Stress & Burnout


In crisis

  • » Call 911
  • » Go to ED
  • » Call National Suicide Hotline

Urgent/counseling or

medical error/litigation stress

Test Yourself

Stress screen from Mental Health America
Mental Health Screen (depression, anxiety, bipolar, PTSD) from Mental Health America

General Stress

Understanding Stress - HelpGuide.Org
Types of Stress - APA
Warning Signs of Stress - APA
Six Myths about Stress - APA
Stress - Vaden
Stress - APA
ePhysicianHealth - Anxiety Module

Work Stress

Workplace Stress - APA
What Makes a Workplace Stressful? - Jeffrey Pfeffer, Professor of Organizational Behavior
Resolving Conflicts at Work - Ombuds David Rasch
Stress and Organizational Change - Help Center
Leadership and Organizational Change - Help Center
Tips for Managing Anger - APA

Traumatic Stress

Coping with traumatic stress - Help Center


Physician Resilience and Burnout - Can You Make the Switch? - article
Reversing Burnout: How to rekindle your passion for your work - article
Physician Satisfaction, Burnout and Patient Care Quality - lecture slides by Mark Linzer, MD
Book: Leiter and Maslach, Banishing Burnout, 2005, ISBN 0-7879-7608-3Z
Book: Cole, Goodrich, Gritz, Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success, 2008, ISBN 1603274502


HIP - offers a variety of stress reduction classes
Tips on Managing Stress - APA
Relaxation - Vaden
Relaxation Techniques for Stress Relief - HelpGuide.org
Progressive Relaxation - Hobart and William Smith Colleges
Eliciting the Relaxation Response - MBMI
Mini-Relaxation Exercises - MBMI




Medical Trainees

The problems program directors inherit: medical student distress at the time of graduation. Dyrbye LN, Moutier C, Durning SJ, Massie FS Jr, Power DV, Eacker A, Harper W,  Thomas MR, Satele D, Sloan JA, Shanafelt TD. Med Teach. 2011 33(9):756-8. PMID: 21854153.

Patterns of distress in US medical students.  Dyrbye LN, Harper W, Durning SJ, Moutier C, Thomas MR, Massie FS, Eacker A, Power DV, Szydlo DW, Sloan JA, Shanafelt TD.  Med Teach. 2011 33(10):834-9. PMID: 21942482.

Development and preliminary psychometric properties of a well-being index for medical students. Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD.  BMC Med Educ. 2010 10:8. PMID: 20105312.

Personal life events and medical student burnout: a multicenter study. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD.  Acad Med. 2006 81(4):374-84. PMID: 16565189.

Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. West CP, Shanafelt TD, Kolars JC. JAMA. 2011 306(9):952-60. PMID: 21900135.

The incidence and predictors of job burnout in first-year internal medicine residents: a five-institution study. Ripp J, Babyatsky M, Fallar R, Bazari H, Bellini L, Kapadia C, Katz JT, Pecker M, Korenstein D. Acad Med. 2011 86(10):1304-1310. PMID: 21869661.

Predictors of persistent burnout in internal medicine residents: a prospective cohort study. Campbell J, Prochazka AV, Yamashita T, Gopal R.  Acad Med. 2010 85(10):1630-4. PMID: 20881685.


Career fit and burnout among academic faculty. Shanafelt TD, West CP, Sloan JA, Novotny PJ, Poland GA, Menaker R, Rummans TA, Dyrbye LN.. Arch Intern Med. 2009 169(10):990-5. PMID: 19468093.

Preventing burnout in academic medicine. Linzer M. Arch Intern Med. 2009 169(10):927-8. PMID: 19468083.

Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Balch CM, Freischlag JA, Shanafelt TD. Arch Surg. 2009 144(4):371-6. PMID: 19380652.

Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. West CP, Dyrbye LN, Sloan JA, Shanafelt TD. J Gen Intern Med. 2009 24(12):1318-21. PMID: 19802645.

Effects on Career/Professionalism

Burnout and serious thoughts of dropping out of medical school: a multi-institutional study. Dyrbye LN, Thomas MR, Power DV, Durning S, Moutier C, Massie FS Jr, Harper W, Eacker A, Szydlo DW, Sloan JA, Shanafelt TD.  Acad Med. 2010 85(1):94-102. PMID: 20042833.

Relationship between burnout and professional conduct and attitudes among US medical students. Dyrbye LN, Massie FS Jr, Eacker A, Harper W, Power D, Durning SJ, Thomas MR, Moutier C, Satele D, Sloan J, Shanafelt TD. JAMA. 2010 304(11):1173-80. PMID: 20841530.

