LAUSR

T he program director (PD) for internal medicine at a large tertiary care hospital has been following the research on resident burnout and wants to proactively identify and address this problem in her program. Through informal conversations, the PD has confirmed that burnout is affecting the residents in this program. The discussion also reveals that burnout has many sources and contributing factors—both personal (eg, marital strain and ailing children) and professional (eg, academic performance anxiety and interprofessional conflicts). Many residents struggled to articulate how these stressors combine to lay the foundation for burnout, explaining: ‘‘It’s not that I can’t manage each problem. I can be a supportive spouse. I’m pretty good with my patients. But, everything, all together, it’s too much. I just can’t be everything for everyone all the time.’’ The PD knows that addressing the burnout problem will require creating a more supportive learning environment and helping individuals develop more resilience. But how can the PD do this when learners struggle to identify the primary cause of their burnout, and suggest that everything (the combination of many causes) is the problem? The program director’s conundrum in this fictional scenario is common. Research has established that residents are affected by fatigue, frustration, and burnout (ie, depersonalization and emotional exhaustion) and suggests that patient care is negatively affected by physician burnout. While these studies offer valuable insights, many PDs struggle to support residents because the causes of burnout cut across multiple aspects of their lives. When everything is contributing to burnout, how can a PD identify starting points for change? Educators and scholars in other domains have investigated this conundrum by applying the concept of role identities. A role identity is ‘‘the character and the role that individuals devise for themselves when occupying specific social positions.’’ To illustrate, many residents have different identities—as physicians, spouses, and/or as parents. Each of these roles informs a resident’s identity at all times—a resident’s identity as a physician is not confined to time spent in the clinical work environment, nor is a resident’s identity as a spouse and a parent confined to time spent at home. We live our multiple roles across all experiences. The concept of role identities has informed research on burnout in nurses, emergency responders, and university-employed academics, helping to identify (1) which roles (both personal and professional) inform the individual’s identity, and (2) how incongruities across these (eg, role strain and role conflict) contribute to an individual’s stress. Since tensions within and across roles affect job performance and well-being, medical educators might also use the concept of role identities to help residents identify some of the root causes of their burnout. In other words, PDs can use role identities as a lens through which to identify competing demands from different roles (eg, being the resident on-call and a parent) and/or within an individual role (eg, managing a particularly difficult colleague and modeling professionalism to junior learners). These can then become the starting points for interventions. Since burnout is not a one-size-fits-all problem, these concepts can help PDs tailor efforts to address each resident’s unique burnout experience. In this Perspective, drawing on theories from sociology, we describe the relationship between burnout and role identities. It is not our goal to review the literature on resident burnout: existing reviews are available. Nor is it our goal to make recommendations for policies to address resident burnout: such recommendations have already been articulated. Instead, we offer 2 concepts related to role identities—role strain and role conflict—as tools for PDs to help residents identify some root causes of their burnout. We also outline ways that the concepts of role strain and role conflict DOI: http://dx.doi.org/10.4300/JGME-D-18-00117.1