Burnout and impostor syndrome among emergency physicians in Japan: a multicenter cross-sectional study

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This study assessed the incidences of burnout and impostor syndrome and their causative factors in Japanese EPs. Methods This cross-sectional study administered questionnaires to 34 Japanese emergency departments (EDs). The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scores, Clance Impostor Phenomenon Scale (CIPS) scores, and their correlations with ED- and EP-level factors underwent a multivariable analysis. Results Of the 307 EPs (70.4%) participants 64 (20.8%), 69 (22.4%), and 197 (64.1%) had MBI-HSS scores that indicated a severe degree of emotional exhaustion (EE), depersonalization, and personal accomplishment (PA), respectively; 34 (11.0%) EPs had severe scores for all three components. Regarding participant CIPS scores, 92 (29.9%) had a higher value than the cutoff. The multivariable analysis of MBI-HSS scores determined severe EE scores were associated with sleep periods (odds ratio [OR], 0.699; 95% confidence interval [CI], 0.496–0.983; P = 0.040) and overnight work (OR, 2.375; 95% CI, 1.006–5.603; P = 0.048). Higher CIPS scores correlated with younger age (OR, 0.941; 95% CI, 0.894–0.991; P = 0.022), personal interviews (OR, 2.636; 95% CI, 1.308–5.312; P = 0.007), and overnight work (OR, 2.679; 95% CI, 1.048–6.851; P = 0.040). Conclusions A high level of burnout was experienced by 11.0% of the participants. Although Japanese EPs more severe scores for PA than EPs in other countries, their CIPS scores were similar. To maintain the well-being of Japanese EPs, ED supervisors should consider supporting younger specialists, interviewing effectively, providing adequate sleep periods, and improving overnight work settings. emergency physician burnout Maslach Burnout Inventory-Human Services Survey Clance Impostor Phenomenon Scale impostor syndrome Introduction Burnout is defined as physical and mental exhaustion caused by long-lasting and high stress levels. It comprises three components: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). 1 Doctors, especially emergency physicians (EPs), have at high risk for burnout due to long working hours,life-threatening situations, and pressure to work quickly and accurately. 1 , 2 In a previous study, we indicated that 8.9% of Japanese EPs experienced high-degree burnout. 3 Furthermore, Japanese EPs had more severe PA scores in the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) than those from other countries. 3 Low PA scores are in the Clance Impostor Phenomenon Scale (CIPS) indicate impostor syndrome. 4 Individuals with this condition experience self-doubt and fear of being considered an intellectual fraud. 5 It can negatively influence mental health, manifesting in anxiety, depression, neuroticism, and low self-esteem, thereby, leading to burnout. 6 Based on the results of a previous study, 3 we hypothesized that severe PA has a higher prevalence among Japanese EPs than among those from other countries owing to impostor syndrome. However, current data on underlying circumstances related to PA of Japanese EPs are limited. This study assessed the incidences of burnout and impostor syndrome and their causative factors among Japanese EPs employed in emergency departments (EDs). Methods The methods applied in this study were compatible to those from a previous study. 3 The primary difference was that we added the CIPS in this study.. Study design and setting In June 2023, this multicenter questionnaire study was performed at 34 academic and community EDs in various Japanese geographic regions. Participants In June 2023, we invited 436 physicians who worked at the 34 participating EDs. Transitional interns were excluded from the enrollment. Questionnaire Data collection As in a previous study, 3 site investigators distributed the questionnaires to the participants, which were completed anonymously, and the participants returned them to the investigator pick-up area. We collected the questionnaires from the site investigators and sent them to IID Co., Ltd. (Tokyo, Japan) for evaluations. ED-level factors Site investigators completed the ED-level questionnaire, which included analyzing the categorization of institutions, types of practice, management, shifts, overtime work, number of hospital beds, annual walk-in ED visits, annual ambulance ED visits, full-time EPs, full-time female EPs, availability of mentors (and targets), and personal interviews. We categorized the institutional addresses into rural and urban categories per the criteria of the Japanese Ministry of Land, Infrastructure, Transport, and Tourism. 7 The details for the Japanese institution categories and practice types have been described a previous study. 3 EP-level factors The participants were instructed to provide information pertaining to their age, sex, status, specialty, weekly working hours, night shift work, marital status, childcare, caregiving, average sleep period, availability of mentors (and targets), personal interviews, discrimination experienced, and work confidence level. The availability of mentors and personal interviews at work were also incorporated into the analyzed EP-level factors, given the different perceptions from the ED- and EP-levels. Maslach Burnout Inventory - Human Services Survey Similar to a previous study, 3 we used the MBI-HSS items interpreted into Japanese by Mind Garden, Inc. (Menlo Park, CA, USA) to assess burnout. Based on other similar studies, 8 – 10 the degree (severe, moderate, mild) of burnout was determined using specific cut-off scores: EE: severe, ≥ 27; DP: severe, ≥ 10; and PA: severe, ≤ 33. The principal researcher obtained a license from Mind Garden, Inc. to administer the copyrighted survey. Clance Impostor Phenomenon Scale The CIPS is a 20-item questionnaire used to assess impostor phenomenon feelings and their frequency. All items are scored on Likert scale from 1 to 5 (from not at all true to very true). Based on other similar studies, 4 , 11 , 12 we defined the presence of impostor syndrome using a cut-off score of 62. Data analyses As per former research, 3 statistical analyses were conducted using Stata/MP17 software (StataCorp. LLC, College Station, TX, USA). The descriptive statistics for both ED and EP characteristics are shown as proportions and medians with interquartile ranges (IQR), as appropriate. A multivariable logistic regression analysis was employed to manage potential confounders among ED- and EP-level factors for MBI-HSS scores, as in a previous study. 3 For the CIPS score analysis, we added the availability of personal interviews and mentors to the EP-level factors. Highly collinear factors were excluded using Pearson’s correlation coefficient. The participants with missing data were eliminated. All P-values were two-tailed, and significance was established at P < 0.05. Results Participant characteristics From the 436 eligible EPs, the participants comprised 322 EPs (73.8%) who responded to the questionnaire. 15 response forms were excluded due to the insufficient number of data points provided. Consequently, 307 (70.4%) were recruited. The ED characteristics are listed in Table 1 , and those of the EPs are listed in Table 2 . A total of 52.9% EPs managed both an intensive care unit and general wards along with the ED, and 23.5% worked overnight. Table 1 Characteristics of emergency department Emergency departments (n = 34) Location Urban 9 (26.4) Rural 25 (73.6) Categories of institute Emergency medical care institutions 10 (29.4) Emergency medical service centers 23 (67.6) Others † 1 (2.9) Practice type Ambulance only 2 (5.9) Walk-in patients only 0 Both 32 (94.1) Number of hospital beds < 500 11 (32.4) 500–1000 21 (61.8) 1000 < 2 (5.9) Management ED only (no bed management) 9 (26.5) ICU only 5 (14.7) General wards only 2 (5.9) All 18 (52.9) No. of annual walk-in ED visit, median [IQR] 9383 [5493–20000] No. of annual ambulance ED visits, median [IQR] 5647 [3400–7774] No. of full-time EPs, median [IQR] 12 [5–18] No. of full-time female EPs, median [IQR] 2 [1–5] Shift type 2-shifts 17 (50.0) 3-shifts 7 (20.6) Overnight 8 (23.5) Others 2 (5.9) Overtime work None 1 (2.9) 3 h 1 (2.9) Mentor All 1 (2.9) Residency 10 (29.4) Staff 2 (5.9) Manager 0 (0) None 21 (61.8) Interview Yes 15 (44.1) No. of interviews in a year, median [IQR] 2 [1–2] No 19 (55.9) Data are given as n (%) unless stated otherwise. ED, emergency department; ICU, intensive care unit; EP, emergency physician; IQR, interquartile range. †: a general hospital and a pediatric medical center provided ED. Table 2 Characteristics of emergency physician Emergency Physicians (n = 307) Age, median [IQR] 36 [29–43] Male 231 (75.2) Status Residency 95 (30.9) Full-time 190 (61.8) Part-time 18 (5.8) Missing 4 (1.3) Specialty Emergency medicine 276 (89.9) Others 29 (9.4) Missing 2 (0.6) Working hours per week, median [IQR] 45 [40–50] Night shift Yes 270 (87.9) Times per month, median [IQR] 5 [4–7] No 37 (12.0) Marital status Married or partnered 219 (71.3) Single 86 (28.0) Missing 2 (0.6) Childcare Yes 158 (51.4) No 148 (48.2) Missing 1 (0.3) Caregiving Yes 11 (3.5) No 296 (96.4) Averaged sleep period, median [IQR] 6 [6–7] Mentor Yes 62 (20.1) Residency 12 Graduated student 1 Full-time staff 43 Part-time staff 1 Manager 9 Missing 2 No 244 (79.4) Missing 1 (0.3) Interview Yes 129 (42.0) No. of interviews in a year, median [IQR] 2 [1–2] No 176 (57.3) Missing 2 (0.6) Discrimination experienced Yes 54 (17.5) Sex 28 Nation 3 Birth place 1 Graduated university 9 PhD 8 Specialty 11 Marital status 6 Childcare 16 Others 10 No 250 (81.4) Missing 3 (0.9) Knowledge and experiences are sufficient for my work Strongly agree 10 (3.2) Agree 68 (22.1) Neutral 91 (29.6) Disagree 88 (28.6) Strongly disagree 50 (16.2) Data are given as n (%) unless stated otherwise. IQR, interquartile range; PhD, Doctor of Philosophy. Maslach Burnout Inventory-Human Services Survey Among the 307 respondents, 64 (20.8%), 69 (22.4%), and 197 (64.1%) EPs had a severe degree of EE, DP, and PA, respectively; 34 (11.0%) EPs scored severely in all three components. The comparative analysis for this study with those from other countries is presented in Table 3 . 