Journal Critique: NEJM Article on Surgical Residency Burnout

This document presents a detailed critique of a journal article focusing on burnout, mistreatment (discrimination, abuse, and harassment), and suicidal thoughts among surgical residents. The critique evaluates various aspects of the article, including the title, abstract, introduction, methodology (PICO components, trial design), inclusion/exclusion criteria, design, randomization, setting, intervention, participant characteristics, generalizability, outcome measures, bias coverage, and statistical analysis. The analysis highlights the strengths and weaknesses of the study, assessing whether the article's components are clearly presented and appropriately addressed. The critique also examines the statistical methods used, the reporting of results, and the handling of patient data throughout the study. The critique finds some deficiencies in the original article, such as a lack of clearly defined primary and secondary outcomes, and insufficient coverage of bias. The analysis also points out areas where the methodology could be improved, such as providing better baseline characteristics of participants and improving data collection methods.

Running head : JOURNAL CRITIQUE
Journal club critiques
Question Answer
1 Title:
Does it reflect complete background of the article
as well as the study method? What could have
been done better?
 The title of article concern with abuse, burnout and
harassment in surgical residency training is prominent and
expose clear picture of the issue.
 Though it could have made better by importing more specific
terms in article title. The title of the article would be made
direct, descriptive, appropriate, accurate, concise, interesting,
unique, and precise.
2 Abstract:
1. Does abstract provides a structured
summary of the article?
2. What could have done better in the
abstract?
 The abstract of the article envisage that physicians especially
trainees who are engaged in the surgical subspecialties they
are at the danger for burnout. The mistreatment that they are
witnessing involves physical or verbal abuse, discrimination
in addition to that sexual abuse which dag them towards
suicidal thoughts or burnouts. The cross sectional national
survey of general surgery residents that is administered in the
year 2018 the examination of in training in American Board

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of Surgery assessed burnout, mistreatment as well as suicidal
thoughts at past year. In among 7409 residents of 262
program of surgical residency there are about 31.9 percent
who reported on disparity that is rest on self-identified
gender. Burn out that is witnessed by surgical trainees is the
symptom of cynicism, mental exhaustion, reduction of
efficiency in working place that is connected to alcoholism,
poor health, suicide, depression in amongst the physicians.
Burnout that is committed in surgical training pose negative
impact on caring of patient and workforce of physician as
there is probability of burn out physician to make report that
they had cause medical errors, reduce frequently working
effort or they may change their field of profession. Thus the
existence of practice of burn out are more occur among
trainees, surgeon in comparison to any other profession.
 The abstract require to be specific, simple, unbiased, clear,
precise, concise, honest, scholarly, and complete structured

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and that must not misrepresentative. The perfect abstract
should formulate proper abstract and they are fundamental
impression and require to be accurate, meticulously,
carefully and must be drafted appropriately. The abstract
must be made in reliable with main article particularly after
revising the paper that involve key meaning prominently.
 Thus it is significant to involve significant terms and words
in abstract for the reason proper indexing purpose in addition
to that retrieval from scientific databases and search engines.
3 Introduction:
1. Does the introduction Clearly orient the
reader to the background of the problems
(rational)?
2. Does it explain the purpose of research
(objective) and list some studies relevant
to the topic.
 The workplace mistreatment that is abuse, discrimination
and also harassment that create environment that is hostile
which inclined to weak psychological impacts and burnout
for instance suicidality. The mistreatment is general in the
areas of medicine especially for the trainees and women
those are subject to differential in power. Surgery is regarded
to designate especially specialty that is of high risk. The
introduction clearly state the background of research as it

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3. Dose it also include the hypothesis.
4. What could have done better in the
Introduction?
pointed out that trainees who are engaged in surgical
specialties they are vulnerable to peril of burnout.
 In other research the information that is collected from
survey with having low rate of response, the method of
distribution that excluded assessment on rate of response for
instance open access and twitter , cohorts that represent
restricted quantum of the definition of variable exposures
and institution. The rate of high response in the
contemporary research is beneficial for assessing the
pervasiveness of mistreatment.
 It involve hypothesis as there was absence of statistical plan
of analysis that is prespecified however there was
specification of priori hypothesis at the period of survey
progress.
 The introduction of the article can be done better as the
strong introduction require to open with robust sentencing to

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induce the reader of the article to recite next sentence . as the
introduction is the response to the question it should be well
structure that involve evidence from the relevant academic
sources.
4 • Methodology:
Does it clearly state the aim and objective of the
study and does it have the 4 components (PICO)?
• 1- Patient and population
• 2- Intervention
• 3- Comparison
• 4- Outcome
 The article have four components that is population and
patient, intervention, comparison, outcome. The population
as discussed in the article the study demography pointed out
that ration of resident who have thought of committing
suicide is 4.5 percent that is less than that of stated in general
population of about 2.0 to 3.3%. Nevertheless because of the
fact that large population with high rate of response enable to
deliver accurate estimation of occurrence. Patient and also
families of patient were the root of gender disparity as well
as racial disparity as stated by 43.6 percentage of residence.
The women’s who made report on gender disparity among
them 49.2 percent were determined with foundation as
families of patient including patients. The reporting on

