Understanding resident wellness: A path analysis of the clinical learning environment at three institutions

Abstract

Purpose

The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout.

Materials and methods

Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout.

Results

Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= −0.12, p=.025; PS: B= −0.37, p<.001). The relationship between stress and residents’ level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout.

Conclusions

Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.

Keywords:

• Clinical learning environment
• medical residents
• burnout
• wellness
• psychological safety

Acknowledgements

The authors wish to thank the residents who participated in this pilot and Amy Hirsch for manuscript preparation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Previous presentations

International Conference on Resident Education 2022, Montreal.

Additional information

Funding

This project was supported by American Medical Association Innovation Grant. University of Cincinnati College of Medicine receives funding for Sally A. Santen as a consultant outside of this work from the American Medical Association.

Notes on contributors

Nastassia M. Savage

Nastassia M. Savage, PhD, is a Visiting Assistant Professor at Department of Psychology, Old Dominion University, Norfolk, VA and was Director of Organizational Assessment and Evaluation at School of Medicine, Virginia Commonwealth University, Richmond, VA.

Sally A. Santen

Sally A. Santen, MD, PhD, is a Senior Associate Dean Virginia Commonwealth University, Richmond, VA and Professor at Emergency Medicine and Medical Education, University of Cincinnati, OH.

Meagan Rawls

Meagan Rawls, MS, PhD, is a Senior Institutional Research Analyst for Bon Secours Mercy Health and was Program Coordinator at School of Medicine, Virginia Commonwealth University, Richmond, VA.

David A. Marzano

David A. Marzano, MD, is an Associate Professor at Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI.

Jean H. Wong

Jean H. Wong, MD, is an Assistant Professor of Family Medicine, Department of Family Medicine, University of Michigan, Ann Arbor, MI.

Heather L. Burrows

Heather L. Burrows, MD, PhD, is an Associate Chair of Education, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

Ralph A. Hicks

Ralph A. Hicks, MD, is a Professor of Clinical Pediatrics, Department of Pediatrics, Indiana University, Indianapolis, IN.

Brian M. Aboff

Brian M. Aboff, MD, MMM, is a Senior Associate Dean for Graduate Medical Education, Designated Institutional Official, Virginia Commonwealth University Health System, Richmond, VA.

Robin R. Hemphill

Robin R. Hemphill, MD, MPH, is Chief of Staff, Cincinnati Veterans Association Medical Center.