3 , 4 , 13 Table 3 Comparison with other studies from other countries This study (n = 307) Previous study, 2023 (n = 267) Takayesu, 2014 (n = 218) Legassie, 2008 (n = 48) Emotional Exhaustion Severe 64 (20.8%) 43 (16.1%) 72 (33.0%) 14 (29.2%) Moderate 88 (28.6%) 81 (30.3%) 82 (37.6%) 15 (31.3%) Mild 155 (50.4%) 143 (53.5%) 64 (29.3%) 19 (39.6%) Depersonalization Severe 69 (22.4%) 53 (19.8%) 128 (58.7%) 26 (54.2%) Moderate 61 (19.8%) 44 (16.4%) 51 (23.3%) 9 (18.8%) Mild 177 (57.6%) 170 (63.6%) 38 (17.4%) 13 (27.1%) Personal Accomplishment Severe 197 (64.1%) 179 (67.0%) 129 (59.1%) 15 (31.3%) Moderate 64 (20.8%) 32 (11.9%) 56 (25.6%) 20 (41.7%) Mild 46 (14.9%) 56 (20.9%) 30 (13.7%) 13 (27.1%) We outlined the degree (severe, moderate, mild) of each dimension of burnout using cutoff scores: EE: severe, ≥ 27; moderate, 17–26; mild, ≤ 16; DP: severe, ≥ 10; moderate, 6–9; mild, ≤ 5; and PA: severe, ≤ 33; moderate, 34–39; mild, ≥ 40. Clance Impostor Phenomenon Scale Among the 307 respondents, 11 (3.5%) had intense impostor experiences, and 92 (29.9%) EPs exceeded the cutoff score. Of the latter, 16 (17.3%) EPs answered that they agreed or strongly agreed their knowledge and experiences were sufficient for their work. Factors associated with MBI-HSS scores The ED- and EP-level factors corresponding to MBI-HSS scores are displayed in Table 4 . The ED-level factors comparison between institutions demonstrated a significant association of overnight work with severe EE scores (odds ratio [OR], 2.375; 95% confidence interval [CI], 1.006–5.603; P = 0.048). Considering the EPs-level factors, the average sleep period had a significant association with more severe EE scores (OR, 0.699; 95% CI, 0.496–0.983; P = 0.040). Although there were no significant differences, bed management was indicative of severe EE scores (OR, 2.431; 95% CI, 0.962–6.139; P = 0.060). Table 4 Emergency department-level and emergency physician-level factors associated with the Maslach Burnout Inventory - Human Services Survey scores EE DP PA OR (95%CI) P-value OR (95%CI) P-value OR (95%CI) P-value ED-level Categories of institute Emergency medical service centers (vs. others) 0.718 (0.327–1.577) 0.410 0.833 (0.382–1.814) 0.646 1.046 (0.524–2.087) 0.898 Bed management (vs. no) 2.431 (0.962–6.139) 0.060 1.582 (0.625–4.006) 0.333 1.825 (0.751–4.431) 0.184 Overnight (vs. shifts) 2.375 (1.006–5.603) 0.048 1.249 (0.511–3.053) 0.625 1.004 (0.445–2.265) 0.991 Overtime work > 1 h (vs. no) 1.038 (0.455–2.370) 0.928 0.874 (0.401–1.906) 0.736 1.219 (0.617–2.408) 0.568 EP-level Age 0.985 (0.941–1.031) 0.536 0.984 (0.942–1.028) 0.482 0.989 (0.953–1.026) 0.570 Female (vs. male) 0.848 (0.394–1.825) 0.674 0.954 (0.473–1.925) 0.896 0.889 (0.471–1.675) 0.717 Working hours per week 1.007 (0.986–1.029) 0.493 1.009 (0.988–1.031) 0.363 0.998 (0.979–1.018) 0.913 Night shift per month 1.050 (0.924–1.194) 0.452 0.970 (0.856–1.098) 0.633 1.012 (0.910–1.125) 0.821 Childcare (vs. no) 0.897 (0.415–1.936) 0.783 0.489 (0.237–1.007) 0.052 0.824 (0.447–1.520) 0.536 Caregiving (vs. no) 2.526 (0.603–10.572) 0.204 3.522 (0.860-14.422) 0.080 2.225 (0.423–11.690) 0.345 Sleep period 0.699 (0.496–0.983) 0.040 0.826 (0.594–1.148) 0.256 0.784 (0.585–1.049) 0.102 EE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment; OR, odds ratio; CI, confidence interval; ED, emergency department; EP, emergency physician. Factors associated with CIPS scores The ED- and EP-level factors and MBI-HSS scores associated with CIPS scores are listed in Table 5 . The comparison of ED-level factors between institutions showed that overnight work had a significant association with high CIPS scores (OR, 2.679; 95% CI, 1.048–6.851; P = 0.040). Regarding EPs-level factors, younger age had a significant association with high CIPS scores (OR, 0.941; 95% CI, 0.894–0.991; P = 0.022). A similar pattern was observed between personal interviews and high CIPS scores (OR, 2.636; 95% CI, 1.308–5.312; P = 0.007). For the MBI-HSS, severe EE scores were significantly associated with high CIPS scores (OR, 1.040; 95% CI, 1.007–1.073; P = 0.016). Moreover, participants with PA were significantly associated with high CIPS scores (OR, 0.948; 95% CI, 0.918–0.979; P = 0.001). Table 5 Emergency physician-level and emergency department-level factors, and the Maslach Burnout Inventory - Human Services Survey scores associated with the Clance Impostor Phenomenon Scale CIPS ≧ 62 OR (95%CI) P-value ED-level Categories of institute Emergency medical service centers (vs. others) 1.043 (0.456–2.384) 0.919 Bed management (vs. no) 1.201 (0.430–3.355) 0.726 Overnight (vs. shifts) 2.679 (1.048–6.851) 0.040 Overtime work > 1 h (vs. no) 1.904 (0.818–4.431) 0.135 EP-level Age 0.941 (0.894–0.991) 0.022 Female (vs. male) 1.720 (0.880–3.361) 0.112 Working hours per week 0.979 (0.957–1.002) 0.087 Night shift per month 0.956 (0.846–1.081) 0.479 Childcare (vs. no) 1.197 (0.557–2.574) 0.644 Caregiving (vs. no) 1.803 (0.336–9.684) 0.491 Sleep period 0.984 (0.698–1.386) 0.927 Interview (vs. no) 2.636 (1.308–5.312) 0.007 Mentor (vs. no) 0.652 (0.292–1.452) 0.295 MBI-HSS EE 1.040 (1.007–1.073) 0.016 DP 1.002 (0.944–1.063) 0.942 PA 0.948 (0.918–0.979) 0.001 CIPS, Clance Impostor Phenomenon Scale; OR, odds ratio; CI, confidence interval; ED, emergency department; EP, emergency physician; MBI-HSS, Maslach Burnout Inventory-Human Services Survey; EE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment. Discussion In this survey on burnout conducted with 307 EPs who worked in 34 Japanese EDs, 11.0% scored as having severe forms of all three components in the MBI-HSS. Subsequently, 29.9% of the EPs exceeded the CIPS cutoff score. The multivariable analysis determined that the average sleep period and overnight work were associated with more severe EE scores in the MBI-HSS. Moreover, the multivariable analysis revealed that younger age, personal interviews, and overnight work were associated with high CIPS scores. To the best of our knowledge, this was the first study to include both a burnout and impostor syndrome survey administered to Japanese EPs. As shown in Table 3 , the distribution of MBI-HSS scores for Japanese EPs was similar to that in a previous study. 3 The PA scores were more severe than those of studies from other countries. The incidence of impostor syndrome among medical personnel has a broad range of values from 22.5–85.7% in published literature. 12 We hypothesized that the reason for the higher incidence of severe PA scores for Japanese EPs than for those from other countries is related to imposter syndrome; however, the incidence of impostor syndrome in this research was compatible to that reported in other countries. Therefore, we need to consider other factors that contribute to the higher incidence of more severe PA scores among Japanese EPs, in addition to the distinct Japanese character described in a previous study. 3 Additionally, we found that one of the unique Japanese factors, such as overnight work, 14 was associated with severe EE and high CIPS scores. Overnight work occurs when doctors stand by at a hospital all night to handle emergency situations. Some of them work continuously during the day after overnight work. Japanese EPs tend to work longer hours than other specialty physicians. 15 To improve overtime work, the number of Japanese EDs that schedule shift work has recently increased. However, some institutions cannot introduce shift work because of the lack of staff. Japanese EPs account for only 1.2% of the total number of Japanese physicians. 