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sexual discrimination were made by 10.3 percent of residents
of which 19.9 were women and about 3.9 percent were men.
The women who made report on the issue of sexual
harassment the foundation are families of patients or
patients. For instance the training of employee may lessen
mistreatment that is originating from corresponding staff and
physician it unlikely reduce mistreatment that is caused by
the families of patients as well as by patients. Another
components of article intervention is clearly underlined in
the article. The foundation of mistreatment that varies by
particular category of mistreatment may deliver significant
data to regard at the time of framing intervention. Therefore
through the procedure of targeted intervention that is rest on
National Comparative information the next trial.
Nevertheless providing the connection of mistreatment along
with suicidal thoughts and burnout minimize the issue of
mistreatment which might be the efficient way for the

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enhancement of welfare of the residents.
 As because discrimination, perceived abuse as well as abuse
were highly interlink with each other the construction of sole
composite indicator for fundamental comparison. The
composite designate the maximum frequency of report that is
made on mistreatment vulnerability. Thus the minimal
arrangement in between the pairwise comparisons with
regard to the category of mistreatment at the level of
program , therefore the program have higher subsistence of
single category of mistreatment not essentially have greater
subsistence of other. The major outcome assessment is
burnout symptoms were ascertained with the implementation
of abbreviated, modified Maslach Burnout Inventory that
made examination on depersonalization and emotional
exhaustion
,5 Methodology:
Does it include the trial design and setting (justify
The article does not specifically implement trial design as the issues
and analysis in trial performance must be anticipated at the period of

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your answer)
• Meta-analysis ( highest validity)
• Randomized controlled trials
• Prospective Cohort studies
• Case control
• Case series
• Cross over studies
trial design and should be addressed thoughtfully
6 Article evaluation
• Are the inclusions and exclusion criteria
included and properly explained: how,
where were the patient identified?
The article evaluates the issue of mistreatment without having
stringent definition that permit the analysis of vulnerability that is
observed by residents.
7 • Design: describe the design
(randomization and blinding or others) of
the trial?
The administration of assessment with ABSITE control post
examination relief and distress related to examination that might
affected reporting.

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8 • Randomization Is applied to minimize
bias?
Randomization is not implemented in the procedure of reduction of
bias individual conduct on ABSITE is traced the residents might had
issue regarding non confidentiality however assurance that review
data will be deidentified bias on social desirability would desired to
undervalue mistreatment.
9 • Setting is described? The setting is described in the study the survey on multiple choice
was administered instantaneously post January 2018 by American
Board of Surgery in training examination, the annual examination
that is computer based engaged by training of resident in the
program of general surgery that is credited by Accreditation Council
for graduate Medical Education
10 • Intervention: described the intervention
method?
Intervention is described in the research as mistreatment source
differ from particular type of mistreatment that may deliver
significant data to regard at the time of designing intervention.
11 • Participant: did they include the baseline
characteristics of participants?
• Is the data collections process is
The article failed to include baseline aspect of participants. The
differentiation is drag by heterogeneity in the definition of burnout
in addition to that bias that are non-response that is as partial survey

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mentioned and is it appropriate? where the participant those who react to survey are probable to stand
burned in comparison to individuals who do not react to the same as
the prior studies has unmeasurable and low rate of response or
involved restricted amount of institution.
The data collection method is not proper as the connection in
between the burnout and mistreatment has recommended by the
means of qualitative data however they had failed to empirically
examine it in greater population. There is failure in arriving to active
outcome due to confidentiality and DE identification of data that
have guarantee as precondition of completion of survey.
12 • Is the generalizability included? Generalizability is not included in the article
13 • Is the primary and secondary outcome
indicated/defined?
The secondary and primary outcome had not been identified or
indicated in the article.
14 • Is the bias covered properly? The bias is not covered properly as the concurrent survey
administration with ABSITE may control the outcome which
includes post examination relief and distress that is examination

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related that might hamper reporting. The appropriate evaluation
must state the purpose, content, organization and bias on the part of
publisher by this article lacks the same. In addition to that it does not
clearly stated the procedure for identification of patients.
15 Statistics
1. What level of measurement is used to
measure each of the major variables?
2. What descriptive or inferential statistics
are reported?
3. Were these descriptive or inferential
statistics appropriate to the level of
measurement for each variable?
4. Are the inferential statistics used
appropriate to the intent of the
hypotheses?
5. Does the author report the level of
significance set for the study? If so, what
 The multivariable model of logistic regression that were
implemented to inspect all residents demographics that are
available which include marital status and gender in addition
to that aspect of program that is connected with suicidal
thoughts and burnout both including and excluding of
exposure of mistreatment that is abuse, discrimination and
also sexual abuse.
 It had been examined by the primary model that the
connection of variable of composite mistreatment with
suicidal thoughts and burnout.
 The exposure variable of mistreatment was individually
structured to inspect the connection in between suicidal

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is it?
6. If tables or figures are used, do they meet
the following standards?
thoughts and burnout.
 The models that were assessed with standard error that is
responsible for clustering of residents within the program
 The effect modification in between gender and mistreatment
was discovered by serial adding of the interaction terms that
was multiplicative. The author failed to report important set
for research.
 The figures or table used do not fulfill the standards.
16 Results:
17 • The outcome of the study as well as the
proper statistical data is explained?
In order to facilitate presentation and interpretation of data the
residents were demarcated in those who made report of weekly
occurrence for minimum six times in aMBI and the one who made
report about the occurrence of symptoms less than one time in week.
Thus it has failed to explain statistical data and outcome properly
18 • All patients were accounted for from the
beginning till the end of the study?
The patients are not accounted from beginning to end od research