Residents’ Perceptions of Faculty Behaviors and Resident Burnout: a Cross-Sectional Survey Study Across a Large Health Care Organization

BackgroundData suggests the learning environment factors influence resident well-being. The authors conducted an assessment of how residents’ perceptions of faculty-resident relationships, faculty professional behaviors, and afforded autonomy related to resident burnout.MethodsAll residents at one organization were surveyed in 2019 using two items from the Maslach Burnout Inventory and the faculty relationship subscale of the Johns Hopkins Learning Environment Scale (JHLES, range 6 to 30). Residents were also asked about faculty professional behaviors (range 0 to 30), and satisfaction with autonomy across various clinical settings.ResultsA total of 762/1146 (66.5%) residents responded to the survey. After adjusting for age, gender, postgraduate year, and specialty, lower (less favorable) JHLES-faculty relationship subscale score (parameter estimate, − 3.08, 95% CI − 3.75, − 2.41, p < 0.0001), fewer observed faculty professional behaviors (parameter estimate, − 3.34, 95% CI − 4.02, − 2.67, p < 0.0001), and lower odds of satisfaction with autonomy in the intensive care settings (OR 0.46, 95% CI 0.30, 0.70, p = 0.001), but not other care settings, were reported by residents with burnout in comparison to those without. Similar relationships were observed when emotional exhaustion and depersonalization were analyzed separately as continuous variables.ConclusionIn this cohort, resident perceptions of faculty relationships, faculty professional behaviors, and satisfaction with autonomy in the intensive care unit were associated with resident burnout. Additional longitudinal studies are needed to elucidate the direction of these relationships and determine if faculty development can reduce resident burnout.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06452-3.

There is a high prevalence of burnout among residents.^1–4 This is grounds for concern, as resident well-being impacts quality of patient care and residents’ competency, career satisfaction, specialty choice, and personal health.^1,2,4–8 A complex array of factors within the clinical learning environment influence resident well-being.^4,9,10 Conceptually, burnout results when job demands (e.g., excessive workload, administrative burdens, inadequate technology usability) exceed job resources (e.g., professional relationships, autonomy, meaning and purpose in work, professional development, organizational culture).¹¹ Specifically within the learning environment, high faculty demands, inadequate emotional support from faculty, stressful faculty relationships, hostile faculty behaviors, poor mentorship relationships, and insufficient autonomy are associated with higher risk of burnout among residents.^3,4,12,13 On the other hand, residents who report greater opportunities for learning, better teaching quality, and more frequent direct observation and feedback—all of which increase “job resources”—are less likely to have burnout.^1,13–15 Although previous studies are informative, most included small numbers of learners, involved one specialty, were conducted outside the USA, or did not control for potential confounders.The Accreditation Council for Graduate Medical Education (ACGME) common program requirements state that clinical settings where graduate medical education occurs must ensure learning environments promote resident well-being and that the health of learning environments must be monitored.¹⁶ Additionally, the ACGME common program requirements specify that faculty have a direct role in creating and sustaining an effective learning environment, and faculty development must occur to equip the faculty with the capacity to do so.¹⁶ To guide such efforts, we surveyed residents in all specialty training programs across a large health system to identify faculty behaviors associated with resident burnout. We hypothesized that poor faculty-resident relationships, suboptimal faculty professional behaviors, and dissatisfaction with autonomy would be associated with resident burnout.