{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T10:25:46Z","timestamp":1792923946877,"version":"4.5.0"},"reference-count":57,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"DOI":"10.1001\/jamanetworkopen.2021.19110","type":"journal-article","created":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T20:04:03Z","timestamp":1628539443000},"page":"e2119110","source":"Crossref","is-referenced-by-count":112,"title":["Association of Characteristics of the Learning Environment and US Medical Student Burnout, Empathy, and Career Regret"],"prefix":"10.1001","volume":"4","author":[{"given":"Liselotte N.","family":"Dyrbye","sequence":"first","affiliation":[{"name":"Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Satele","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin P.","family":"West","sequence":"additional","affiliation":[{"name":"Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"issue":"11","key":"zoi210569r1","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1097\/ACM.0000000000000482","article-title":"Distress among matriculating medical students relative to the general population.","volume":"89","author":"Brazeau","year":"2014","journal-title":"Acad Med"},{"issue":"3","key":"zoi210569r2","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1097\/ACM.0000000000000134","article-title":"Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.","volume":"89","author":"Dyrbye","year":"2014","journal-title":"Acad Med"},{"issue":"6","key":"zoi210569r3","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/ACM.0000000000003175","article-title":"Does empathy decline in the clinical phase of medical education? a nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools.","volume":"95","author":"Hojat","year":"2020","journal-title":"Acad Med"},{"issue":"8","key":"zoi210569r4","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1080\/0142159X.2019.1584275","article-title":"Does empathy change during undergraduate medical education? a meta-analysis.","volume":"41","author":"Spatoula","year":"2019","journal-title":"Med Teach"},{"issue":"9","key":"zoi210569r5","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1111\/med.2004.38.issue-9","article-title":"Decline in empathy in medical education: how can we stop the rot?","volume":"38","author":"Spencer","year":"2004","journal-title":"Med Educ"},{"issue":"8","key":"zoi210569r6","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1097\/ACM.0b013e318221e615","article-title":"Empathy decline and its reasons: a systematic review of studies with medical students and residents.","volume":"86","author":"Neumann","year":"2011","journal-title":"Acad Med"},{"issue":"11","key":"zoi210569r7","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1001\/jama.2010.1318","article-title":"Relationship between burnout and professional conduct and attitudes among US medical students.","volume":"304","author":"Dyrbye","year":"2010","journal-title":"JAMA"},{"issue":"9","key":"zoi210569r9","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1001\/jama.296.9.1071","article-title":"Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.","volume":"296","author":"West","year":"2006","journal-title":"JAMA"},{"issue":"2","key":"zoi210569r10","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/medu.12083","article-title":"Association of medical student burnout with residency specialty choice.","volume":"47","author":"Enoch","year":"2013","journal-title":"Med Educ"},{"issue":"15","key":"zoi210569r11","doi-asserted-by":"publisher","first-page":"2708","DOI":"10.1016\/j.ejca.2010.05.014","article-title":"Prevalence and causes of burnout amongst oncology residents: a comprehensive nationwide cross-sectional study.","volume":"46","author":"Blanchard","year":"2010","journal-title":"Eur J Cancer"},{"issue":"10","key":"zoi210569r12","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1097\/ACM.0b013e3181f0c4e7","article-title":"Predictors of persistent burnout in internal medicine residents: a prospective cohort study.","volume":"85","author":"Campbell","year":"2010","journal-title":"Acad Med"},{"issue":"5","key":"zoi210569r13","doi-asserted-by":"publisher","first-page":"334","DOI":"10.7326\/0003-4819-149-5-200809020-00008","article-title":"Burnout and suicidal ideation among U.S. medical students.","volume":"149","author":"Dyrbye","year":"2008","journal-title":"Ann Intern Med"},{"issue":"7","key":"zoi210569r14","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.7457","article-title":"Association of racial bias with burnout among resident physicians.","volume":"2","author":"Dyrbye","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"11","key":"zoi210569r15","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1080\/0142159X.2019.1630731","article-title":"How does medical education affect empathy and compassion in medical students? a meta-ethnography: BEME Guide No. 57.","volume":"41","author":"Krishnasamy","year":"2019","journal-title":"Med Teach"},{"issue":"5","key":"zoi210569r16","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1097\/ACM.0000000000003094","article-title":"Redesigning the learning environment to promote learner well-being and professional development.","volume":"95","author":"Dyrbye","year":"2020","journal-title":"Acad Med"},{"issue":"5","key":"zoi210569r17","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1097\/ACM.0000000000000204","article-title":"The prevalence of medical student mistreatment and its association with burnout.","volume":"89","author":"Cook","year":"2014","journal-title":"Acad Med"},{"issue":"1","key":"zoi210569r18","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1177\/0846537119885672","article-title":"Burnout in Canadian radiology residency: a national assessment of prevalence and underlying contributory factors.","volume":"71","author":"Ferguson","year":"2020","journal-title":"Can