Do you feel like you aren’t very effective? Most measures of burnout don’t see an effect on one’s sense of personal accomplishment. How come?
Burnout is typically defined as emotional exhaustion, depersonalization, and poor personal accomplishment. The gold standard for measuring burnout, Maslach Burnout Inventory (MBI), often does not correlate a sense of poor personal accomplishment with burnout. But what if the MBI is inaccurately assessing the impact of burnout of personal accomplishment. This is worrisome. Data based on this scale might be missing the impact of burnout on feelings of self-worth.
Check in with yourself on the freely available burnout scale so you can track your burnout status and well-being over time.
First, let’s look at what the MBI is telling us. In Do Changes in Resident’s Workload Decrease Burnout?, I noted research by Busireddy et al. on the value of different interventions for medical residents, including reducing work hours.
Busireddy Kiran R, Miller Jonathan A, Ellison Kathleen, Ren Vicky, Qayyum Rehan, Panda Mukta. Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review. J Grad Med Educ. June 2017;9(3):294-301. doi:10.4300/JGME-D-16-00372.1.
Their review found that the personal accomplishments score of the MBI lacks utility as a measure of burnout or as a rating to track over time; this is a common finding in the use of the MBI in health professionals. To me, it makes no sense that burnout would not be affecting such an important measure, especially one that goes the heart of what one would consider one’s self-worth.
The lack of predictability of the MBI’s personal accomplishments score may be due to the non-standard design of the scale rather than personal accomplishment not being an important part of burnout. The MBI uses of a “reversed score” calculation for personal accomplishment; that is asking the questions backward and then subtracting the actual score from the highest possible score.
Unfortunately, using a reversed score design for an inventory question is not the same as posing the question as a negative. To further clarify, a question posed as a negative would potentially look like this:
Personal Inefficacy
(Negative effects measured by wording the question negatively)
- I can’t solve the problems that arise in my patients.
- I believe that I don’t make an effective contribution to my patients.
- In my opinion, I am not a good doctor.
- I am not stimulated when I reach my patient care goals.
- My patients are not gaining from my care.
- I am not confident that I am effective in treating patients.
Alternatively, here is a “reversed score” scale of Personal Efficacy where the question is stated positively, but the value of the rating items need to be reversed (e.g., subtracted from the highest possible value) in order to understand personal inefficacy. This is the strategy used in the Maslach Burnout Inventory (MBI).
Personal Efficacy
(Negative effects measured by reverse scoring a positively worded question)
- I can efficiently solve the problems that arise in my patients.
- I believe that I make an effective contribution to my patients.
- In my opinion, I am a good doctor.
- I feel stimulated when I reach my patient care goals.
- My patients are gaining from my care.
- I am confident that I am effective in treating patients.
A study by Bresó et al. (2007) looked at a reformulated scale for assessing personal inefficacy that did not require a reverse score. It showed better predictability of this item. Keep in mind, however, that Bresó’s study was done with a different population and used a different variation of the MBI focusing on college students.
Bresó Edgar, Salanova Marisa, Schaufeli Wilmar B. In Search of the “Third Dimension” of Burnout: Efficacy or Inefficacy?. Applied Psychology. July 2007;56(3):460-478. doi:10.1111/j.1464-0597.2007.00290.x.
A non-reversed scale for personal accomplishment (efficacy) would match other MBI scales for emotional exhaustion and depersonalization. It may better assess the personal accomplishments component of burnout. Unfortunately, because the MBI is a proprietary scale, it is unlikely that the owner will address this issue or alter the scale.
Rarely discussed is the potential that the personal accomplishments scale is not as appropriate for a career-oriented profession, such as medicine. Scales that include career satisfaction may be better indications of burnout for such professionals. Slowly these scales are being introduced in evaluations of burnout.
