The validation of a two-item measure of burnout and comparison to the full Maslach burnout inventory: a survey of Saudi healthcare trainees

Background Burnout is recognized as a disorder in 11th revision of the International Classification of Disease, has a high prevalence amongst healthcare workers and trainees, and has significant sequelae on their health and on patient care. The standard scales to assess burnout like the Maslach burnout inventory-human services survey (MBI-HSS) take time and effort to be completed, and are more appropriate for research rather than clinical settings. There is a short two-item version that has been validated among different healthcare providers and is easier to administer, improving response rates. Objective Our study aimed to validate the two-item MBI-HSS in a national cohort of Saudi health-care trainees, and to compare the prevalence of burnout when using the two-item. MBI-HSS with the prevalence yielded by the full version of the MBI-HSS at various cut off scores (standard, generalized and high cut off scores or definitions). Methods This study was a secondary in-depth analysis of data that was collected during an online survey-based cross-sectional study that targeted all healthcare professions’ training programs across Saudi Arabia between February and May 2019. Main outcome measures The primary outcome was to validate the two-items MBI-HSS in terms of diagnosing burnout, compared to the full version of MBI-HSS and examine its psychometric properties. The secondary outcomes were: comparing the prevalence of burnout yielded by the full version versus the two-items MBI-HSS. Results A total of 6,066 of 11,500 Saudi healthcare trainees (57.4%) participated in the survey. There was a significant correlation between the two-item MBI-HSS and the standard, generalized and high burnout definitions on the full MBI -HSS. The 2-item MBI-HSS had a sensitivity of 87.6%, a specificity of 76.35%, a positive predictive value of 82.5%, and a negative predictive value of 82.8% when using the standard definition of burnout. The prevalence of burnout was 48.3% when the 2-item MBI was used. It was 56.1% based on the Standard Burnout definition, 76.2% based on the Generalized Burnout definition and 17.5% based on the High Burnout definitions. Conclusions This is the first study to validate the two-item MBI in a national sample of Saudi health-care trainees, to our knowledge. Results indicate a high prevalence of burnout amongst Saudi health care trainees, and that the two-item MBI-HSS is a valid easy to use tool to measure burnout in this population. This may inform the use of this short measure among this population for educational, wellbeing and research purposes. They can also inform the evaluation and monitoring of programs addressing wellbeing amongst Saudi trainees, as well as be generalized to other populations.