Is Sleep the Missing Link in Trainee Wellbeing?

Background: Recent studies demonstrate an association between sleep quality, sleep quantity, and physician burnout, but the exact role on physician well-being is not fully understood. More than half of resident physicians in the United States suffer from burnout, which peaks during residency training. Our objective was to identify sleep chronotypes in pediatric interns before initiation of residency and evaluate for temporal correlations with the development of burnout.

Methods: We performed a 9 month prospective, observational pilot study during the 2020-2021 academic year. Chronotypes were determined by the MiniMunich Chronotype Questionnaire, and internal timing of subjects was determined by the Morningness Eveningness Questionnaire. The Maslach Burnout Inventory assessed levels of burnout, the Brief Resilience Scale assessed participant resilience, and the Epworth Sleepiness Scale assessed daytime sleepiness. Burnout was defined as having a high subscale score for emotional exhaustion ≥ 27 and/or depersonalization ≥13. Questionnaires were completed at enrollment and every 3 months during the study. Descriptive statistics and correlation coefficients were calculated for the study measures.

Results: Sixty-three residents were approached for enrollment. Twenty-three residents enrolled in the study, 8 withdrew or were lost to follow up, 3 withdrew but allowed use of data; complete data was obtained on 15 residents. Baseline demographics, well-being, and sleep parameters are presented in Table 1. At the initiation of the study, 80% of participants identified as intermediate chronotypes (not strong evening or morning types), with no change noted in their chronotypes during the study period. Individual subcomponents and overall burnout scores increased at 3 months and 6 months. Report of sleepiness increased over the study period. Individuals with a Morningness clock had an inverse correlation with high depersonalization at the 9-month follow-up (r = -0.70).

Conclusion: Recognition of trainee sleep disorders are important not only for schedule development that considers workhour restrictions, but also for prioritizing patient care as acute and chronic sleep deprivation can impact patient safety. Early detection and intervention to improve both sleep deprivation and burnout are warranted in health-care professionals.
We demonstrate that chronotype is correlated with specific components of burnout. This work has broad implications for GME work hour restrictions and resident wellbeing. Early targeted therapy for resident physicians with sleep disorders may mitigate burnout in physicians and improve patient safety.