16 In order to facilitate the implementation of more shift work in Japanese EDs, there is a necessity to retain and secure Japanese EPs. Another unique Japanese factor, bed management, had the strong association with severe EE scores. Some Japanese EPs are in charge of both an intensive care unit and general wards, as well as the ED. Therefore, it is suggested that Japanese EPs are more overloaded than those in other countries. Similar to a previous study, 3 we found that sleep period and age were associated with mental health. Overtime work for younger EPs and sleep periods had an association with burnout and depression risks 17 . The importance of providing a sufficient sleep period and support systems for younger EPs should be addressed. Performing personal interviews was associated with high CIPS scores. Interviews are effective in detecting personal problems and experiences that are difficult to detect using quantitative data such as the MBI-HSS and CIPS scores. 18 In this study, we did not assess the personal interview details. Therefore, we could not determine, how personal interviews contributed to the high CIPS scores. Future studies should concentrate on the details of personal interviews to accurately assess the association between them and CIPS scores. In contrast, 5.2% of the EPs, who answered that they agreed or strongly agreed that their knowledge and experiences were sufficient for their work, exceeded the cutoff for the CIPS score. This indicates that scoring methods, such as the MBI-HSS and CIPS, are effective in detecting mental issues that EPs are unaware of. ED supervisors should properly assess the well-being of EPs using scoring systems and interviews. Potential limitations Our research has several primary limitations, similar to a previous study. 3 First, we could not validate whether the participants actually had burnout and impostor syndrome. However, the MBI-HSS and CIPS are the most commonly applied evaluation tools that can suggest burnout and impostor syndrome; thus, we used them to tentatively analyze the participants, similar to other studies. 19 , 20 Second, this research was observational; thus it did not analyze the direct cause-and-effect relationship between burnout, impostor syndrome, and other factors. Finally, we only evaluated 34 EDs, which suggests a selection bias. Of these, 67.6% were from emergency medical service centers, which comprise only 6.3% of emergency medical care institutions in Japan. 21 In the future, we aim to conduct this survey nationwide in Japan. Conclusions In this multicenter survey of 307 Japanese EPs, 11.0% had high degrees of burnout. Subsequently, 29.9% of the EPs exceeded the CIPS cutoff score. Although these Japanese EPs scored more severely in PA than EPs from other countries, their CIPS scores were similar. Overnight work, a unique factor in Japan, strongly affected the well-being of Japanese EPs. To maintain the well-being of Japanese EPs, ED supervisors should implement support for younger EPs and effective interviewing, as well as ensure they have adequate sleep periods. Declarations Acknowledgements We thank the site principal investigators and EPs who work at the following sites: Chikashi Ashimine, MD (University Hospital Kyoto Prefectural University of Medicine, Kyoto); Yusuke Hagiwara, MD, MPH (Tokyo Metropolitan Children’s Medical Center, Tokyo); Shinya Hara, MD (Kochi Red Cross Hospital, Kochi); Masako Hata, MD (Matsue Red Cross Hospital, Shimane); Tetsuya Hoshino, MD (University of Tsukuba Hospital, Ibaraki); Jin Irie, MD (Hirosaki General Medical Center, Aomori); Kouhei Ishikawa, MD, PhD (Juntendo University Shizuoka Hospital, Shizuoka); Asami Ito, MD, PhD (Mie University Hospital, Mie); Daisuke Kasugai, MD, PhD (Nagoya University Hospital, Aichi); Yoichi Kato, MD (Japanese Red Cross Kumamoto Hospital, Kumamoto); Kazuki Kobayashi, MD (Nagaoka Red Cross Hospital, Niigata); Kentaro Kobayashi, MD (National Center for Global Health and Medicine, Tokyo); Asako Matsushima, MD, PhD (Nagoya City University East Medical Center, Aichi); Toshifumi Miki, MD (Chikamori Hospital, Kochi); Atsushi Morizane, MD (Kochi Health Sciences Center, Kochi); Ayako Nagashima, MD (Kohnodai Hospital, National Center for Global Health and Medicine, Chiba); Yukiko Nakayama, MD (Okinawa Prefectural Chubu Hospital, Okinawa); Misa Sasanami, MD (Hiroshima City Hiroshima Citizens Hospital, Hiroshima); Yushi Segawa, MD (Fujita Health University Hospital, Aichi); Hajime Sekii, MD (JR Tokyo General Hospital, Tokyo); Yasuyuki Sumida, MD (Rakuwakai Otowa Hospital, Kyoto); Hiroki Takami, MD, (Juntendo University Nerima Hospital, Tokyo); Kotaro Takebe, MD (North Medical Center Kyoto Prefectural University of Medicine, Kyoto); Yukitoshi Toyoda, MD, PhD (Saiseikai Yokohamashi Tobu Hospital, Kanagawa); Naoki Yamada, MD (University of Fukui Hospital, Fukui); Hiroshi Yamagami, MD (Shonan Kamakura General Hospital, Kanagawa); Erika Yawata, MD (Niigata University Medical and Dental Hospital, Niigata); and the institutions to which the authors belong. Funding This study was supported by Japan Society for the Promotion of Science KAKENHI Grant Number 22K21153. Data availability statement The data are not available due to privacy restrictions. Ethics declarations Ethics approval and consent to participate : We conducted all the methods in accordance with the relevant guidelines and regulations. The Institutional Review Board of Juntendo University Urayasu Hospital approved this study (approval no. 2020-067). Informed consent was obtained from all the participants who responded to the questionnaire. Consent for publication: Not applicable. Competing interest: The authors declare no competing interests. Author Contribution All authors (M.M., T.U., N.H., Y.G., H.F., S.T., T.Y., N.S.) contributed to the study’s conception and design. Data collection were performed by All authors (M.M., T.U., N.H., Y.G., H.F., S.T., T.Y., N.S.) , and M.M. and T.U. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The first draft of the manuscript, all figures, and tables were prepared by M.M., and all authors commented on previous versions of the manuscript. All authors (M.M., T.U., N.H., Y.G., H.F., S.T., T.Y., N.S.) read and approved the final manuscript. References Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001;52:397-422. Stehman CR, Testo Z, Gershaw RS, Kellogg AR. Burnout, drop out, suicide: physician loss in emergency medicine, part I. West J Emerg Med 2019;20(3):485-494. Morikawa M, Uechi T, Hanaki N, et al. Burnout among Japanese emergency medicine physicians: a multicentric questionnaire study. Acute Med Surg 2023;10(1):e848. Legassie J, Zibrowski EM, Goldszmidt MA. 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Ministry of Health, Labour and Welfare of Japan. Handbook of Health and Welfare Statistics 2023. Number of Physicians and Dentists in Healthcare Facilities by Department. (https://www.mhlw.go.jp/english/database/db-hh/2-2.html). Accessed December 10, 2024. Wada H, Basner M, Cordoza M, Dinges D, Tanigawa T. Objective alertness, rather than sleep duration, is associated with burnout and depression: A national survey of Japanese physicians. J Sleep Res 2024:e14304. Dicicco-Bloom B, Crabtree BF. The qualitative research interview. Med Educ 2006;40(4):314-321. Boutou A, Pitsiou G, Sourla E, Kioumis I. Burnout syndrome among emergency medicine physicians: an update on its prevalence and risk factors. Eur Rev Med Pharmacol Sci 2019;23(20):9058-9065. Mak KKL, Kleitman S, Abbott MJ. Impostor phenomenon measurement scales: a systematic review. Front Psychol 2019;10:671. Ministry of Health LaW. Summary of Static/Dynamic Surveys of Medical Institutions and Hospital Report. (https://www.mhlw.go.jp/english/database/db-hss/dl/05_Outline_of_Results_Survey_of_Medical_Institutions_2020.pdf). Accessed December 17, 2024. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 18 Jul, 2025 Editor assigned by journal 15 Jul, 2025 Editor invited by journal 27 Jun, 2025 Submission checks completed at journal 25 Jun, 2025 First submitted to journal 25 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6875221","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488760572,"identity":"b6fcd4a7-7cee-443c-9d24-b7f144f2bef5","order_by":0,"name":"Miki Morikawa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYLCChAMMcowNYCYzRESCCC3GQC0gXcRqYTjAkAhUjqQFH9CddvjYhwdn7NKbZ+Qef/Bxh7UcA/vhBwyWO3BrMbudljwj4UZybuOMvMTGmWfSjRl40gwYJM/g05JjzJDwgRmoJcewmbftMNCFOQwMkm0EtdSnM4K0/AVp4X9DjJYbhxPAWhhBWiQI2pKWzJBw5rhhY88bw5m9benGbBLPDA7g90vyYcYfx6rlDdtzDD78bLOW4+dPfvhYEk+IwYFhA5TBBsSHJRtwq4QDeWQO40ditIyCUTAKRsFIAQDJqFU8UX9CwQAAAABJRU5ErkJggg==","orcid":"","institution":"Juntendo University Urayasu Hospital","correspondingAuthor":true,"prefix":"","firstName":"Miki","middleName":"","lastName":"Morikawa","suffix":""},{"id":488760573,"identity":"b2ee7e58-a7d9-44b7-a51c-bcb3581063ae","order_by":1,"name":"Takahiro Uechi","email":"","orcid":"","institution":"Japan Organization of Occupational Health and Safety (JOHAS) Yokohama Rosai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Takahiro","middleName":"","lastName":"Uechi","suffix":""},{"id":488760574,"identity":"3fb7433c-06d5-46a1-9ed0-fea4fdb0a6d4","order_by":2,"name":"Nao Hanaki","email":"","orcid":"","institution":"Osaka University","correspondingAuthor":false,"prefix":"","firstName":"Nao","middleName":"","lastName":"Hanaki","suffix":""},{"id":488760575,"identity":"00494784-0ae7-4c48-a7f4-94bf93fa8277","order_by":3,"name":"Yukari Goto","email":"","orcid":"","institution":"Nagoya