We recently discussed research by Busireddy et al. on the value of different interventions for medical residents, such as 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 also 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 may be due to its use of a “reversed score” calculation; that is, subtracting the actual score from the highest possible score. 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. 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:
(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).
(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.
If you are trying to assess your own level of burnout, it may help to use a non-reversed scale. In our self-assessment survey, we have included such questions to assist with self-assessment. We do not have sufficient data to provide normalized values, but we hope the scale is a helpful start to your own exploration of functioning well in terms of well-being and burnout.
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. In the assessment of resident burnout, career regret may be a more significant marker of burnout. We have included such questions as well.