Beyond substance abuse: stress, burnout, and depression as causes of physician impairment and disruptive behavior. Brown SD, Goske MJ, Johnson CM. J Am Coll Radiol. 2009 6(7):479-85. PMID: 19560063.

Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Williams ES, Konrad TR, Scheckler WE, Pathman DE, Linzer M, McMurray JE, Gerrity M, Schwartz M. Health Care Manage Rev. 2010 35(2):105-15. PMID: 20234217.

Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA. Ann Surg. 2011 254(4):558-68. PMID: 21946217.

Physician burnout: a potential threat to successful health care reform. Dyrbye LN, Shanafelt TD. JAMA. 2011 305(19):2009-10. PMID: 21586718.

Effects on Patients

Physician wellness: a missing quality indicator. Wallace JE, Lemaire JB, Ghali WA.  Lancet. 2009 374(9702):1714-21. PMID: 19914516.

Physician wellness and patient safety. Campbell DA Jr. Ann Surg. 2010 251(6):1001-2. PMID: 20485129.

How do distress and well-being relate to medical student empathy? A multicenter study. Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD.  J Gen Intern Med. 2007 22(2):177-83. PMID: 17356983.

Association of resident fatigue and distress with perceived medical errors. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. JAMA. 2009 302(12):1294-300. PMID: 19773564.

Rates of medication errors among depressed and burnt out residents: prospective cohort study. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP. BMJ. 2008 336(7642):488-91. PMID: 18258931.

Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance.  Hassan I. Br J Surg. 2006 93:1554-1559. PMID: 17054315.

Burnout and medical errors among American surgeons. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag J. Ann Surg. 2010 251(6):995-1000. PMID: 19934755.

Physician burnout and patient-physician communication during primary care encounters. Ratanawongsa N, Roter D, Beach MC, Laird SL, Larson SM, Carson KA, Cooper LA. J Gen Intern Med. 2008 23(10):1581-8. PMID: 18618195.

Doctors' stress responses and poor communication performance in simulated bad-news consultations. Brown R, Dunn S, Byrnes K, Morris R, Heinrich P, Shaw J.  Acad Med. 2009 84(11):1595-602. PMID: 19858823.

Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients.  Halbesleben JR, Rathert C.  Health Care Manage Rev. 2008 33(1):29-39.  PMID: 18091442.

The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study.  Williams ES, Manwell LB, Konrad TR, Linzer M.  Health Care Manage Rev. 2007 32(3):203-12. PMID: 17666991.

Adverse events

Housestaff and medical student attitudes toward medical errors and adverse events.  Vohra PD, Johnson JK, Daugherty CK, Wen M, Barach P. Jt Comm J Qual Patient Saf. 2007 33(8):493-501. PMID: 17724946.

Residents’ responses to medical error: coping, learning, and change.  Engel KG, Rosenthal M, Sutcliffe KM.  Acad Med 2006 81(1):86-93. PMID: 16377827.

Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.  West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, Shanafelt TD. JAMA. 2006 296(9):1071-8. PMID: 16954486.

Personal consequences of malpractice lawsuits on American surgeons. Balch CM, Oreskovich MR, Dyrbye LN, Colaiano JM, Satele DV, Sloan JA, Shanafelt TD.  J Am Coll Surg. 2011 Sep 2. [Epub ahead of print] PMID: 21890381.

The emotional impact of medical errors on practicing physicians in the United States and Canada.  Waterman AD, et al. Jt Comm J Qual Patient Saf  2007 33(8):467-476.  PMID: 17724943.

Coping with a medical malpractice suit. Charles SC. West J Med. 2001 174:55-58. PMID: 11154674.

The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. Qual Saf Health Care. 2009 18(5):325-30. PMID: 19812092.

The role of an ethical culture for the prevention and recovery of "second victims".  Nelson WA, Beyea SC. Qual Saf Health Care. 2009 18(5):323-4. PMID: 19812091.

Caring for our own: deploying a systemwide second victim rapid response team. Scott SD, Hirschinger LE, Cox KR, McCoig M, Hahn-Cover K, Epperly KM, Phillips EC, Hall LW Jt Comm J Qual Patient Saf. 2010 36(5):233-40. PMID: 20480757.

Peer support: healthcare professionals supporting each other after adverse medical events. van Pelt F. Qual Saf Health Care. 2008 17(4):249-52. PMID: 18678720.

To err is human: supporting the patient care provider in the aftermath of an unanticipated adverse clinical outcome. Devencenzi T, O'Keefe J. Int J Emerg Ment Health. 2006 8(2):131-5. PMID: 16703852.



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