Maslach Burnout Inventory Toolkit Debrief with Dr. Mary: Reflection and Takeaways

In this episode of The Holistic Physician Coaching Podcast, Dr. Jessica Singh meets with Dr. Mary, a family medicine physician in her first year of residency, to debrief her baseline Maslach Burnout Inventory Toolkit results.

The Maslach Burnout Inventory Toolkit combines the Maslach Burnout Inventory and the Areas of Worklife Survey to measure burnout within the context of work life. According to Mind Garden, the Maslach Burnout Inventory is recognized as a leading measure of burnout and has been validated by more than 35 years of research. The Areas of Worklife Survey complements the Maslach Burnout Inventory by providing additional information about employees’ perceptions of workplace qualities that may influence whether they experience greater work engagement or burnout.

Dr. Mary completed the assessment through the lens of how she was doing at work before starting maternity leave, creating a meaningful point of reflection before returning to work and a baseline for the coaching engagement. Together, Dr. Singh and Dr. Mary explore professional fulfillment, emotional exhaustion, depersonalization, personal accomplishment, and workplace factors that may contribute to burnout or support engagement.

Dr. Mary also shares insights of her experience as a resident physician, including workload, autonomy, peer support, system frustrations, and the importance of self-awareness in recognizing when burnout may be emerging. Dr. Mary reflects on what her results mean to her, how the assessment can support ongoing self-reflection, and why anchoring into personal accomplishment matters during challenging seasons of training. 

Subscribe to The Holistic Physician Coaching Podcast to access this featured episode and the full library of subscriber-only content, including physician coaching sessions, exclusive coaching debrief episodes with Dr. Jessica Singh, and coach mentoring sessions in which Dr. Singh receives mentoring in her own coaching practice.

The podcast is dedicated to making physician coaching more accessible while offering meaningful support to physicians and those who coach them. Your subscription directly supports our mission and helps sustain our work.

Timestamps

0 - Laying the Foundation for the MBI Debrief with Dr. Mary

12:00 - Dr. Mary’s Reflections on Her Maslach Burnout Inventory Toolkit Results and Key Takeaways

Resources Mentioned in this Episode: 

Maslach Burnout ToolkitTM available through Mind Garden (https://www.mindgarden.com/). 

Subscribe to the podcast: www.holisticphysiciancoachingpodcast.com 

The podcast is provided by the Center for Health and Wellness Coaches.

Transcript

[00:00:00] Dr. Jessica Singh: Welcome to the Holistic Physician Coaching Podcast. I'm your host, Dr. Jessica Singh. This podcast explores physician health, wellbeing, and fulfillment, embracing all aspects of the human experience. Just as in medicine where a single interaction can transform a life. This podcast is grounded on the belief that each coaching conversation has the power.

[00:00:29] To inspire, heal, and bring about meaningful change.

[00:00:36] In this episode, I have the privilege of meeting with Mary, who is a family medicine physician in the United States in her first year of residency. Today, we will be going over her Maslow Burnout Inventory Toolkit assessment. Mary, Thank you so much for taking the assessment. I wanted to ask how your experience was just even completing the questionnaire.

[00:00:59] Dr. Mary: It's good. I think there was some interesting questions. I can't recall any specific right now, but, it was good. And I filled it out primarily with the perspective of how I was doing before starting maternity leave because I haven't really been working since. So it'll be interesting to see how it changes when I go back.

[00:01:17] Dr. Jessica Singh: I wanted to ask if you could tell me more about that perspective.

[00:01:21] Dr. Mary: Yeah, it was more so just reflecting on my work experience leading up to maternity leave and how the balance was at work and everything, which is overall pretty positive. I'm hoping that that perspective holds true when I go back and that I don't have more burnout, I guess, recorded on the survey.

[00:01:40] Dr. Jessica Singh: So one of the reasons why I chose This assessment, specifically, is because the Maslach burnout inventory is recognized as one of the leading measures of burnout, and it's validated by over three decades of extensive research. The areas of work life survey, I also find really interesting, especially with working with physicians. Because there's no way I'm going to be with you at work, or objectively know how you're feeling in your environment.

[00:02:03] And so, I really love this because one of the biggest stigmas towards burnout and well being that it's based on the individual, when in reality It's in the environment in the organization. And so hence the areas of work life survey assesses basically your perception of the workplace and qualities that either contribute to burnout or engagement.

[00:02:26] And so together, it's a really interesting way of not only looking at how someone may be experiencing burnout or not experiencing burnout, but also how their work environment, there are certain areas that may or may not be contributing to this. And so, I wanted to ask you, just even before we go into debriefing this assessment, how would you describe your professional fulfillment from your work?

