Let’s review the neurophysiology of burnout. To understand the role of DLPFC in burnout, we need to first understand the concepts of:

–Working memory

Working memory is distinguished by its role in the temporary storage and active manipulation of information, making it indispensable for complex cognitive tasks like reasoning, problem-solving, and comprehension. [1]

Unlike short-term memory, which merely holds information, working memory actively processes it, enabling us to perform tasks that require sustained mental effort, such as mental math or following multi-step instructions. [1,2]

For example, watching a movie mainly uses short term memory and playing a video game uses working memory. Listening to history and physical from a medical student or a resident for a simple case is using short term memory, but when you are taking the history and examining the patient yourself, or developing assessment and plan for a complex patient, you are using the working memory.

References:

1 Eriksson, J., Vogel, E. K., Lansner, A., Bergström, F., & Nyberg, L. (2015). Neurocognitive Architecture of Working Memory. Neuron, 88(1), 33-46. https://doi.org/10.1016/j.neuron.2015.09.020. 

2 Cascella M, Al Khalili Y. Short-Term Memory Impairment. [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan

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—Attention

Attention is a cognitive function that guides the prioritization and selection of some sensory information at the expense of other information.

Attention network theory proposes three different networks, which are separate, but often overlap. [1] These networks are:

1.An alerting network to deploy attentional resources in anticipation (When you get a notification on your phone, it alerts you to that stimulation while you are still paying attention to this page)

2.An orienting network to direct attention to a cued location (When you pick up your phone and look at the notification, while still paying attention to this page, but part of your attention is now diverted)

3.A control network to select relevant information at the expense of concurrently available information (if it is something interesting or important on the message, you open the message and draw your full attention from this page to that message, ignoring what you are reading on this page).

Now let’s face it. We have been spending a lot more time on the screen, especially on the smart phones in the past 15 or so years. It is a big driver for our lack of attention in doing tasks on hand.

Reference:

1. Markett, S., Nothdurfter, D., Focsa, A., Reuter, M., & Jawinski, P. (2022). Attention networks and the intrinsic network structure of the human brain. Human Brain Mapping, 43(4), 1431-1448. https://doi.org/10.1002/hbm.25734

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–Multitasking

•The ability to manage and perform multiple tasks simultaneously—relies heavily on the DLPFC. [1]

•When we multitask, the DLPFC allocates attention, manages competing demands, and switches focus between tasks. [2]

•It helps prioritize tasks, update goals, and inhibit irrelevant information, thereby maintaining efficiency even when juggling multiple activities. [2]

Everyone is able to multi-task effectively. However, because the DLPFC has a limited capacity, excessive multitasking can lead to cognitive overload, reducing performance and increasing the likelihood of errors.

References:

1.Verghese, Ashika et al. “Prefrontal Cortex Structure Predicts Training-Induced Improvements in Multitasking Performance.” The Journal of neuroscience : the official journal of the Society for Neuroscience vol. 36,9 (2016): 2638-45. doi:10.1523/JNEUROSCI.3410-15.2016

2.Yoshida, Wako, et al. "Hierarchical Rule Switching in Prefrontal Cortex." NeuroImage, vol. 50, no. 1, 2010, pp. 314-322, https://doi.org/10.1016/j.neuroimage.2009.12.017. Accessed 27 Mar. 2025.

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–Neuroplasticity

Think about the day to day tasks you used to do when you were a student. You used to do some tasks, like memorizing a lecture or an entire book chapter much more easily but taking history from the patient used to be so challenging. The tasks that you do on a day to day bases now are much easier for you. That is because of the constant modifications of the networks in your brain. Now how does the brain do all these amazing things it does? It has an inherent mechanism called Neuroplasticity.

•It is the brain's ability to reorganize and form new neural connections throughout life. It is essential for learning, memory, and recovery from injury. [1]

•As the brain adapts to new experiences, the DLPFC is involved in modifying neural circuits to optimize cognitive performance and behavioral responses. [2, 3]

References:

1. Marzola, Patrícia, et al. "Exploring the Role of Neuroplasticity in Development, Aging, and Neurodegeneration." Brain Sciences, vol. 13, no. 12, 2023, p. 1610, https://doi.org/10.3390/brainsci13121610.  

2. Webler, Ryan D., et al. "DLPFC Stimulation Alters Working Memory Related Activations and Performance: An Interleaved TMS-fMRI Study." Brain Stimulation, vol. 15, no. 3, 2022, pp. 823-832, https://doi.org/10.1016/j.brs.2022.05.014. 

3. Mansouri, Farshad A., et al. "Conflict-induced Behavioural Adjustment: A Clue to the Executive Functions of the Prefrontal Cortex." Nature Reviews Neuroscience, vol. 10, no. 2, 2009, pp. 141-152, https://doi.org/10.1038/nrn2538.  

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