Ekisaikai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yukari","middleName":"","lastName":"Goto","suffix":""},{"id":488760576,"identity":"7b7b0673-2f67-47d3-af1b-63a3928e536e","order_by":4,"name":"Hiraku Funakoshi","email":"","orcid":"","institution":"Tokyo-bay Urayasu Ichikawa Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Hiraku","middleName":"","lastName":"Funakoshi","suffix":""},{"id":488760577,"identity":"2d5daa4b-126e-4cbd-8092-4fe21b1f57c1","order_by":5,"name":"Shinya Takeuchi","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Shinya","middleName":"","lastName":"Takeuchi","suffix":""},{"id":488760578,"identity":"948090cc-4549-45ce-945a-06a6cfa6bf5e","order_by":6,"name":"Tsukasa Yajima","email":"","orcid":"","institution":"Nagoya City University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tsukasa","middleName":"","lastName":"Yajima","suffix":""},{"id":488760579,"identity":"8fe76051-0013-4993-ae1b-827072748bd2","order_by":7,"name":"Nobuhiro Sato","email":"","orcid":"","institution":"Niigata City General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nobuhiro","middleName":"","lastName":"Sato","suffix":""}],"badges":[],"createdAt":"2025-06-11 23:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6875221/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6875221/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87385889,"identity":"574e864e-b9a1-44a2-bead-d42a261cb269","added_by":"auto","created_at":"2025-07-23 08:53:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1013226,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6875221/v1/fe5c3332-625a-4024-97a7-9e16cdfddf22.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Burnout and impostor syndrome among emergency physicians in Japan: a multicenter cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBurnout is defined as physical and mental exhaustion caused by long-lasting and high stress levels. It comprises three components: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Doctors, especially emergency physicians (EPs), have at high risk for burnout due to long working hours,life-threatening situations, and pressure to work quickly and accurately.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In a previous study, we indicated that 8.9% of Japanese EPs experienced high-degree burnout.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Furthermore, Japanese EPs had more severe PA scores in the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) than those from other countries.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eLow PA scores are in the Clance Impostor Phenomenon Scale (CIPS) indicate impostor syndrome.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Individuals with this condition experience self-doubt and fear of being considered an intellectual fraud.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e It can negatively influence mental health, manifesting in anxiety, depression, neuroticism, and low self-esteem, thereby, leading to burnout.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBased on the results of a previous study,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e we hypothesized that severe PA has a higher prevalence among Japanese EPs than among those from other countries owing to impostor syndrome. However, current data on underlying circumstances related to PA of Japanese EPs are limited.\u003c/p\u003e\u003cp\u003eThis study assessed the incidences of burnout and impostor syndrome and their causative factors among Japanese EPs employed in emergency departments (EDs).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe methods applied in this study were compatible to those from a previous study.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The primary difference was that we added the CIPS in this study..\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eIn June 2023, this multicenter questionnaire study was performed at 34 academic and community EDs in various Japanese geographic regions.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eIn June 2023, we invited 436 physicians who worked at the 34 participating EDs. Transitional interns were excluded from the enrollment.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eAs in a previous study,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e site investigators distributed the questionnaires to the participants, which were completed anonymously, and the participants returned them to the investigator pick-up area. We collected the questionnaires from the site investigators and sent them to IID Co., Ltd. (Tokyo, Japan) for evaluations.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eED-level factors\u003c/h3\u003e\n\u003cp\u003eSite investigators completed the ED-level questionnaire, which included analyzing the categorization of institutions, types of practice, management, shifts, overtime work, number of hospital beds, annual walk-in ED visits, annual ambulance ED visits, full-time EPs, full-time female EPs, availability of mentors (and targets), and personal interviews.\u003c/p\u003e\u003cp\u003eWe categorized the institutional addresses into rural and urban categories per the criteria of the Japanese Ministry of Land, Infrastructure, Transport, and Tourism.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e The details for the Japanese institution categories and practice types have been described a previous study.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEP-level factors\u003c/h2\u003e\u003cp\u003eThe participants were instructed to provide information pertaining to their age, sex, status, specialty, weekly working hours, night shift work, marital status, childcare, caregiving, average sleep period, availability of mentors (and targets), personal interviews, discrimination experienced, and work confidence level. The availability of mentors and personal interviews at work were also incorporated into the analyzed EP-level factors, given the different perceptions from the ED- and EP-levels.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMaslach Burnout Inventory - Human Services Survey\u003c/h3\u003e\n\u003cp\u003eSimilar to a previous study,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e we used the MBI-HSS items interpreted into Japanese by Mind Garden, Inc. (Menlo Park, CA, USA) to assess burnout. Based on other similar studies,\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e the degree (severe, moderate, mild) of burnout was determined using specific cut-off scores: EE: severe, \u0026ge; 27; DP: severe, \u0026ge; 10; and PA: severe, \u0026le; 33. The principal researcher obtained a license from Mind Garden, Inc. to administer the copyrighted survey.\u003c/p\u003e\n\u003ch3\u003eClance Impostor Phenomenon Scale\u003c/h3\u003e\n\u003cp\u003eThe CIPS is a 20-item questionnaire used to assess impostor phenomenon feelings and their frequency. All items are scored on Likert scale from 1 to 5 (from not at all true to very true). Based on other similar studies,\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e we defined the presence of impostor syndrome using a cut-off score of 62.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData analyses\u003c/h2\u003e\u003cp\u003eAs per former research,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e statistical analyses were conducted using Stata/MP17 software (StataCorp. LLC, College Station, TX, USA). The descriptive statistics for both ED and EP characteristics are shown as proportions and medians with interquartile ranges (IQR), as appropriate. A multivariable logistic regression analysis was employed to manage potential confounders among ED- and EP-level factors for MBI-HSS scores, as in a previous study.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e For the CIPS score analysis, we added the availability of personal interviews and mentors to the EP-level factors. Highly collinear factors were excluded using Pearson\u0026rsquo;s correlation coefficient. The participants with missing data were eliminated. All P-values were two-tailed, and significance was established at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eParticipant characteristics\u003c/h2\u003e\u003cp\u003eFrom the 436 eligible EPs, the participants comprised 322 EPs (73.8%) who responded to the questionnaire. 15 response forms were excluded due to the insufficient number of data points provided. Consequently, 307 (70.4%) were recruited. The ED characteristics are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and those of the EPs are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. A total of 52.9% EPs managed both an intensive care unit and general wards along with the ED, and 23.5% worked overnight.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of emergency department\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency departments (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (26.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (73.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategories of institute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency medical care institutions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (29.