Can a simple screening tool with just 2 questions identify burnout? A 2012 study by Dyrbye et al. investigates if two questions can provide an adequate assessment of emotional exhaustion and depersonalization measures seen in the Maslach Burnout Inventory (MBI).
West Colin P, Dyrbye Liselotte N, Satele Daniel V, Sloan Jeff A, Shanafelt Tait D. Concurrent Validity of Single-Item Measures of Emotional Exhaustion and Depersonalization in Burnout Assessment. J Gen Intern Med. November 2012;27(11):1445-1452. doi:10.1007/s11606-012-2015-7.
The 22-item MBI is burdensome to administer and time-consuming to fill out. Due to the difficulty in filling it out, it invariably misses individuals who are unwilling to spend the time. Or it only appeals to individuals who already partially recognize that they are burned out. So, perhaps the surveys that people opt into are biased toward folks willing to fill out such a scale. To reach the goal of identifying all individuals with burnout in the population of medical professionals, we need a simpler scale.
Dyrbye et al. adapted questions from the MBI-equivalent and used the same scale in their simplified, 2-question version.
Questions
- I feel burned out from my work” [emotional exhaustion]
- I have become more callous toward people since I took this job” [depersonalization]
Scale
- 6 – Every day
- 5 – A few times a week
- 4 – Once a week
- 3 – A few times a month
- 2 – Once a month or less
- 1 – A few times a year
- 0 – Never
The study looked at a range of medical students, internal medicine residents from a single institution, and practicing surgeons. For this specific population, the simpler scale with just two questions was indeed consistently associated with results from the complete MBI assessment. The very limited population raises enthusiasm for the broader use of such a scale to identify specific burned out individuals. However, the actual sensitivity and specificity of the scale in wider populations is uncertain.
Detection is just the start. One to two questions is unlikely to be a useful means to track change over time. There are several components to emotional exhaustion and depersonalization.
Additionally, the authors did not assess the “Personal Accomplishment” component of the MBI with either question. This may be due to the fact that the MBI has not been useful in detecting burnout. Still, it may be helpful to include a third question to assess this important factor despite the MBI’s weakness in this endeavor. A potential such question that follows the same 6 to 0 scale and is not “reversed” as it is on the MBI would be:
- My effort is of poor quality [personal accomplishment]
Nor does the 2-question strategy assess career regret as a component of burnout. Burnout and accomplishment scales tend to look at more general issues that might apply to any worker. In contrast, medical professionals are engaged in a profession with a long training period of at least 7 years, and often far longer if one includes fellowship. Departure is hindered by expectations, debt, and self-perception as a medical doctor. Thus, career regret is a substantial finding for this population and deserves to be assessed. A fourth single question might be:
- I regret going into medicine [career regret]
A score on any of these four questions would need to be adapted to approximate the score as if all the questions in that category were the same. This yields the following estimates of medium and high risk [adapted to increase specificity and decrease sensitivity]:
- I feel burned out from my work” [emotional exhaustion]
- medium = 2
- high >= 3
- I have become more callous toward people since I took this job” [depersonalization]
- medium – 1-2
- high =>=3
- My effort is of poor quality [personal accomplishment]
- medium = 4
- high => 5
- I regret going into medicine [career regret] – no data available, I estimate this is similar to emotional exhaustion
- medium = 2
- high >= 3
With only a single question for each category, there will be a very limited “baseline” measure to assess change over time. So, perhaps these questions should be used as a highly specific (no means no) and insensitive (yes probably means yes, but it might mean no) screen that prompts a complete assessment of the symptoms of burnout. The addition of the two questions mentioned above would further improve specificity, but likely decrease sensitivity as they would catch folks with high ratings, but without true burnout.
Check in with yourself with our freely available self-checks, including a burnout scale that implements a similar overview.
