Letters to the Editor  |   June 2018
Tool for Predicting Medical Student Burnout From Sustained Stress Levels
Author Notes
  • Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence 
Article Information
Medical Education
Letters to the Editor   |   June 2018
Tool for Predicting Medical Student Burnout From Sustained Stress Levels
The Journal of the American Osteopathic Association, June 2018, Vol. 118, 364-365. doi:
The Journal of the American Osteopathic Association, June 2018, Vol. 118, 364-365. doi:
Web of Science® Times Cited: 1
To the Editor: 
We read with great interest the article by Johnson et al1 in the March 2018 issue of The Journal of the American Osteopathic Association. The authors performed an observational study to examine the factors of the Medical Education Hassles Scale-R to identify subscales that would be useful to categorize hassles for research and assessment purposes. They identified 7 subscales: (1) Academic and Time Pressures, (2) Financial, (3) Social, (4) External Influences, (5) Day-to-Day Functioning, (6) Relationships With Immediate Family, and (7) Health. The authors should be congratulated for performing a well-designed study on an important topic (ie, well-being) in graduate medical education and physician practice.2,3 The need to identify specific areas for intervention is an innovative concept that has not been appropriately explored.4,5 
Although the study1 was well conducted, some elements of the study need to be clarified by the authors. First, the assessment instrument used 101 individual questions, which represents a long length of participation that can induce response fatigue in participants. Current instruments evaluating burnout have been validated using only 2 questions.6 Second, the authors did not examine the degree to which program leadership contributes to burnout. It is possible that program leadership wellness and support can be protective to student burnout. Third, other factors leading to trainees’ burnout (eg, working hours, control over professional life) may also have affected the study results and need to be further explored. 
We would welcome some comments from Johnson et al1 to address these issues and thus further substantiate the findings of this important study. 
Johnson JC, Degenhardt BF, Smith CK, Wolf TM, Peterson DF. Tool for predicting medical student burnout from sustained stress levels: factor analysis of the Medical Education Hassles Scale-R. J Am Osteopath Assoc. 2018;118(3):170-180. doi: 10.7556/jaoa.2018.036 [CrossRef] [PubMed]
De Oliveira GSJr. Biological evidence of the impact of burnout on the health of anesthesiologists. J Clin Anesth. 2017;41:62. doi: 10.1016/j.jclinane.2017.06.011 [CrossRef] [PubMed]
Chan AM, Cuevas ST, Jenkins JII. Burnout among osteopathic residents: a cross-sectional analysis. J Am Osteopath Assoc. 2016;116(2):100-105. doi: 10.7556/jaoa.2016.023 [CrossRef] [PubMed]
Vinson AE, Zurakowski D, Randel GI, Schlecht KD. National survey of US academic anesthesiology chairs on clinician wellness. J Clin Anesth. 2016;34:623-631. doi: 10.1016/j.jclinane.2016.06.015 [CrossRef] [PubMed]
Gonzalez LS, Donnelly MJ. A survey of residency program directors in anesthesiology regarding mentorship of residents. J Clin Anesth. 2016;33:254-265. doi: 10.1016/j.jclinane.2016.03.004 [CrossRef] [PubMed]
West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318-1321. doi: 10.1007/s11606-009-1129-z [CrossRef] [PubMed]