Comprehensive Characterization of the General Surgery Residency Learning Environment and the Association With Resident Burnout

Ann Surg. 2021 Jul 1;274(1):6-11. doi: 10.1097/SLA.0000000000004796.


Objectives: To characterize the learning environment (ie, workload, program efficiency, social support, organizational culture, meaning in work, and mistreatment) and evaluate associations with burnout in general surgery residents.

Background summary data: Burnout remains high among general surgery residents and has been linked to workplace exposures such as workload, discrimination, abuse, and harassment. Associations between other measures of the learning environment are poorly understood.

Methods: Following the 2019 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. The learning environment was characterized using an adapted Areas of Worklife survey instrument, and burnout was measured using an abbreviated Maslach Burnout Inventory. Associations between burnout and measures of the learning environment were assessed using multivariable logistic regression.

Results: Analysis included 5277 general surgery residents at 301 programs (85.6% response rate). Residents reported dissatisfaction with workload (n = 784, 14.9%), program efficiency and resources (n = 1392, 26.4%), social support and community (n = 1250, 23.7%), organizational culture and values (n = 853, 16.2%), meaning in work (n = 1253, 23.7%), and workplace mistreatment (n = 2661, 50.4%). The overall burnout rate was 43.0%, and residents were more likely to report burnout if they also identified problems with residency workload [adjusted odds ratio (aOR) 1.60, 95% confidence interval (CI) 1.31-1.94], efficiency (aOR 1.74; 95% CI 1.49-2.03), social support (aOR 1.37, 95% CI 1.15-1.64), organizational culture (aOR 1.64; 95% CI 1.39-1.93), meaning in work (aOR 1.87; 95% CI 1.56-2.25), or experienced workplace mistreatment (aOR 2.49; 95% CI 2.13-2.90). Substantial program-level variation was observed for all measures of the learning environment.

Conclusions: Resident burnout is independently associated with multiple aspects of the learning environment, including workload, social support, meaning in work, and mistreatment. Efforts to help programs identify and address weaknesses in a targeted fashion may improve trainee burnout.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bullying
  • Burnout, Professional / diagnosis
  • Burnout, Professional / epidemiology
  • Burnout, Professional / etiology*
  • Chicago / epidemiology
  • Cross-Sectional Studies
  • Efficiency, Organizational
  • Female
  • General Surgery / education*
  • General Surgery / organization & administration
  • Health Surveys
  • Humans
  • Internship and Residency / methods
  • Internship and Residency / organization & administration*
  • Job Satisfaction
  • Learning
  • Logistic Models
  • Male
  • Occupational Health
  • Organizational Culture
  • Prejudice
  • Risk Factors
  • Social Support
  • Workload
  • Workplace Violence