Development of a conceptual model for understanding the learning environment and surgical resident well-being

• Published in: The American journal of surgery Vol. 221; no. 2; pp. 323 - 330
• Main Authors: Zhang, Lindsey M., Cheung, Elaine O., Eng, Joshua S., Ma, Meixi, Etkin, Caryn D., Agarwal, Gaurava, Shanafelt, Tait D., Riall, Taylor S., Nasca, Thomas, Bilimoria, Karl Y., Hu, Yue-Yung, Johnson, Julie K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2021; Elsevier Limited
• Subjects: Burnout; Burnout, Professional - prevention & control; Burnout, Professional - psychology; Conceptual model; Domains; Efficiency; Factor analysis; Humans; Internship and Residency - organization & administration; Interprofessional Relations; Learning; Model forms; Models, Educational; Physicians; Randomized Controlled Trials as Topic; School environment; Specialties, Surgical - education; Statistical analysis; Surgeons; Surgery; Surgical education; Surgical residents; Surveys and Questionnaires; Well-being; Wellness; Work-Life Balance; Workload; Workload - psychology; Wellness; Well-being; Burnout; Surgical residents; Conceptual model; Surgical education
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.10.026

Surgeon burnout is linked to poor outcomes for physicians and patients. Several conceptual models exist that describe drivers of physician wellness generally. No such model exists for surgical residents specifically.
A conceptual model for surgical resident well-being was adapted from published models with input gained iteratively from an interdisciplinary team. A survey was developed to measure residents’ perceptions of their program. A confirmatory factor analysis (CFA) tested the fit of our proposed model construct.
The conceptual model outlines eight domains that contribute to surgical resident well-being: Efficiency and Resources, Faculty Relationships and Engagement, Meaning in Work, Resident Camaraderie, Program Culture and Values, Work-Life Integration, Workload and Job Demands, and Mistreatment. CFA demonstrated acceptable fit of the proposed 8-domain model.
Eight distinct domains of the learning environment influence surgical resident well-being. This conceptual model forms the basis for the SECOND Trial, a study designed to optimize the surgical training environment and promote well-being.
•New conceptual model created to explain drivers of surgery resident burnout.•Surgery resident wellness influenced by eight learning environment domains.•Resident perceptions of training program can be measured using conceptual model.•Impact of surgical learning environment forms basis of the SECOND Trial.•The SECOND Trial, a national, randomized study aims to improve surgical training.