Assoc Radiol J"},{"issue":"1","key":"zoi210569r19","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.jvs.2019.02.064","article-title":"Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout.","volume":"71","author":"Wang","year":"2020","journal-title":"J Vasc Surg"},{"issue":"18","key":"zoi210569r20","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1056\/NEJMsa1903759","article-title":"Discrimination, abuse, harassment, and burnout in surgical residency training.","volume":"381","author":"Hu","year":"2019","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi210569r21","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/medu.2016.50.issue-1","article-title":"A narrative review on burnout experienced by medical students and residents.","volume":"50","author":"Dyrbye","year":"2016","journal-title":"Med Educ"},{"issue":"3","key":"zoi210569r22","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1111\/med.2009.43.issue-3","article-title":"The learning environment and medical student burnout: a multicentre study.","volume":"43","author":"Dyrbye","year":"2009","journal-title":"Med Educ"},{"issue":"12","key":"zoi210569r23","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1001\/jama.2019.0167","article-title":"Notice of retraction and replacement: Dyrbye et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA. 2018;320(11):1114-1130.","volume":"321","author":"Dyrbye","year":"2019","journal-title":"JAMA"},{"issue":"21","key":"zoi210569r25","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1001\/jama.2016.17573","article-title":"Association between learning environment interventions and medical student well-being: a systematic review.","volume":"316","author":"Wasson","year":"2016","journal-title":"JAMA"},{"issue":"5","key":"zoi210569r26","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1001\/jamainternmed.2020.0030","article-title":"Assessment of the prevalence of medical student mistreatment by sex, race\/ethnicity, and sexual orientation.","volume":"180","author":"Hill","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"2","key":"zoi210569r27","first-page":"98","article-title":"Measuring the medical school learning environment.","volume":"53","author":"Marshall","year":"1978","journal-title":"J Med Educ"},{"key":"zoi210569r29","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1472-6920-7-6","article-title":"Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study.","volume":"7","author":"Dahlin","year":"2007","journal-title":"BMC Med Educ"},{"issue":"6","key":"zoi210569r30","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1111\/med.2005.39.issue-6","article-title":"Stress and depression among medical students: a cross-sectional study.","volume":"39","author":"Dahlin","year":"2005","journal-title":"Med Educ"},{"issue":"8","key":"zoi210569r31","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1097\/ACM.0b013e31822203d8","article-title":"Empathic and sympathetic orientations toward patient care: conceptualization, measurement, and psychometrics.","volume":"86","author":"Hojat","year":"2011","journal-title":"Acad Med"},{"key":"zoi210569r32","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1037\/0022-3514.44.1.113","article-title":"Measuring individual differences in empathy: evidence for a multi-dimensional approach.","volume":"44","author":"Davis","year":"1983","journal-title":"J Pers Soc Psychol"},{"issue":"9","key":"zoi210569r33","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1001\/jama.2011.1247","article-title":"Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.","volume":"306","author":"West","year":"2011","journal-title":"JAMA"},{"issue":"12","key":"zoi210569r34","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1001\/jama.2009.1389","article-title":"Association of resident fatigue and distress with perceived medical errors.","volume":"302","author":"West","year":"2009","journal-title":"JAMA"},{"issue":"6","key":"zoi210569r35","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/BF00439226","article-title":"Health state valuations from the general public using the visual analogue scale.","volume":"5","author":"Gudex","year":"1996","journal-title":"Qual Life Res"},{"issue":"4","key":"zoi210569r36","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1200\/JCO.2006.06.209","article-title":"Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial.","volume":"24","author":"Rummans","year":"2006","journal-title":"J Clin Oncol"},{"issue":"12","key":"zoi210569r37","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/0021-9681(81)90058-8","article-title":"Measuring the quality of life of cancer patients: a concise QL-index for use by physicians.","volume":"34","author":"Spitzer","year":"1981","journal-title":"J Chronic Dis"},{"issue":"2","key":"zoi210569r38","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s11606-006-0039-6","article-title":"How do distress and well-being relate to medical student empathy? a multicenter study.","volume":"22","author":"Thomas","year":"2007","journal-title":"J Gen Intern Med"},{"issue":"4","key":"zoi210569r39","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress.","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"issue":"12","key":"zoi210569r40","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1177\/1359105313508346","article-title":"New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4).","volume":"18","author":"Warttig","year":"2013","journal-title":"J Health Psychol"},{"issue":"13","key":"zoi210569r41","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1001\/archinte.159.13.1417","article-title":"Career satisfaction of US women physicians: results from the Women Physicians\u2019 Health Study.","volume":"159","author":"Frank","year":"1999","journal-title":"Arch Intern Med"},{"issue":"3","key":"zoi210569r42","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/SLA.0b013e3181ac4dfd","article-title":"Burnout