[00:02:53] Dr. Mary: Pretty high, I would say, which I feel like is a good, maybe unique thing, but maybe not so unique an intern here, maybe more unique once you're transitioning to like, third year residency or in full attending mode. But it's a great shift going from being a medical student to being an intern. At least personally, I feel like it's a lot more liberating.

[00:03:17] You have a lot more autonomy. And I feel like what I'm actually doing is really helping patients and being valued. As you would hope, going from being a student.

[00:03:26] Dr. Jessica Singh: So you are experiencing it sounds like a high level of professional fulfillment in enjoying the autonomy and the evolution of your responsibilities in transitioning, in your transition from a student to being the physician.

[00:03:42] Dr. Mary: Definitely.

[00:03:44] Dr. Jessica Singh: I guess because the education on burnout medical education is so varied, I'd love to know just, , what your background with education has been on burnout and either how you've seen it manifest.

[00:03:56] Or I know you have mentioned already a couple times that, you know, I hope it's not more burnt out when I go back to work. So I guess my question for you is, what does burnout mean to you for a physician?

[00:04:08] Dr. Mary: In my mind, I feel like burnout is very similar in its spectrum to depression, kind of like work depression is how I see it in my mind, almost where you have lost a lot of satisfaction of what used to bring you satisfaction. There's more frustration and agitation and or feelings of numbness and the workforce and in your day to day and interaction with patients if you're working clinically. That's at least how I see it. I'm not, it's no professional definition or anything, but I've gotten some good background teaching on burnout, at least in my first and second year with some workshops that I attended in medical school, things like that. But yeah, I would say it's certainly not exclusive to clinicians, but is a huge problem in the medical field, of course.

[00:04:57] Thanks.

[00:04:58] Dr. Jessica Singh: Thank you for so honestly answering. Obviously, this isn't a textbook. This is meant to ask what it means to you, so I really appreciate your sharing so candidly. Because these are the conversations, right? Everyone talks about burnout, but what does it mean to you?

[00:05:12] And so I know it might sound obvious about the problems of burnout in healthcare, I guess, first hand, just through your medical school career, and even just, the first six months of being an intern, how have you seen burnout either manifest for you or the people that you work with?

[00:05:30] Dr. Mary: I feel like the root of burnout that I've seen is number one, exhaustion. co residents or attendings who are just working around the clock or pulling 24s, or on call all the time. I feel like exhaustion leads to to a lot of the depersonalization because you're just dragging yourself across the floor trying to get the checklist done.

[00:05:52] And then a lot of the human connection and the meaning behind what you're doing is lost in that because you are so exhausted. So depersonalization of the patient and treating people more like objects or seeing them less as human beings and with validated feelings and just kind of disregarding

[00:06:12] the feelings of others, whether that's the patients or the co workers too. And I feel like I've seen in my experience as a student, and then now that intern frustration being a huge contributor to burnout. So, frustration with the medical system, frustration with medical insurance, and, decisions that hospital administrators decide or clinic administrators, you know, all of that. I find the definition, I've heard this before, but like the definition of insanity is doing the same thing over and over expecting a different outcome. And I feel like that is a huge part of burnout and how the system tells us to do the same thing over and over in a certain way. But then these four very sick, maybe uninsured patients are coming back to the hospital with the same thing over and over.

[00:06:56] You do the same thing over and over, but there is no different outcome and that drives people insane. I think that's another big source of the frustration and burnout.

[00:07:05] Dr. Jessica Singh: Very simply, honestly said. It's really frustrating when things are done the same way, especially when you're a scientist and you're educated and you know, we're supposed to be learning from our history. And so, it's interesting because in your description of burnout, basically, you've essentially described the three areas that the Maslach Burnout Inventory assesses for.

[00:07:27] So it assesses for emotional exhaustion, which is exactly what you said. The exhaustion was number one. The deep personalization that happens and from your description and is also like a dehumanization of medicine. And then there's this feeling of personal accomplishment that's also measured by the Maslach burnout inventory.

[00:07:45] Because as you had mentioned, you were saying your fulfillment might feel very high right now and that sense of accomplishment of that alignment, it obviously impacts our experiences of burnout. So it's interesting because obviously this is validated by lots of years of research. And just in talking about it from experience, you can get to the core aspects of it. Similarly, when you talk about the system and the struggles that providers have had with the system that you've seen, So the reason the areas of work life survey is administered in conjunction with this is because it measures six areas of the work environment that may be contributing to burnout, either in a protective or in a non protective way, such as the workload control. You had mentioned the increase in autonomy and your evolution from being a student to an intern, reward, community, fairness, and alignment of values.

