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Background: Burnout is an accelerating phenomenon in the healthcare environment, with implications for physician wellbeing, patient safety, and the quality of healthcare. The ability to manage uncertainty has been identified as a potentially important determinant of burnout in physicians and is now a recognized competency for trainees. No prior studies have evaluated the association of fellows’ reaction to uncertainty with burnout metrics, including resilience and engagement. Methods: Cross-sectional online survey in July 2018 of sub-specialty fellows in the Department of Medicine at Massachusetts General Hospital, a large academic medical center, using validated scales of resilience, engagement, empowerment, burnout, and reaction to uncertainty. Results: Of the 317 eligible participants, 102 (32%) completed the reaction to uncertainty scale. In bivariate analyses, stress from uncertainty was significantly higher among women (44.9 (9.7) vs. 38.1 (11.2); p = 0.002), younger fellows (<= 30 years of age) (47.0 (6.3) vs. 39.6 (11.5); p = 0.006), and graduates of US medical schools (42.3 (10.9) vs. 36.1 (10.6); p = 0.03). Stress from uncertainty was inversely correlated with work engagement (r = -0.26; p = 0.009), work empowerment (r = -0.37; p = 0.003) and resilience (r = -0.38; p < 0.001), and positively correlated with burnout (r = 0.29; p = 0.004). Conclusion: At a time when concern for trainee wellbeing is high, with much speculation about causes of burnout, we find that efforts to decrease stress from uncertainty may pay dividends in reducing burnout, and increasing resilience, engagement and empowerment.

Stress from Uncertainty Predicts Resilience and Engagement among Subspecialty Medicine Fellows