) residents were not married. Only 14 (22.9%) had job experience, either in government or nongovernment sector before starting their postgraduation. More than half of the participants were residents of 2nd year (39, 63.93%), 14 (22.95%) were of 1st year, and only 8 (13.11%) were in their 3rd year of residency. Nineteen, i.e., 31.1% admitted of occurrence of negative life event in preceding 1 year in any form.

On calculating the internal consistency of Likert Scales used, Cronbach alpha (α) showed adequate reliability (for TEIQue-SF-0.73, PSS-0.71, and Shirom-Melamed Burnout Measure-0.79).

Correlation between trait emotional intelligence, burnout, and perceived stress

Burnout has been found to have a significant positive correlation on calculation of spearman’s rank correlation coefficient by concurrent deviation method with perceived stress and negative correlation with TEI-well-being whereas positively correlated with TEI-self-control and sociability though not significant. Physical fatigue factor of burnout has a significant positive correlation with TEI-emotionality. Perceived stress also have negative correlation with TEI-well being [Table 1].
Table 1: Correlation between perceived stress, trait emotional intelligence, and burnout of participants

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Correlation between work-related profiles and burnout score

On doing partial correlation between burnout and average working hours, (median, interquartile range 133.00, 104), number of night duties (3.00, 6), and number of emergency duties (2.00, 9) in the preceding month showed positive correlation though not significant [Table 2].
Table 2: Correlation of work-related profiles of participants and burnout scores

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It was hypothesized from correlations that, TEI mediates the effect of perceived stress on burnout [Figure 1]. Mediation analysis showed that total (path c) as well as direct (path c’) effect of PS on burnout is statistically significant (P < 0.05). Indirect effect of PS on burnout through TEI is also significant. ab = 0.22, confidence interval does not include zero, so, mediation occurred and effects of perceived stress is significantly reduced by mediator (TEI) which could only account for roughly 7% of the total effect, so, percent mediation of 0.07 [Table 3].
Figure 1: Hypothesized model of mediation. (A) c path: Total effect of perceived stress on burnout. (B) a path: direct effect of perceived stress on trait emotional intelligence, b path: direct effect of trait emotional intelligence on burnout, c’ path: direct effect of perceived stress on burnout.

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Table 3: Output of mediation analysis

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   Discussion Top


Burnout may be the result of unrelenting stress, but it is not the same as too much stress. Being burnt out means feeling empty, devoid of motivation, and it may affect health-care services adversely. Different peer-reviewed, English-language articles suggest that burnout and perceived stress levels are high among the resident doctors partly contributed by exhaustive duty hours, too many night duties and over and above, powerless responsibility in workplace. A study by Prins et al. have found more self-reported errors in patient care by resident doctors having significantly high level of burnout.[9] In the Netherlands, a similar questionnaire-based study revealed that, 41.1% of residents self-reported burnout in tertiary care settings among whom, 71% accepted for presence of perceived stress behind it. Residents with burnout reported to commit significantly more errors (P < 0.001).[10] Pompili et al. found burnout to be an important issue in mediating hopelessness, a psychometric marker for suicide risk. They found disengagement and exhaustion to be significant predictors of Beck’s Hopelessness Scale score.[11]

The current study has found a significant positive correlation (P < 0.001) with perceived stress supported by a similar study by Swami et al. conducted among residents doctors.[12] The current study has also revealed night duties and emergency duties to be correlated positively with burnout; however, the association was not significant. Swami et al. in their study found workload and night duties to have weak correlation whereas physical fatigue factor to have significant correlation with workload.[12] Gander et al. found junior doctors working >40 h a week scored as excessively sleepy even felt close to falling asleep at wheel and reported a fatigue-related clinical error. Night work and schedule instability were independently associated with more fatigue measures.[13] Gelfand et al. in their university-based study from the department of surgery revealed burnout to be present with high-emotional exhaustion (50%), high depersonalization (56%), and low personal accomplishment. Within 6 months of rescheduling of duty hours, only a minority of residents showed a low level of personal accomplishments (23%).[14] Shirom et al. found that workload had no direct effect on burnout but mediated its effect through perceived stress. This may indicate toward other factors to be responsible.[15]

The current study has found burnout to have negative correlation with TEI-well-being whereas positive correlation with TEI-self-control and sociability. Physical fatigue (P < 0.001) and cognitive weariness (P = 0.04) factors have significant positive correlations with TEI emotionality, and physical fatigue factor of burnout has negative correlation with TEI well-being; however, it was not statistically significant (P > 0.05). Satterfield et al. in their study found both the EI1 and EI2, standing for EI at the start and end-point of academic year showed a negative correlation in correlation matrix.[3] Weng HC found higher self-rated EI which was significantly associated with less burnout (P < 0.001) and higher job satisfaction (P < 0.01).[16] Higher patient satisfaction was correlated with less burnout (P < 0.04) and less burnout was found to be associated with higher job satisfaction (P < 0.001). EI was found to be correlated with almost all subdimensions of burnout (P < 0.01–0.001). Higher EI was found to be correlated with less burnout and higher job satisfaction. A study in Indian perspective by Faye et al. found 70% of residents had poor EI and EI significantly was correlated with clinical anger.[17] Pau AKH in a London-based study among dental undergraduates showed EI and its factors correlated positively with each other (P < 0.01) and inversely with total PSS score (P < 0.01).[18] The current study, in mediation analysis, showed that TEI mediated the effect of perceived stress on burnout. A similar study by Swami et al., following the mediation analysis showed perceived stress to mediate the effect of TEI on Burnout.[12]