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency medical service centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (67.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmbulance only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk-in patients only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (94.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of hospital beds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (32.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e500\u0026ndash;1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (61.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1000 \u0026lt;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED only (no bed management)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (26.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (14.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral wards only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (52.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of annual walk-in ED visit, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9383 [5493\u0026ndash;20000]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of annual ambulance ED visits, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5647 [3400\u0026ndash;7774]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of full-time EPs, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 [5\u0026ndash;18]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of full-time female EPs, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 [1\u0026ndash;5]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShift type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2-shifts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (50.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3-shifts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (20.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvernight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (23.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvertime work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (23.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (70.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMentor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (29.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManager\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (61.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterview\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (44.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of interviews in a year, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 [1\u0026ndash;2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (55.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are given as n (%) unless stated otherwise.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eED, emergency department; ICU, intensive care unit; EP, emergency physician; IQR, interquartile range.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u0026dagger;: a general hospital and a pediatric medical center provided ED.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of emergency physician\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Physicians (n\u0026thinsp;=\u0026thinsp;307)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 [29\u0026ndash;43]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e231 (75.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (30.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e190 (61.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePart-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (5.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (1.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecialty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e276 (89.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking hours per week, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 [40\u0026ndash;50]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNight shift\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e270 (87.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTimes per month, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 [4\u0026ndash;7]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (12.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried or partnered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e219 (71.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (28.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158 (51.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e148 (48.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (3.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e296 (96.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAveraged sleep period, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 [6\u0026ndash;7]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMentor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (20.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduated student\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull-time staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePart-time staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManager\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244 (79.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterview\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129 (42.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of interviews in a year, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 [1\u0026ndash;2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176 (57.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiscrimination experienced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (17.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth place\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduated university\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecialty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e250 (81.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge and experiences are sufficient for my work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrongly agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (3.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (22.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91 (29.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88 (28.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrongly disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (16.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are given as n (%) unless stated otherwise. IQR, interquartile range;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003ePhD, Doctor of Philosophy.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMaslach Burnout Inventory-Human Services Survey\u003c/h2\u003e\u003cp\u003eAmong the 307 respondents, 64 (20.8%), 69 (22.4%), and 197 (64.1%) EPs had a severe degree of EE, DP, and PA, respectively; 34 (11.0%) EPs scored severely in all three components. The comparative analysis for this study with those from other countries is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison with other studies from other countries\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThis study\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;307)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrevious study, 2023\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;267)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTakayesu, 2014\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;218)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLegassie, 2008\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEmotional Exhaustion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (33.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (37.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (31.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155 (50.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143 (53.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (29.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (39.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDepersonalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (19.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e128 (58.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (54.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (19.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e177 (57.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e170 (63.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (27.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePersonal Accomplishment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e197 (64.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e179 (67.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129 (59.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (31.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (11.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (25.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (41.