In Reply:

We appreciate the authors’ interest in our study and for bringing to light the important regulatory and ethical aspects of research related to burnout and wellness. From a regulatory standpoint, the reviewing institutional review board (IRB) determined that our study entailed no greater than minimal risk and met the criteria for exemption from IRB review and approval. However, from an ethical standpoint, like the letter's authors, we fully recognized the potentially sensitive nature of our data and therefore instituted several measures ourselves to safely manage them.

First, as part of our online consent process in this voluntary study, residents were informed that their results would be kept strictly confidential and deidentified by a departmental research assistant with no evaluative role in their training. As such, no other investigator nor any member of the residency leadership was able to identify the results. Result deidentification also meant we were unable to pinpoint those residents that faculty mentors felt were experiencing burnout. This was done to ensure that both residents and faculty felt comfortable answering the survey honestly. Residency leadership, however, were made aware of aggregate data so that burnout and wellness could be addressed as a program.

Second, understanding that the data being collected were potentially sensitive, we included in the online survey an option for the resident to receive via secure e‐mail their personalized burnout results. This confidential feedback was provided only if the resident wished to receive them (not all of them wanted their results). No investigator nor member of residency leadership was privy to any identifying results other than the research assistant who deidentified all data and facilitated these feedback e‐mails. One of the benefits of using an extensively validated instrument1 in our survey was that we were able to provide residents their individual scores in addition to program and national averages so that they could consider their results in context. Furthermore, all residents who wished to obtain result feedback also received a curated list of burnout and wellness resources on local, state, and national levels. These resources were provided to residents regardless of their actual results and regardless of whether their faculty mentor believed they were experiencing burnout.

We felt that this design ensured both honest reporting and responsible handling of sensitive data. As an important aside, from our experience with other projects, these regulatory and ethical issues are much different when the survey includes items that assess for major depressive disorder or suicidality. Our group is currently developing a manuscript that addresses these issues in detail.