[00:08:36] And so it's very difficult, especially in residency, when your residency is dictated by a match system to have any control over the work environment that you were in. And that is arguably the hardest time of your life and training.

[00:08:50] Dr. Mary: Yes, a lot that is out of our control. Even where you end up working and then in the system itself that you may not have chosen or it wasn't your top choice. Yeah, a lot of frustration. I can see behind that.

[00:09:02] Dr. Jessica Singh: And so, before we get into debriefing your specific report, I wanted to ask you, as you think about now your work environment, and where you are right now as residents, what factors do you think you feel are sources of support that you have, or sources of frustration?

[00:09:20] Dr. Mary: I honestly feel the relationship with my cohort, my peer interns Is like exceptional and it's a huge source of support, which is wonderful. I think we just all got very lucky that our personalities mesh really well. And I know that's definitely not the case with every resident cohort. so that's very helpful, especially with me being on maternity leave.

[00:09:40] No one's been like, talking smack or being, oh, my gosh, we have to take her night shifts or something. Everyone's been really, really supportive. And then I haven't had close interactions with all of our attendings on a regular basis yet, but the ones that I have, I felt very supported by them.

[00:09:54] We have generally younger attendings in our residency program. And so I feel like that is useful in the sense that they're close to their experience in residency. And so they can relate and try to at least empathize, if not make positive changes in the program. So that's a good, good source of support.

[00:10:12] And then you said the second question being bad sources, I suppose, or not supported. 

[00:10:17] Dr. Jessica Singh: Yeah, or just, areas of the work environment that may lead or be a cause of frustration.

[00:10:22] Dr. Mary: Well, there is a constant fight in my program, I think, between patients, not to the patients themselves, but the system where, say, the family wants them to be hospitalized because they really just want placement into a skilled nursing facility. That's a huge source of frustration, especially because my inpatient medicine team, we have no cap for patients.

[00:10:47] And so we essentially call ourselves babysitters whenever there's, five or six patients who have just been there for like a week to two weeks waiting for insurance authorized. Okay. You know, or wherever they're needing to go rehab. so That drives me crazy for the many reasons we all know is that, you know, the longer in the hospital, the sicker you can get ultimately. 

[00:11:07] Dr. Jessica Singh: So it's kind of the way the policy is, like you had mentioned, the system kind of going in the same way and being a source of frustration.

[00:11:14] Dr. Mary: Right.

[00:11:15] Dr. Jessica Singh: And so you had said that you had taken this assessment with the perspective of you being on maternity which is where you are right now, and that you were hoping that your scores, you know, that the burnout doesn't increase when you go back. Why is that important to you?

[00:11:29] Dr. Mary: I think it's with what we're talking about, too, with the stress and anxiety I have with going back, a lot of that is anxious worry that I'm not going to find satisfaction in my work, I'm going to be burnt out and exhausted by trying to multitask so many things at once, and I'm going to be worried about home while I'm at work, and then worried about work when I'm home, and then quality of life at home and quality of life at work. 

[00:11:53] Dr. Jessica Singh: So it's wanting to achieve what you had said, that work life balance and in all domains of life. So looking at where you are right now, in terms of your Maslach burnout inventory scale, So they assessed your scores for emotional exhaustion, depersonalization, and personal accomplishment. The percentile I'm going to read to you, as described on the report, means that this percentage of people rated themselves as having less frequency of that scale topic.

[00:12:22] So for instance, you scored a 49th percentile of emotional exhaustion. And basically that means that 49 percent of people felt emotional exhaustion less frequently than you did. And the next one like depersonalization, where you had 45 percentile. So this report compares you to a general population of over 11, 000 people. That's where this percentile is coming from. And this specific one is also for medical personnel. So you scored basically 55 percent of people answering this had more depersonalization than you did.

[00:13:00] And then the last part was personal accomplishment. We're used to having good grades and whatnot. So sometimes the higher number on this assessment does, it's not a right or wrong or a good or bad or anything, but for personal accomplishment, you actually scored in the 81st percentile, meaning that 81 percent of people felt personal accomplishment less frequently than you did.

[00:13:24] So I'm going to pause for a moment and ask how you feel like your scores may have resonated with you.

[00:13:31] Dr. Mary: Yeah, no, I'm actually surprised I was pretty in the middle for like emotional exhaustion. I guess I kind of expected myself to be a little better and with depersonalization too, but at the same time, knowing where I was prior to starting leave and just running through the motions. I mean, I answered as honestly as I could. So I can see how maybe that is not as good as a score as I expected but glad that I scored, I think, significantly better in terms of the personal accomplishment. I think a lot of that is coming from a medical student perspective, where I was so, so frustrated.