   Conclusion Top


In resource-poor settings, especially in developing countries like as in India, perceived stress and hence burnout among the resident doctors is the direct legacy of excessive workload. Limiting with continued duties, prescheduling of work, recess between duties might be intervention strategies. Status of EI abilities suggests the introduction of a specific curriculum over and above the current hidden one. It is necessary for those who make the policies and who are involved in training residents to find this construct on a useful way to develop critical professionalism and competency in the future.

Limitations

Sample size was small enough and from a single medical college giving questionable generalization of the study. Other influencing factors for stress were not sought for.

Multicentric study with large sample preferably with a longitudinal design and educational intervention provision in-between, if possible would have been better future option.

Acknowledgment

The authors are acknowledged to all the study participants who despite their heavy working load never told a single “no” in participating in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Thomas NK. Resident burnout. JAMA 2004;292:2880-9.  Back to cited text no. 1
    
2.
Shirom A. Job-related burnout: A review. In: Quick JC, Tetrick LE, editors. Handbook of Occupational Health Psychology. Washington, D.C.: APA; 2003. p. 245-64.  Back to cited text no. 2
    
3.
Satterfield J, Swenson S, Rabow M. Emotional intelligence in internal medicine residents: Educational implications for clinical performance and burnout. Ann Behav Sci Med Educ 2009;14:65-8.  Back to cited text no. 3
    
4.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.  Back to cited text no. 4
    
5.
Petrides KV, Furnham A. The role of trait emotional intelligence in a gender-specific model of organizational variables. J Appl Soc Psychol 2006;36:552-69.  Back to cited text no. 5
    
6.
Shirom A. Burnout in work organizations. In: Cooper CL, Robertson I, editors. International Review of Industrial and Organizational Psychology. New York: Wiley; 1989. p. 26-48.  Back to cited text no. 6
    
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Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008;40:879-91.  Back to cited text no. 7
    
8.
Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 2004;36:717-31.  Back to cited text no. 8
    
9.
Prins JT, van der Heijden FM, Hoekstra-Weebers JE, Bakker AB, van de Wiel HB, Jacobs B,et al. Burnout, engagement and resident physicians’ self-reported errors. Psychol Health Med 2009;14:654-66.  Back to cited text no. 9
    
10.
West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM,et al. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 2006;296:1071-8.  Back to cited text no. 10
    
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Pompili M, Innamorati M, Narciso V, Kotzalidis GD, Dominici G, Talamo A,et al. Burnout, hopelessness and suicide risk in medical doctors. Clin Ter 2010;161:511-4.  Back to cited text no. 11
    
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Swami MK, Mathur DM, Pushp BK. Emotional intelligence, perceived stress and burnout among resident doctors: An assessment of the relationship. Natl Med J India 2013;26:210-3.  Back to cited text no. 12
    
13.
Gander P, Purnell H, Garden A, Woodward A. Work patterns and fatigue-related risk among junior doctors. Occup Environ Med 2007;64:733-8.  Back to cited text no. 13
    
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Gelfand DV, Podnos YD, Carmichael JC, Saltzman DJ, Wilson SE, Williams RA,et al. Effect of the 80-hour workweek on resident burnout. Arch Surg 2004;139:933-8.  Back to cited text no. 14
    
15.
Shirom A, Nirel N, Vinokur AD. Physician burnout as predicted by subjective and objective workload and by autonomy. In: Halbesleben JR, editor. Handbook of Stress and Burnout in Healthcare. Hauppauge, NY: Nova Science Publishers; 2009. p. 141-55.  Back to cited text no. 15
    
16.
Weng HC, Hung CM, Liu YT, Cheng YJ, Yen CY, Chang CC,et al. Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Med Educ 2011;45:835-42.  Back to cited text no. 16
    
17.
Faye A, Kalra G, Swamy R, Shukla A, Subramanyam A, Kamath R,et al. Study of emotional intelligence and empathy in medical postgraduates. Indian J Psychiatry 2011;53:140-4.  Back to cited text no. 17
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Pau AK, Croucher R. Emotional intelligence and perceived stress in dental undergraduates. J Dent Educ 2003;67:1023-8.  Back to cited text no. 18
    


    Figures

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    Tables

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