Table 1.

Description of studies retained by the literature review

Study	Country	Design	Sample	N	Response rate	Measured dimensions of burnout	Observed measure on quality of care	Association with burnout
Fahrenkopf et al. 2008 [22]	USA	Observational prospective cohort study	Paediatric residents	246	50%	EE and DPa	Missing or wrong prescription of drugs	Not associated with adverse patient treatment
Zantinge et al. 2009 [23]	Netherlands	Observation of video-recorded consultations and questionnaire	GPs	142	89%	EE, DP and PAb	Length of consultations, level of verbal communication, eye contact, and focus on psychosocial issues	PA associated with GPs communicating less affectively, being less patient-centred and less eye contact. EE and DP not associated with adverse patient treatment
Kushnir et al. 2014 [24]	Israel	Cross-sectional observational study	GPs/Primary care	136	99%	EE, DP and PAc	Number of referrals for diagnostic imaging, specialized health services or nurse sensitive treatments	Associated with more referrals
Yuguero Torres et al. 2015 [25]	Spain	Prospective observational study (1 year)	GPs	217	50%	EE, DP and PAd	Number of prescribed sick leaves	Not associated with prescribing more or longer sick leaves
Garrouste-Orgeas et al. 2015 [26]	France	Prospective observational study (2-year)	Doctors, nurses and care workers in intensive care unit	1988 (330 doctors)	77%	EE, DP and PAe	Medical errors (i.e., error of execution or error of planning). Adverse events were patient harms caused by medical interventions.	Not associated with adverse patient treatment
Welp et al. 2015 [19]	Switzerland	Observational study	Doctors and nurses in intensive care unit	1425 (243 doctors)	Not specified	EE, DP and PAf	Length of stay in hospital and standardized mortality ratio	Associated with increased standardized mortality ratio, but not length of stay
Pedersen et al. 2015 [27]	Denmark	Register study and questionnaire	GPs	835	72%	EE, DP and PAg	Number of requisitions for PSA among healthy male patients	Not associated with increased requisitions for PSA
Kwah et al. 2016 [28]	USA	Prospective observational study (1 year)	First-year residents in internal medicine	54	98% (initial), 59% (cohort)	EE and DPh	Medication prescription errors with potential for adverse drug effects	Not associated with increase in medical errors
Sun et al. 2017 [29]	USA	Cross-sectional observational study	Primary care	102	Not specified	EE, DP and PAf	Antibiotic prescriptions for acute respiratory infections	Not associated with increase in prescriptions
Noroxe et al. 2019 [20]	Denmark	Prospective observational study (6 months)	GPs	781	50.2%	EE, DP and PAi	Conditions not requiring hospitalization in the case of appropriate intervention in primary care (ambulatory care sensitive conditions)	Associated with increased frequency of hospitalizations of ambulatory care sensitive conditions
Noroxe et al. 2019 [21]	Denmark	Prospective observational study (6 months)	GPs	409	50.2%	EE, DP and PAi	Change of GP (unrelated to change of address)	Associated with increased likelihood of changing GPs

Abbreviations: EE emotional exhaustion, DP depersonalization, PA personal accomplishment (reduced), GP general practitioner, PSA prostate-specific antigen, MBI Maslach Burnout Inventory

^aDefined burnout as EE > 27 and DP > 10

^bEE, DP and PA were dichotomized into low and high scores, and outcomes reported for each dimension

^cOverall burnout was measured as an average of the responses to items EE and DP (continuous variable)

^dScores for each category were divided into low, moderate and high

^eBurnout measured as

(1) a combination of high EE and DP with low PA (dimensions dichotomized), and

(2) defined as over a cut-off of a global MBI score of 9

^fEach dimension used as a continuous variable

^gBurnout defined as high level of emotional exhaustion > 26

^hBurnout defined as a high EE or high DP subscore (dichotomized variables)

ⁱBurnout measured

1) in four quartiles for each dimension

2) As a composite score by adding up points corresponding to the quartile of each subscale (reversed score for personal accomplishment);

one point for scores in the first quartile, and two, three and four points for subsequent quartiles, respectively. The composite score was categorized into five groups, with increasing score indicating higher burnout