[00:14:04] I would score way worse on all of these if I had put it as a medical student, because even with a program where I was blessed to do a fair amount, honestly, you're still has lots of barriers with that. And there's a huge learning curve too. So even if you have the desire to be more effective, there's still a huge learning curve as with intern year as well.

[00:14:23] So that may be why I place things more in the middle for the first two categories is part of that learning curve, creating barriers for me to feel like I'm being more effective.

[00:14:33] Dr. Jessica Singh: And what about the scores surprised you?

[00:14:36] Dr. Mary: Well, I think it's just because I'm so early in my training. Part of me is like, Oh no, I'm already just the average yeah, I don't know if that means only can go down from there, or, if there's obviously room for improvement that I can go back 

[00:14:51] Dr. Jessica Singh: Yeah, so they saying that these scores are based on percentiles of a general population of 11, 000 people. And it's subjective. The way you feel when you answer these questions is based at your state of mind at a current point in time, right?

[00:15:05] In this instance, maternity leave. So with that being said, do you feel, just to answer your own question, what does the score mean to you? What insights are you gaining from this?

[00:15:16] Dr. Mary: Well, thank you for clarifying. It's not just 11, 000 physicians but diverse cohort. But I think for me, that brings more awareness that I, when I'm with patients, kind of reassess: am I present with this person, treating them as a human being, or am I kind of zoning out and running in and out of the rooms because I have to go around soon or something?

[00:15:36] Um it helps me to have more awareness in this moment, make sure that I am not swinging too far the other way, 

[00:15:44] Dr. Jessica Singh: So raising awareness of where you are. Have you done any previous burnout assessments before?

[00:15:51] Dr. Mary: I think I've done similar ones, not this one, but in medical school, I'm pretty sure during a workshop that we had about burnout but I took part in. 

[00:15:59] Dr. Jessica Singh: Do you feel like it may be important for you, either through some validated assessment or in your own way to continuously check in with yourself, right? When you're with your patients and whatnot. How do you feel like assessing your burnout may be impactful to you?

[00:16:15] Dr. Mary: Well, I think again, it's good for self reflection and kind of check where I am. Right now in my career and that I'm aware if I'm kind of slipping in one category or if I'm needing some help. 

[00:16:26] Dr. Jessica Singh: Sure. So, again, helps to raise awareness, maybe objectively if you're using an assessment and maybe get support when needed or give more attention to some place that maybe overlooked due to other demands you might be experiencing. And so, those were your scores with burnout. Is anything else coming to you right now on that topic before we move into the areas of work life survey scores that you had?

[00:16:54] Dr. Mary: Not at the moment. But again, it's good to know that I feel good fulfilling right now and wanting to maintain that I suppose is a big positive I will say from this exam. Not an exam. That was a Freudian slip. Wow. That's hilarious. The assessment.

[00:17:12] Dr. Jessica Singh: How would you like to anchor in that feeling of personal accomplishment?

[00:17:17] Dr. Mary: Just remembering this, remembering the test, remembering the moment, and maintaining that, knowing that my efforts do make a difference, even if the system sometimes can make me feel otherwise. 

[00:17:28] Dr. Jessica Singh: So really, checking in with yourself again. So now we're going to move on to discussing your areas of work life survey. And so this assessed six qualities of the work area, work environment, workload, control, reward, community, fairness, and values. And these percentiles are a little different.

[00:17:49] They're based on a general population of over 22, 000 people over a diverse range of occupations, but it's similar numbers. So for instance, for workload, they ranked your, the way you had answered a 24 percentile, meaning that your degree of workload is better than 24 percent of people surveyed.

[00:18:14] For control, you had a 72, your scores fell in the 72th percentile. So that way your degree of fit or agreement with you and the control you're experiencing at work is better than 72 percent of people surveyed. So I'll just pause because there's six of them, and we just discussed workload and control.

[00:18:35] So I just want to pause for a moment and ask how that's resonating with you right now.

[00:18:41] Dr. Mary: A little surprised. I guess I'd maybe expect that to be flipped, but again, I answered the questions honestly in the moment, so maybe feeling that as an intern, the workload is a bit much for me. There's a lot to learn all at once. There's a big learning curve in general, so I guess I'm not surprised then. Then the degree of control. Yeah, maybe because I'm naive, honestly, in terms of my perception of what is under my control right now, with, taking care of patients in the hospital setting and getting them discharged, because there's so much of medicine that happens outside of the clinic and outside of the hospital.