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (20.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (27.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eWe outlined the degree (severe, moderate, mild) of each dimension of burnout using cutoff scores: EE: severe, \u0026ge; 27; moderate, 17\u0026ndash;26; mild, \u0026le; 16; DP: severe, \u0026ge; 10; moderate, 6\u0026ndash;9; mild, \u0026le; 5; and PA: severe, \u0026le; 33; moderate, 34\u0026ndash;39; mild, \u0026ge; 40.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eClance Impostor Phenomenon Scale\u003c/h2\u003e\u003cp\u003eAmong the 307 respondents, 11 (3.5%) had intense impostor experiences, and 92 (29.9%) EPs exceeded the cutoff score. Of the latter, 16 (17.3%) EPs answered that they agreed or strongly agreed their knowledge and experiences were sufficient for their work.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with MBI-HSS scores\u003c/h2\u003e\u003cp\u003eThe ED- and EP-level factors corresponding to MBI-HSS scores are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The ED-level factors comparison between institutions demonstrated a significant association of overnight work with severe EE scores (odds ratio [OR], 2.375; 95% confidence interval [CI], 1.006\u0026ndash;5.603; P\u0026thinsp;=\u0026thinsp;0.048). Considering the EPs-level factors, the average sleep period had a significant association with more severe EE scores (OR, 0.699; 95% CI, 0.496\u0026ndash;0.983; P\u0026thinsp;=\u0026thinsp;0.040). Although there were no significant differences, bed management was indicative of severe EE scores (OR, 2.431; 95% CI, 0.962\u0026ndash;6.139; P\u0026thinsp;=\u0026thinsp;0.060).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEmergency department-level and emergency physician-level factors associated with the Maslach Burnout Inventory - Human Services Survey scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eDP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003cp\u003e(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003cp\u003e(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003cp\u003e(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategories of institute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency medical service centers\u003c/p\u003e\u003cp\u003e(vs. others)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.718 (0.327\u0026ndash;1.577)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.833 (0.382\u0026ndash;1.814)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.646\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.046 (0.524\u0026ndash;2.087)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.898\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBed management\u003c/p\u003e\u003cp\u003e(vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.431 (0.962\u0026ndash;6.139)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.582 (0.625\u0026ndash;4.006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.825 (0.751\u0026ndash;4.431)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvernight (vs. shifts)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.375 (1.006\u0026ndash;5.603)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.249 (0.511\u0026ndash;3.053)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.004 (0.445\u0026ndash;2.265)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.991\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvertime work\u0026thinsp;\u0026gt;\u0026thinsp;1 h\u003c/p\u003e\u003cp\u003e(vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.038 (0.455\u0026ndash;2.370)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.928\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.874 (0.401\u0026ndash;1.906)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.219 (0.617\u0026ndash;2.408)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEP-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.985 (0.941\u0026ndash;1.031)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.984 (0.942\u0026ndash;1.028)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.989 (0.953\u0026ndash;1.026)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.570\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale (vs. male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.848 (0.394\u0026ndash;1.825)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.954 (0.473\u0026ndash;1.925)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.889 (0.471\u0026ndash;1.675)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.717\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking hours per week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.007 (0.986\u0026ndash;1.029)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.009 (0.988\u0026ndash;1.031)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.998 (0.979\u0026ndash;1.018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.913\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNight shift per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.050 (0.924\u0026ndash;1.194)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.452\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.970 (0.856\u0026ndash;1.098)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.633\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.012 (0.910\u0026ndash;1.125)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildcare (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.897 (0.415\u0026ndash;1.936)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.783\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.489 (0.237\u0026ndash;1.007)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.824 (0.447\u0026ndash;1.520)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.536\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiving (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.526 (0.603\u0026ndash;10.572)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.522 (0.860-14.422)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.225 (0.423\u0026ndash;11.690)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSleep period\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.699 (0.496\u0026ndash;0.983)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.826 (0.594\u0026ndash;1.148)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.784 (0.585\u0026ndash;1.049)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eEE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment; OR, odds ratio; CI, confidence interval; ED, emergency department; EP, emergency physician.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with CIPS scores\u003c/h2\u003e\u003cp\u003eThe ED- and EP-level factors and MBI-HSS scores associated with CIPS scores are listed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The comparison of ED-level factors between institutions showed that overnight work had a significant association with high CIPS scores (OR, 2.679; 95% CI, 1.048\u0026ndash;6.851; P\u0026thinsp;=\u0026thinsp;0.040). Regarding EPs-level factors, younger age had a significant association with high CIPS scores (OR, 0.941; 95% CI, 0.894\u0026ndash;0.991; P\u0026thinsp;=\u0026thinsp;0.022). A similar pattern was observed between personal interviews and high CIPS scores (OR, 2.636; 95% CI, 1.308\u0026ndash;5.312; P\u0026thinsp;=\u0026thinsp;0.007). For the MBI-HSS, severe EE scores were significantly associated with high CIPS scores (OR, 1.040; 95% CI, 1.007\u0026ndash;1.073; P\u0026thinsp;=\u0026thinsp;0.016). Moreover, participants with PA were significantly associated with high CIPS scores (OR, 0.948; 95% CI, 0.918\u0026ndash;0.979; P\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEmergency physician-level and emergency department-level factors, and the Maslach Burnout Inventory - Human Services Survey scores associated with the Clance Impostor Phenomenon Scale\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCIPS\u0026thinsp;≧\u0026thinsp;62\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003cp\u003e(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategories of institute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency medical service centers\u003c/p\u003e\u003cp\u003e(vs. others)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.043 (0.456\u0026ndash;2.384)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.919\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBed management (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.201 (0.430\u0026ndash;3.355)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvernight (vs. shifts)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.679 (1.048\u0026ndash;6.851)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvertime work\u0026thinsp;\u0026gt;\u0026thinsp;1 h (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.904 (0.818\u0026ndash;4.431)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEP-level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.941 (0.894\u0026ndash;0.991)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale (vs. male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.720 (0.880\u0026ndash;3.361)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking hours per week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.979 (0.957\u0026ndash;1.002)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNight shift per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.956 (0.846\u0026ndash;1.081)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildcare (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.197 (0.557\u0026ndash;2.574)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.644\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiving (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.803 (0.336\u0026ndash;9.684)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.491\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSleep period\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.984 (0.698\u0026ndash;1.386)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.927\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterview (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.636 (1.308\u0026ndash;5.312)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMentor (vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.652 (0.292\u0026ndash;1.452)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.295\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMBI-HSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.040 (1.007\u0026ndash;1.073)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.002 (0.944\u0026ndash;1.063)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.948 (0.918\u0026ndash;0.979)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eCIPS, Clance Impostor Phenomenon Scale; OR, odds ratio; CI, confidence interval; ED, emergency department; EP, emergency physician; MBI-HSS, Maslach Burnout Inventory-Human Services Survey; EE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this survey on burnout conducted with 307 EPs who worked in 34 Japanese EDs, 11.0% scored as having severe forms of all three components in the MBI-HSS. Subsequently, 29.9% of the EPs exceeded the CIPS cutoff score. The multivariable analysis determined that the average sleep period and overnight work were associated with more severe EE scores in the MBI-HSS. Moreover, the multivariable analysis revealed that younger age, personal interviews, and overnight work were associated with high CIPS scores. To the best of our knowledge, this was the first study to include both a burnout and impostor syndrome survey administered to Japanese EPs.\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the distribution of MBI-HSS scores for Japanese EPs was similar to that in a previous study.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The PA scores were more severe than those of studies from other countries. The incidence of impostor syndrome among medical personnel has a broad range of values from 22.5\u0026ndash;85.7% in published literature.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e We hypothesized that the reason for the higher incidence of severe PA scores for Japanese EPs than for those from other countries is related to imposter syndrome; however, the incidence of impostor syndrome in this research was compatible to that reported in other countries. Therefore, we need to consider other factors that contribute to the higher incidence of more severe PA scores among Japanese EPs, in addition to the distinct Japanese character described in a previous study.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAdditionally, we found that one of the unique Japanese factors, such as overnight work,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e was associated with severe EE and high CIPS scores. Overnight work occurs when doctors stand by at a hospital all night to handle emergency situations. Some of them work continuously during the day after overnight work. Japanese EPs tend to work longer hours than other specialty physicians.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e To improve overtime work, the number of Japanese EDs that schedule shift work has recently increased. However, some institutions cannot introduce shift work because of the lack of staff. Japanese EPs account for only 1.2% of the total number of Japanese physicians.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In order to facilitate the implementation of more shift work in Japanese EDs, there is a necessity to retain and secure Japanese EPs. Another unique Japanese factor, bed management, had the strong association with severe EE scores. Some Japanese EPs are in charge of both an intensive care unit and general wards, as well as the ED. Therefore, it is suggested that Japanese EPs are more overloaded than those in other countries.\u003c/p\u003e\u003cp\u003eSimilar to a previous study,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e we found that sleep period and age were associated with mental health. Overtime work for younger EPs and sleep periods had an association with burnout and depression risks\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The importance of providing a sufficient sleep period and support systems for younger EPs should be addressed.\u003c/p\u003e\u003cp\u003ePerforming personal interviews was associated with high CIPS scores. Interviews are effective in detecting personal problems and experiences that are difficult to detect using quantitative data such as the MBI-HSS and CIPS scores.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e In this study, we did not assess the personal interview details. Therefore, we could not determine, how personal interviews contributed to the high CIPS scores. Future studies should concentrate on the details of personal interviews to accurately assess the association between them and CIPS scores. In contrast, 5.2% of the EPs, who answered that they agreed or strongly agreed that their knowledge and experiences were sufficient for their work, exceeded the cutoff for the CIPS score. This indicates that scoring methods, such as the MBI-HSS and CIPS, are effective in detecting mental issues that EPs are unaware of. ED supervisors should properly assess the well-being of EPs using scoring systems and interviews.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePotential limitations\u003c/h2\u003e\u003cp\u003eOur research has several primary limitations, similar to a previous study.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e First, we could not validate whether the participants actually had burnout and impostor syndrome. However, the MBI-HSS and CIPS are the most commonly applied evaluation tools that can suggest burnout and impostor syndrome; thus, we used them to tentatively analyze the participants, similar to other studies.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Second, this research was observational; thus it did not analyze the direct cause-and-effect relationship between burnout, impostor syndrome, and other factors. Finally, we only evaluated 34 EDs, which suggests a selection bias. Of these, 67.6% were from emergency medical service centers, which comprise only 6.3% of emergency medical care institutions in Japan.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In the future, we aim to conduct this survey nationwide in Japan.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this multicenter survey of 307 Japanese EPs, 11.0% had high degrees of burnout. Subsequently, 29.9% of the EPs exceeded the CIPS cutoff score. Although these Japanese EPs scored more severely in PA than EPs from other countries, their CIPS scores were similar. Overnight work, a unique factor in Japan, strongly affected the well-being of Japanese EPs. To maintain the well-being of Japanese EPs, ED supervisors should implement support for younger EPs and effective interviewing, as well as ensure they have adequate sleep periods.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the site principal investigators and EPs who work at the following sites: Chikashi Ashimine, MD (University Hospital Kyoto Prefectural University of Medicine, Kyoto); Yusuke Hagiwara, MD, MPH (Tokyo Metropolitan Children’s Medical Center, Tokyo);\u0026nbsp;Shinya Hara, MD (Kochi Red Cross Hospital, Kochi); Masako Hata, MD (Matsue Red Cross Hospital, Shimane); Tetsuya Hoshino, MD (University of Tsukuba Hospital, Ibaraki); Jin Irie, MD (Hirosaki General Medical Center, Aomori); Kouhei Ishikawa, MD, PhD (Juntendo University Shizuoka Hospital, Shizuoka); Asami Ito, MD, PhD (Mie University Hospital, Mie); Daisuke Kasugai, MD, PhD (Nagoya University Hospital, Aichi); Yoichi Kato, MD (Japanese Red Cross Kumamoto Hospital, Kumamoto); Kazuki Kobayashi, MD (Nagaoka Red Cross Hospital, Niigata); Kentaro Kobayashi, MD (National Center for Global Health and Medicine, Tokyo); Asako Matsushima, MD, PhD (Nagoya City University East Medical Center, Aichi); Toshifumi Miki, MD (Chikamori Hospital, Kochi); Atsushi Morizane, MD (Kochi Health Sciences Center, Kochi); Ayako Nagashima, MD (Kohnodai Hospital, National Center for Global Health and Medicine, Chiba); Yukiko Nakayama, MD (Okinawa Prefectural Chubu Hospital, Okinawa); Misa Sasanami, MD (Hiroshima City Hiroshima Citizens Hospital, Hiroshima); Yushi Segawa, MD (Fujita Health University Hospital, Aichi); Hajime Sekii, MD (JR Tokyo General Hospital, Tokyo); Yasuyuki Sumida, MD (Rakuwakai Otowa Hospital, Kyoto); Hiroki Takami, MD, (Juntendo University Nerima Hospital, Tokyo); Kotaro Takebe, MD (North Medical Center Kyoto Prefectural University of Medicine, Kyoto); Yukitoshi Toyoda, MD, PhD (Saiseikai Yokohamashi Tobu Hospital, Kanagawa); Naoki Yamada, MD (University of Fukui Hospital, Fukui); Hiroshi Yamagami, MD (Shonan Kamakura General Hospital, Kanagawa); Erika Yawata, MD (Niigata University Medical and Dental Hospital, Niigata); and the institutions to which the authors belong.