الفهرس 
Medical ResidencyOnly 14 pages are availabe for public view
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Abstract
Medical residency has a negative impact on
residents’ sleep, which may, alongside stressful situations
and high workload, contribute to the development of
burnout symptoms and a decline in empathy, all of which
eventually affecting the quality of patient care. The
hypothesis in this study assumes that sleep disturbances and
burnout symptoms negatively impact empathy among
medical residents.
In this cross-sectional descriptive study, 150
residents (72 male and 78 female) doing their training at the
Ain Shams University hospitals were recruited to complete
a questionnaire of information regarding sociodemographic data and working conditions, the Pittsburgh
Sleep Quality Index (PSQI), the Maslach Burnout
Inventory (MBI) and the Interpersonal Reactivity Index
(IRI). Statistical analyses were conducted using SPSS 22nd
version. Standard univariate statistics were used to
characterize the sample. We used chi-square and Fisher
exact tests to evaluate associations.
On examining the sleep patterns of the studied
residents, our findings point out a statistically insignificant,
however clinically relevant, bad sleep quality among 96.7%
of all residents as measured by the PSQI. Total average
PSQI score was 10.4±2.5 (interval 2-16). Females scored slightly higher than males with 10.7±2.5 and 10.1±2.4
respectively, but the difference was insignificant. In a linear
regression for the factors influencing the PSQI, his study
demonstrated that the factors that affected the total PSQI
score the most were the number of hours of sleep before
residency, the number of days off and the male gender
(R2=0.970, P<0.001).
As regards burnout, this study demonstrated a highly
statistically significant (P= <0.001) severe emotional
exhaustion in 58% of all studied residents, a statistically
insignificant 91.3% experiencing severe depersonalization
(P= 0.647) and 74% experiencing low personal
achievement (P= 0.647). Concerning the rates of burnout in
different medical specialties, this study shows the highest
rates of emotional exhaustion among general surgery
residents at 100% of the studied sample followed by
anaesthesiology at 77.8% of the studied sample and highest
rates of depersonalization in general surgery, specialty
surgery, anesthesiology, dermatology, geriatrics and
pediatrics all at 100% and lowest among radiology
residents.
As regards empathy, this study demonstrates lowest
rates of empathy in residents as follows: ObGyn scored
lowest on fantasy scale (11.8±4.5) and perspective taking
(12.9±5.6), general internal medicine scored lowest on empathic concern (13.0±6.1) and general surgery scored
lowest on personal distress (10.0±5.8). Regarding changes
in empathy, a statistically significant negative correlation
was also demonstrated between the duration of residency
and fantasy scale (p 0.016). It also points out a statistically
insignificant negative correlation (P= 0.214) with empathic
concern and positive correlation (P= 0.931) with personal
distress.
This study revealed statistically significant positive
correlations between PSQI total score and emotional
exhaustion (r= 0.326, P<0.001) and depersonalization (r=
0.220, P= 0.007) burnout scales and a negative correlation
with the personal achievement (r= -0.246, P= 0.002)
subscale, indicating the effect poor sleep quality has on
increasing the dimensions of emotional exhaustion and
depersonalization and diminishing the sense of personal
achievement among residents.
The findings from this study did not point out to
statistically significant correlations between total sleep
quality and empathy subscales, however they suggested
positive correlation between poor sleep quality and fantasy
(r= 0.010, P= 0.911) and personal distress scales (r= 0.144,
P= 0.093) and negative correlations with empathic concern
and perspective taking.Of the most notable findings of this study is the
highly significant negative correlation between emotional
exhaustion (r=-0.279, P<0.001) and depersonalization (r=
0.382, P<0.001) and positive correlation with reduction in
personal achievement (r= 0.447, P<0.001). This reflects a
decrease in other-oriented feelings of sympathy and
concern for people in distress with increasing emotional
exhaustion and depersonalization and an unexpected
increase with the reduction of sense of loss of personal
achievement.
The findings from this study indicate that poor sleep
quality and higher burnout scores are significantly
correlated with lower empathy scores. These factors not
only decrease physician wellness, but also hinder accurate
diagnosis and lower the quality of medical care. Although
this study is a cross-sectional study and cannot suggest a
causative relationship between the levels of poor sleep
quality, burnout and empathy. It can suggest a correlation
between them that should be further investigated by
prospective studies.