[00:19:23] Dr. Jessica Singh: So you feel like they, they resonate with this situation you're experiencing.

[00:19:28] Dr. Mary: Definitely.

[00:19:29] Dr. Jessica Singh: Then moving on. So in terms of reward, your feeling of reward or fit with the organization, you had 75%, meaning that you're scored better than 75 percent of people surveyed. Similarly for community, you were in the 60th percentile. So your feeling of community, and I know you mentioned that at the beginning of this talk too, and even in previous coaching sessions, how you felt grateful for the cohort you're with.

[00:19:54] So you had a better fit or agreement than 60 percent of people surveyed.

[00:20:01] Dr. Mary: Yeah, I think both of 

[00:20:02] those track, again, like we're talking about, I have. I feel like a very good sense of community in my intern cohort, and even like with the other classes of residence too, although not as close. And then for reward, I guess that aligns pretty well with high score that I had, or higher, I guess, in comparison to the other general population for personal accomplishment, which is great.

[00:20:24] I'm really hoping that that reward aspect is maintained again when I go back, and I feel that leaving home and child and husband is worth it.

[00:20:34] 

[00:20:35] Dr. Jessica Singh: Having the alignment of work with your values in life. Then the last two values, one was, so for fairness, you had responded in the 82nd percentile feeling that you had a better fit or agreement with your organization in terms of fairness than 82 percent of people surveyed. And then the last one is values. so you had scored 76, And that was to align with everything you've been saying.

[00:21:03] Dr. Mary: I would say that that also fits. Again, maybe my fairness perception will change as I get grips on things about the hospital or my program or, whatever. Although generally I feel like people's experiences are pretty positive so I'm there. And with values to I think part of that stems, not that this is by any means like a necessary thing for my work environment.

[00:21:25] But, I work for a Catholic institution, I suppose, the hospital system, Catholic affiliated and I'm not Catholic, but I'm Christian and that's, you know, service to others is a big part of my value systems. At least having that message be spread around the hospital, whether that's always the case, I don't know.

[00:21:41] But having that message there is, I think, helpful to make me feel like my work environment aligns with my value.

[00:21:47] Dr. Jessica Singh: So it sounds like this assessment, this burnout tool, what's been coming is maybe a more

[00:21:55] big picture in terms of the attributes of emotional exhaustion. You had said, , you were surprised at your scores, but then you had answered them honestly, but also a validation or positive reinforcement of the personal accomplishment that you're experiencing and the stronger attributes of your work that you're experiencing.

[00:22:14] Dr. Mary: Yeah, that's exactly right.

[00:22:16] Dr. Jessica Singh: So just to conclude this debriefing, what would you say your biggest takeaways are?

[00:22:22] Dr. Mary: Hmm. Biggest takeaways I think right now. The things that I can control from this assessment would be my emotions and the way that I treat others. So the first two categories, we talked about

[00:22:33] Yeah, emotional exhaustion and depersonalization, which both of those things I feel like are more in my control than, say, like, my community or if my work aligns with my values, things like that. There's a lot of it, I think, really improves with good self care and maybe changing my perspective.

[00:22:53] Dr. Jessica Singh: Did you find this assessment worth your time?

[00:22:55] Dr. Mary: Yeah, no, I think it was a very interesting reflection tool. And again, I'm very eager to see, you know, the space line compared to maybe a few months down the road, what it'll look like. Hopefully, I'm not crashing and burning. Hopefully, you know, maybe it'll take a dip various aspects, but then I'll be able to recover in different ways.

[00:23:16] Dr. Jessica Singh: Sure. So as an experiment, right, as an experiment without being graded.

[00:23:20] Dr. Mary: Yes, not an exam.

[00:23:23] Dr. Jessica Singh: Exactly. And yes, about five or six months from now, we'll do another assessment and we'll see where you go.

[00:23:28] Dr. Mary: Awesome. Perfect. Thank you, Jessica. That's helpful.

[00:23:32] Dr. Jessica Singh: Thank you so much, Mary.

[00:23:33] Thank you for listening to the Holistic Physician Coaching Podcast. This podcast is dedicated to making coaching more accessible and to support both physicians and those who coach them. Subscribe to access exclusive subscriber only episodes, including physician coaching sessions, coaching debriefs, and coach mentoring sessions that offer valuable insights for professional development for coaches.

[00:24:03] Your support helps sustain this work. Subscribe and leave a thoughtful review at www.holisticphysiciancoachingpodcast.com. Sending you warmth and light.