and career satisfaction among American surgeons.","volume":"250","author":"Shanafelt","year":"2009","journal-title":"Ann Surg"},{"issue":"1","key":"zoi210569r44","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1186\/s12909-019-1839-9","article-title":"Improving students\u2019 learning environment by DREEM: an educational experiment in an Iranian medical sciences university (2011-2016).","volume":"19","author":"Bakhshialiabad","year":"2019","journal-title":"BMC Med Educ"},{"issue":"10","key":"zoi210569r45","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1111\/med.2010.44.issue-10","article-title":"Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students.","volume":"44","author":"Dyrbye","year":"2010","journal-title":"Med Educ"},{"issue":"10","key":"zoi210569r46","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1097\/ACM.0b013e31822c1236","article-title":"The incidence and predictors of job burnout in first-year internal medicine residents: a five-institution study.","volume":"86","author":"Ripp","year":"2011","journal-title":"Acad Med"},{"key":"zoi210569r47","doi-asserted-by":"crossref","DOI":"10.1016\/j.mayocp.2020.12.036","article-title":"A longitudinal study exploring learning environment culture and subsequent risk of burnout among resident physicians overall and by gender.","author":"Dyrbye","year":"2021","journal-title":"Mayo Clin Proc"},{"issue":"3","key":"zoi210569r48","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.0870","article-title":"Assessment of programs aimed to decrease or prevent mistreatment of medical trainees.","volume":"1","author":"Mazer","year":"2018","journal-title":"JAMA Netw Open"},{"issue":"12","key":"zoi210569r49","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1097\/ACM.0000000000003709","article-title":"Is it mistreatment? practices for productive teacher-learner interactions.","volume":"95","author":"Ainsworth","year":"2020","journal-title":"Acad Med"},{"issue":"9","key":"zoi210569r50","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1097\/ACM.0000000000001137","article-title":"Medical student perceptions of the learning environment at the end of the first year: a 28-medical school collaborative.","volume":"91","author":"Skochelak","year":"2016","journal-title":"Acad Med"},{"issue":"11","key":"zoi210569r51","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.4065\/81.11.1443","article-title":"The benefits of pass-fail grading on stress, mood, and group cohesion in medical students.","volume":"81","author":"Rohe","year":"2006","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"zoi210569r52","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/s40037-012-0012-5","article-title":"Academic self-efficacy: from educational theory to instructional practice.","volume":"1","author":"Artino","year":"2012","journal-title":"Perspect Med Educ"},{"issue":"5","key":"zoi210569r53","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/ACM.0b013e31819f6d78","article-title":"A change to pass\/fail grading in the first two years at one medical school results in improved psychological well-being.","volume":"84","author":"Bloodgood","year":"2009","journal-title":"Acad Med"},{"issue":"11","key":"zoi210569r54","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1097\/ACM.0b013e3182305d81","article-title":"Relationship of pass\/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study.","volume":"86","author":"Reed","year":"2011","journal-title":"Acad Med"},{"issue":"6","key":"zoi210569r55","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1097\/ACM.0000000000003058","article-title":"The effectiveness of teaching clinical empathy to medical students: a systematic review and meta-analysis of randomized controlled trials.","volume":"95","author":"Fragkos","year":"2020","journal-title":"Acad Med"},{"issue":"8","key":"zoi210569r56","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0221412","article-title":"Curricula for empathy and compassion training in medical education: a systematic review.","volume":"14","author":"Patel","year":"2019","journal-title":"PLoS One"},{"issue":"5","key":"zoi210569r57","doi-asserted-by":"publisher","first-page":"376","DOI":"10.3109\/0142159X.2013.769678","article-title":"Cause or effect? the relationship between student perception of the medical school learning environment and academic performance on USMLE Step 1.","volume":"35","author":"Wayne","year":"2013","journal-title":"Med Teach"},{"key":"zoi210569r8","volume-title":"Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-being","author":"National Academies of Sciences, Engineering and Medicine","year":"2019"},{"key":"zoi210569r28","volume-title":"Handbook of Stress and Burnout in Health Care","author":"Demerouti","year":"2008"},{"key":"zoi210569r24","unstructured":"Irby? DM. Improving Environments for Learning in the Health Professions. Proceedings of a conference sponsored by Josiah Macy Jr. Foundation in April 2018; New York, NY: Josiah Macy Jr. Foundation, 2018. Accessed July 1, 2021. https:\/\/macyfoundation.org\/publications\/improving-environments-for-learning-in-the-health-professions"},{"key":"zoi210569r43","unstructured":"Association of American Medical Colleges. FACTS: Graduates to US Medical Schools by Sex, 1980-1981 through 2018-2019. Accessed November 16, 2020. https:\/\/www.aamc.org\/media\/9631\/download"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2782834\/dyrbye_2021_oi_210569_1627686277.51456.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T20:04:15Z","timestamp":1628539455000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2782834"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,9]]},"references-count":57,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.19110","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,9]]}}}