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Japan Society for the Promotion of Science KAKENHI Grant Number 22K21153.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are not available due to privacy restrictions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: We conducted all the methods in accordance with the relevant guidelines and regulations. The Institutional Review Board of Juntendo University Urayasu Hospital approved this study\u0026nbsp;(approval no. 2020-067). Informed consent was obtained from all the participants who responded to the\u0026nbsp;questionnaire.\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eCompeting interest:\u003c/strong\u003e The authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors (M.M., T.U., N.H., Y.G., H.F., S.T., T.Y., N.S.) contributed to the study\u0026rsquo;s conception and design. Data collection were performed by All authors (M.M., T.U., N.H., Y.G., H.F., S.T., T.Y., N.S.) , and M.M. and T.U. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The first draft of the manuscript, all figures, and tables were prepared by M.M., and all authors commented on previous versions of the manuscript. All authors (M.M., T.U., N.H., Y.G., H.F., S.T., T.Y., N.S.) read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001;52:397-422. \u003c/li\u003e\n\u003cli\u003eStehman CR, Testo Z, Gershaw RS, Kellogg AR. Burnout, drop out, suicide: physician loss in emergency medicine, part I. West J Emerg Med 2019;20(3):485-494.\u003c/li\u003e\n\u003cli\u003eMorikawa M, Uechi T, Hanaki N, et al. Burnout among Japanese emergency medicine physicians: a multicentric questionnaire study. Acute Med Surg 2023;10(1):e848. \u003c/li\u003e\n\u003cli\u003eLegassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: impostorism and burnout syndrome in residency. J Gen Intern Med 2008;23(7):1090-1094. \u003c/li\u003e\n\u003cli\u003eClance PR, Imes SA. The impostor phenomenon in high achieving women: dynamics and therapeutic intervention. Psycotherapy 1978;15(3):241-247.\u003c/li\u003e\n\u003cli\u003eThomas M, Bigatti S. Perfectionism, impostor phenomenon, and mental health in medicine: a literature review. Int J Med Educ 2020;11:201-213. \u003c/li\u003e\n\u003cli\u003eNational Spatial Strategy (National Plan). Ministry of Land, Infrastructure, Transport and Tourism. (https://www.mlit.go.jp/common/001127196.pdf). Accessed January 7, 2025.\u003c/li\u003e\n\u003cli\u003eDoulougeri K, Georganta K, Montgomery A. \u0026ldquo;Diagnosing\u0026rdquo; burnout among healthcare professionals: can we find consensus? Cogent Med 2016;3:1.\u003c/li\u003e\n\u003cli\u003eShanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc 2022;97(12):2248-2258. \u003c/li\u003e\n\u003cli\u003eRotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. JAMA 2018;320(11):1131-1150. \u003c/li\u003e\n\u003cli\u003eHolmes SW, Kertay L, Adamson LB, Holland CL, Clance PR. Measuring the impostor phenomenon: a comparison of Clance\u0026apos;s IP Scale and Harvey\u0026apos;s I-P Scale. J Pers Assess 1993;60(1):48-59. \u003c/li\u003e\n\u003cli\u003eGottlieb M, Chung A, Battaglioli N, Sebok-Syer SS, Kalantari A. Impostor syndrome among physicians and physicians in training: a scoping review. Med Educ 2020;54(2):116-124. \u003c/li\u003e\n\u003cli\u003eKimo Takayesu J, Ramoska EA, Clark TR, et al. Factors associated with burnout during emergency medicine residency. Acad Emerg Med 2014;21(9):1031-1035. \u003c/li\u003e\n\u003cli\u003eNomura O, Mishina H, Kobayashi Y, Ishiguro A, Sakai H, Kato H. Limitation of duty hour regulations for pediatric resident wellness: a mixed methods study in Japan. Medicine (Baltimore) 2016;95(37):e4867. \u003c/li\u003e\n\u003cli\u003eKoike S, Wada H, Ohde S, Ide H, Taneda K, Tanigawa T. Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey. BMC Public Health 2024;24(1):164. \u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare of Japan. Handbook of Health and Welfare Statistics 2023. Number of Physicians and Dentists in Healthcare Facilities by Department. (https://www.mhlw.go.jp/english/database/db-hh/2-2.html). Accessed December 10, 2024.\u003c/li\u003e\n\u003cli\u003eWada H, Basner M, Cordoza M, Dinges D, Tanigawa T. Objective alertness, rather than sleep duration, is associated with burnout and depression: A national survey of Japanese physicians. J Sleep Res 2024:e14304. \u003c/li\u003e\n\u003cli\u003eDicicco-Bloom B, Crabtree BF. The qualitative research interview. Med Educ 2006;40(4):314-321. \u003c/li\u003e\n\u003cli\u003eBoutou A, Pitsiou G, Sourla E, Kioumis I. Burnout syndrome among emergency medicine physicians: an update on its prevalence and risk factors. Eur Rev Med Pharmacol Sci 2019;23(20):9058-9065. \u003c/li\u003e\n\u003cli\u003eMak KKL, Kleitman S, Abbott MJ. Impostor phenomenon measurement scales: a systematic review. Front Psychol 2019;10:671. \u003c/li\u003e\n\u003cli\u003eMinistry of Health LaW. Summary of Static/Dynamic Surveys of Medical Institutions and Hospital Report. (https://www.mhlw.go.jp/english/database/db-hss/dl/05_Outline_of_Results_Survey_of_Medical_Institutions_2020.pdf). Accessed December 17, 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"emergency physician, burnout, Maslach Burnout Inventory-Human Services Survey, Clance Impostor Phenomenon Scale, impostor syndrome","lastPublishedDoi":"10.21203/rs.3.rs-6875221/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6875221/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEmergency physicians (EPs) experience impostor syndrome and burnout. This study assessed the incidences of burnout and impostor syndrome and their causative factors in Japanese EPs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study administered questionnaires to 34 Japanese emergency departments (EDs). The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scores, Clance Impostor Phenomenon Scale (CIPS) scores, and their correlations with ED- and EP-level factors underwent a multivariable analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 307 EPs (70.4%) participants 64 (20.8%), 69 (22.4%), and 197 (64.1%) had MBI-HSS scores that indicated a severe degree of emotional exhaustion (EE), depersonalization, and personal accomplishment (PA), respectively; 34 (11.0%) EPs had severe scores for all three components. Regarding participant CIPS scores, 92 (29.9%) had a higher value than the cutoff. The multivariable analysis of MBI-HSS scores determined severe EE scores were associated with sleep periods (odds ratio [OR], 0.699; 95% confidence interval [CI], 0.496\u0026ndash;0.983; P\u0026thinsp;=\u0026thinsp;0.040) and overnight work (OR, 2.375; 95% CI, 1.006\u0026ndash;5.603; P\u0026thinsp;=\u0026thinsp;0.048). Higher CIPS scores correlated with younger age (OR, 0.941; 95% CI, 0.894\u0026ndash;0.991; P\u0026thinsp;=\u0026thinsp;0.022), personal interviews (OR, 2.636; 95% CI, 1.308\u0026ndash;5.312; P\u0026thinsp;=\u0026thinsp;0.007), and overnight work (OR, 2.679; 95% CI, 1.048\u0026ndash;6.851; P\u0026thinsp;=\u0026thinsp;0.040).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eA high level of burnout was experienced by 11.0% of the participants. Although Japanese EPs more severe scores for PA than EPs in other countries, their CIPS scores were similar. To maintain the well-being of Japanese EPs, ED supervisors should consider supporting younger specialists, interviewing effectively, providing adequate sleep periods, and improving overnight work settings.\u003c/p\u003e","manuscriptTitle":"Burnout and impostor syndrome among emergency physicians in Japan: a multicenter cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 08:37:51","doi":"10.21203/rs.3.rs-6875221/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-18T16:50:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-16T03:32:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-27T06:18:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-26T01:08:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-06-26T01:05:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ff36289-524e-4970-9ffe-484297798640","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-23T08:37:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 08:37:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6875221","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6875221","identity":"rs-6875221","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}