==== Front United European Gastroenterol J United European Gastroenterol J UEG spueg United European Gastroenterology Journal 2050-6406 2050-6414 SAGE Publications Sage UK: London, England 33021157 10.1177/2050640620964643 10.1177_2050640620964643 Letter to the Editor Burnout in gastroenterology: Better awareness and research are needed https://orcid.org/0000-0001-5103-7311Ong John 123 Swift Carla 1 https://orcid.org/0000-0001-9851-0401Ong Sharon 45 1 East of England Gastroenterology Training Programme, Cambridge, UK 2 Department of Engineering, University of Cambridge, Cambridge, UK 3 Department of Medicine, National University of Singapore, Singapore 4 Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore 5 Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Sciences, Sengkang General Hospital, Singapore John Ong, Department of Engineering, University of Cambridge, Trumpington Street, CB2 1PZ, UK. Email: jo401@cam.ac.uk 6 10 2020 12 2020 6 10 2020 8 10 1248 1249 © Author(s) 20202020United European GastroenterologyThis article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).typesetterts2 ==== Body We read with interest the article by Buscarini et al.1 Although burnout is defined as an ‘occupational phenomenon’ rather than a mental health illness by the World Health Organization, we fully agree that it remains an important issue to address in gastroenterology, especially in the coronavirus disease 2019 era. Previous large-scale burnout studies in gastroenterology have originated mostly from the USA (pre-pandemic), and the current prevalence in the field remains poorly understood globally. Also, previous results cannot be reliably extrapolated across countries because of differences in health-care systems, working environment, study population, burnout detection tools and burnout criteria.2 Therefore, the scale of the problem must first be understood locally to compel organisational change. In managing burnout, we believe greater awareness of the syndrome is also needed amongst gastroenterologists to enable self-reporting, since a gold standard detection tool does not exist currently. Symptoms of emotional exhaustion and depersonalisation are telling of burnout. However, abnormal symptoms in only one domain can be reflective of an individual’s personality type.3 Symptoms of low personal accomplishment alone correlates poorly with burnout. These may exist in unaffected individuals and often have poor factor loading in detection tools.3,4 Nonetheless, the most extensively validated and commonly used tool to identify burnout in medical professionals – the 22-item Maslach Burnout Inventory (MBI) – has its limitations and can be costly as well as time-consuming to administer. Therefore, authorities must be prepared to allocate the time and resources to assess individuals holistically in order to achieve meaningful change. Abbreviated versions of the MBI can be inaccurate.5 So, we and other researchers advise against its use. If in doubt, or when burned-out individuals are identified, we also believe they should be referred to mental well-being support services where possible, since burnout may co-exist with undiagnosed mental health conditions such as depression. As such, comprehensive mental-health assessments should not be overlooked or replaced by ‘peer support’ alone. That said, support services must be well advertised and signposted for individuals to access. In a recent pilot study of gastroenterology trainees in the East of England, even though 35.3% had burnout or were at high risk of burnout, 51.6% of all trainees were unaware of available mental well-being services that existed within the training programme.6 In closing, we fully support Buscarini et al.’s call for better safeguards against burnout in gastroenterology. In addition, more research on burnout is also needed within the specialty. Acknowledgements Communications and access to the literature were provided by the University of Cambridge. Declaration of conflicting interests: The authors have no conflicts of interest to declare. Funding: The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: J.O. is funded by the W.D. Armstrong Doctoral Research Training Fellowship at the University of Cambridge and a development grant from the National University of Singapore. J.O. is also funded by the Journal of Gastroenterology and Hepatology Foundation (JGHF, Australia) to conduct burnout research in gastroenterology in Southeast Asia, and the British Society of Gastroenterology to conduct burnout research in gastroenterology in the UK. ORCID iDs John Ong https://orcid.org/0000-0001-5103-7311 Sharon Ong https://orcid.org/0000-0001-9851-0401 ==== Refs References 1 Buscarini E Gecse KB Tiniakos D. Burnout among gastroenterologists: how to manage and prevent it . United European Gastroenterol J 2020 ; 8 : 832 –834 . 2 Rotenstein LS Torre M Ramos MA , et al Prevalence of burnout among physicians: a systematic review . JAMA 2018 ; 320 : 1131 –1150 .30326495 3 Maslach C Jackson S Leiter M. Maslach Burnout Inventory . 4th ed Menlo Park : Mind Garden , 2018 , pp.10 –74 . 4 West CP Dyrbye LN Sloan JA , et al Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals . J Gen Intern Med 2009 ; 24 : 1318 –1321 .19802645 5 Lim WY Ong J Ong S , et al The abbreviated Maslach Burnout Inventory can overestimate burnout: a study of anesthesiology residents . J Clin Med 2019 ; 9 : 1 –14 . 6 Ong J Swift C Ong S , et al Burnout in gastroenterology registrars: a feasibility study conducted in the East of England using a 31-item questionnaire . BMJ Open Gastroenterol 2020 ; 7 : e000401 .