Table 7.

To what degree have you experienced the following?

During the past two weeks I have felt…	Not at all Score=0	Very little Score=1	Moderately Score=2	A lot Score=3	Extremely Score=4
a. A sense of dread when I think about work I have to do	[ ]	[ ]	[ ]	[ ]	[ ]
b. Physically exhausted at work	[ ]	[ ]	[ ]	[ ]	[ ]
c. Lacking in enthusiasm at work	[ ]	[ ]	[ ]	[ ]	[ ]
d. Emotionally exhausted at work	[ ]	[ ]	[ ]	[ ]	[ ]
During the past two weeks my job has contributed to me feeling…	Not at all Score=0	Very little Score=1	Moderately Score=2	A lot Score=3	Extremely Score=4
a. Less empathetic with my patients	[ ]	[ ]	[ ]	[ ]	[ ]
b. Less empathetic with my colleagues	[ ]	[ ]	[ ]	[ ]	[ ]
c. Less sensitive to others’ feelings/emotions	[ ]	[ ]	[ ]	[ ]	[ ]
d. Less interested in talking with my patients	[ ]	[ ]	[ ]	[ ]	[ ]
e. Less connected with my patients	[ ]	[ ]	[ ]	[ ]	[ ]
f. Less connected with my colleagues	[ ]	[ ]	[ ]	[ ]	[ ]