The Relationship Between Residents’ Perceptions of Residency Program Leadership Team Behaviors and Resident Burnout and Satisfaction

Dyrbye, Liselotte N.; Hunderfund, Andrea N. Leep; Winters, Richard C.; Moeschler, Susan M.; Stelling, Brianna E. Vaa; Dozois, Eric J.; Satele, Daniel; West, Colin P.

doi:10.1097/acm.0000000000003538

Cited by 24 publications

(28 citation statements)

References 31 publications

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“…In addition, unmeasured residency characteristics and culture could be associated with burnout in ways that were not captured in our data. 30 Moreover, the professionalism milestones we used in our data set are assessed by program leadership rather than by residents themselves, and may be an inadequate proxy for resident self-assessment of self-care and well-being. Finally, our sample includes only those residents who registered for the ABFM Certification Examination and excludes those whose academic or personal struggles preclude them seeking certification.…”

Section: Discussionmentioning

confidence: 99%

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

Davis

Krishnasamy

Morgan

et al. 2021

Fam Med

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Background and Objectives: Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation. Methods: We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout. Results: Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82). Conclusions: We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.

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Section: Discussionmentioning

confidence: 99%

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

Davis

Krishnasamy

Morgan

et al. 2021

Fam Med

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“…While we applied Messick's unified theory of validity evidence to guide and inform our results, the sampling and convergent validity aspects should be addressed in subsequent work. Ultimately, statistical comparisons of CLEQS data with other data from our programs 35 and the ACGME along with system-wide tools will be completed.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Evidence Supporting a Novel 10-Item Clinical Learning Environment Quick Survey (CLEQS)

Simpson

McDiarmid

Fratta

et al. 2021

Journal of Graduate Medical Education

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Background The clinical learning environment (CLE) is a priority focus in medical education. The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review's (CLER) recent addition of teaming and health care systems obligates educators to monitor these areas. Tools to evaluate the CLE would ideally be: (1) appropriate for all health care team members on a specific unit/project; (2) informed by contemporary learning environment frameworks; and (3) feasible/quick to complete. No existing CLE evaluation tool meets these criteria. Objective This report describes the creation and preliminary validity evidence for a Clinical Learning Environment Quick Survey (CLEQS). Methods Survey items were identified from the literature and other data sources, sorted into 1 of 4 learning environment domains (personal, social, organizational, material) and reviewed by multiple stakeholders and experts. Leaders from 6 interprofessional graduate medical education quality improvement/patient safety teams distributed this voluntary survey to their clinical team members (November 2019–mid-January 2021) using electronic or paper formats. Validity evidence for this instrument was based on the content, response process, internal structure, reliability, relations to other variables, and consequences. Results Two hundred one CLEQS responses were obtained, taking 1.5 minutes on average to complete with good reliability (Cronbach's α ≥ 0.83). The Cronbach alpha for each CE domain with the overall item ranged from 0.50 for personal to 0.79 for social. There were strong associations with other measures and clarity about improvement targets. Conclusions CLEQS meets the 3 criteria for evaluating CLEs. Reliability data supports its internal consistency, and initial validity evidence is promising.

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“…Dyrbye et al 55 based their assessment of burnout in residents at Mayo Clinic on two questions from the MBI -'I feel burned out from my work' and 'I've become more callous toward people since I started this job'. They had previously demonstrated that symptoms of burnout consistent with other measures were present in those who reported a once per week or more frequency on either item.…”

Section: Provision Of Servicementioning

confidence: 99%

The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees – A Narrative Literature Review

Grech

2021

Journal of Medical Education and Curricular Development

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Background: Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual’s ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training. Methods: A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words ‘burnout’ and ‘educational environment’ or ‘clinical learning environment’ or ‘postgraduate medical education’ or ‘learning environment’. Results: A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.

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The Relationship Between Residents’ Perceptions of Residency Program Leadership Team Behaviors and Resident Burnout and Satisfaction

Cited by 24 publications

References 31 publications

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

Preliminary Evidence Supporting a Novel 10-Item Clinical Learning Environment Quick Survey (CLEQS)

The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees – A Narrative Literature Review

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