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

Lindsey M Zhang; Elaine O Cheung; Joshua S Eng; Meixi Ma; Caryn D Etkin; Gaurava Agarwal; Tait D Shanafelt; Taylor S Riall; Thomas Nasca; Karl Y Bilimoria; Yue-Yung Hu; Julie K Johnson

doi:10.1016/j.amjsurg.2020.10.026

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

Am J Surg. 2021 Feb;221(2):323-330. doi: 10.1016/j.amjsurg.2020.10.026. Epub 2020 Oct 21.

Authors

Affiliations

¹ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA; American College of Surgeons, 633 N. St. Clair Street, 23rd Floor, Chicago, IL, 60611, USA; Department of Surgery, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
² Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair St, 19th Floor, Chicago, IL, 60611, USA.
³ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.
⁴ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA; American College of Surgeons, 633 N. St. Clair Street, 23rd Floor, Chicago, IL, 60611, USA; Department of Surgery, University of Alabama, 1808 7th Ave S Ste 202, Birmingham, AL, 35233, USA.
⁵ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 E. Ontario Street, Chicago, IL, 60611, USA.
⁶ Department of Medicine, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA.
⁷ Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA.
⁸ Accreditation Council for Graduate Medical Education, 401 N Michigan Ave, Chicago, IL, 60611, USA.
⁹ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA; American College of Surgeons, 633 N. St. Clair Street, 23rd Floor, Chicago, IL, 60611, USA.
¹⁰ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
¹¹ Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA. Electronic address: Julie.k.johnson@northwestern.edu.

PMID: 33121657
DOI: 10.1016/j.amjsurg.2020.10.026

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Burnout; Conceptual model; Surgical education; Surgical residents; Well-being; Wellness.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Burnout, Professional / prevention & control*
Burnout, Professional / psychology
Humans
Internship and Residency / organization & administration*
Interprofessional Relations
Learning*
Models, Educational*
Randomized Controlled Trials as Topic
Specialties, Surgical / education*
Surveys and Questionnaires
Work-Life Balance
Workload / psychology