{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:14:29Z","timestamp":1791465269660,"version":"4.3.4"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Promoting residents\u2019 wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents\u2019 wellness and learning.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents\u2019 burnout.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>From November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal\/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents\u2019 positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents\u2019 self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents\u2019 perception of impaired personal relationships (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), self-defined burnout (<jats:italic>p<\/jats:italic>\u2009=\u20090.013), program burn-out support (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) and program back-up support (<jats:italic>p<\/jats:italic>\u2009=\u20090.028). For the Internal Medicine Residency program, there were statistically significant improvements in all three MBI factors (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and in clinical learning environment measures (<jats:italic>p<\/jats:italic>\u2009=\u20090.006 to\u2009&lt;\u20090.001). Interventions introduced during the PDSA cycles included organization-directed interventions (such as: faculty and administrative leadership recruitment, workflow interventions and residents\u2019 schedule optimization), and individual interventions (such as: selfcare, mentoring and resilience training).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In our study, for all GME residents, clinical learning environment factors in contrast to MBI factors showed significant improvements. Residents\u2019 positive perception of the clinical learning environment was associated with improved burnout measures. Residents in separate programs responded differently with one program reaching significance in all MBI and clinical learning environment factors measured. Continuous wellbeing assessment of all GME residents and introduction of Institutional and individual program interventions was accomplished.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12909-022-03366-y","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T18:03:27Z","timestamp":1650305007000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Graduate medical education-led continuous assessment of burnout and learning environments to improve residents\u2019 wellbeing"],"prefix":"10.1186","volume":"22","author":[{"given":"Dotun","family":"Ogunyemi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Ghassan","family":"Darwish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Cyr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarkis","family":"Arabian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kedar","family":"Challakere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niren","family":"Raval","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"issue":"1","key":"3366_CR1","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1002\/aet2.10311","volume":"3","author":"A Dam","year":"2019","unstructured":"Dam A, Perera T, Jones M, Haughy M, Gaeta T. The Relationship Between Grit, Burnout, and Well-being in Emergency Medicine Residents. AEM Educ Train. 2019;3(1):14\u20139 PMID: 30680343.","journal-title":"AEM Educ Train."},{"key":"3366_CR2","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1146\/annurev.psych.52.1.397","volume":"52","author":"C Maslach","year":"2001","unstructured":"Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397\u2013422.","journal-title":"Annu Rev Psychol"},{"key":"3366_CR3","unstructured":"ACGME. ACGME Common Program Requirements (Residency). Accredit Counc Med Educ. Published online 2020"},{"key":"3366_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s40037-018-0405-1","author":"SN Van Vendeloo","year":"2018","unstructured":"Van Vendeloo SN, Prins DJ, Verheyen CCPM, et al. The learning environment and resident burnout: a national study. Perspect Med Educ Published online. 2018. https:\/\/doi.org\/10.1007\/s40037-018-0405-1.","journal-title":"Perspect Med Educ Published online"},{"key":"3366_CR5","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1186\/s12909-019-1687-7","volume":"19","author":"P Puranitee","year":"2019","unstructured":"Puranitee P, Stevens F, Pakakasama S, Plitponkarnpim A, Vallibhakara S, Busari J, Heeneman S, Mook W. Exploring burnout and the association with the educational climate in pediatric residents in Thailand. BMC Med Educ. 2019;19:245. https:\/\/doi.org\/10.1186\/s12909-019-1687-7.","journal-title":"BMC Med Educ"},{"issue":"6","key":"3366_CR6","doi-asserted-by":"publisher","first-page":"e07238","DOI":"10.1016\/j.heliyon.2021.e07238.PMID:34189297;PMCID:PMC8215171","volume":"7","author":"N Maghbouli","year":"2021","unstructured":"Maghbouli N, Fatehi F, Mafinejad MK, Pourhassan S, Sohrabpour AA, Ali JH. Burnout and clinical learning environment among residents in Tehran: A cross-sectional study. Heliyon. 2021;7(6):e07238. https:\/\/doi.org\/10.1016\/j.heliyon.2021.e07238.PMID:34189297;PMCID:PMC8215171.","journal-title":"Heliyon"},{"key":"3366_CR7","doi-asserted-by":"publisher","unstructured":"Low, Z.X.; Yeo, K.A.; Sharma, V.K.; Leung, G.K.; McIntyre, R.S.; Guerrero, A.; Lu, B.; Sin Fai Lam, C.C.; Tran, B.X.; Nguyen, L.H.; Ho, C.S.; Tam, W.W.; Ho, R.C. Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis. Int. J. Environ. Res. Public Health 2019, 16, 1479. https:\/\/doi.org\/10.3390\/ijerph16091479","DOI":"10.3390\/ijerph16091479"},{"key":"3366_CR8","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000002250","author":"EK Edmondson","year":"2018","unstructured":"Edmondson EK, Kumar AA, Smith SM. Creating a culture of wellness in residency. Acad Med Published online. 2018. https:\/\/doi.org\/10.1097\/ACM.0000000000002250.","journal-title":"Acad Med Published online"},{"key":"3366_CR9","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2019.10.43830","author":"M Parsons","year":"2020","unstructured":"Parsons M, Bailitz J, Chung AS, et al. Evidence-based interventions that promote resident wellness from the Council of Emergency Residency directors. West J Emerg Med Published online. 2020. https:\/\/doi.org\/10.5811\/westjem.2019.10.43830.","journal-title":"West J Emerg Med Published online"},{"key":"3366_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2017.07.007","author":"S Ross","year":"2017","unstructured":"Ross S, Liu EL, Rose C, Chou A, Battaglioli N. Strategies to Enhance Wellness in Emergency Medicine Residency Training Programs. Ann Emerg Med Published online. 2017. https:\/\/doi.org\/10.1016\/j.annemergmed.2017.07.007.","journal-title":"Ann Emerg Med Published online"},{"key":"3366_CR11","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.4805","author":"RS Patel","year":"2019","unstructured":"Patel RS, Sekhri S, Bhimanadham NN, Imran S, Hossain S. A Review on Strategies to Manage Physician Burnout. Cureus Published online. 2019. https:\/\/doi.org\/10.7759\/cureus.4805.","journal-title":"Cureus Published online"},{"issue":"1","key":"3366_CR12","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/medu.12927","volume":"50","author":"L Dyrbye","year":"2016","unstructured":"Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents Med Educ. 2016;50(1):132\u201349. https:\/\/doi.org\/10.1111\/medu.12927 PMID: 26695473.","journal-title":"A narrative review on burnout experienced by medical students and residents Med Educ"},{"key":"3366_CR13","doi-asserted-by":"publisher","DOI":"10.4300\/jgme-d-09-00026.1","author":"J Eckleberry-Hunt","year":"2009","unstructured":"Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. J Grad Med Educ Published online. 2009. https:\/\/doi.org\/10.4300\/jgme-d-09-00026.1.","journal-title":"J Grad Med Educ Published online"},{"key":"3366_CR14","doi-asserted-by":"publisher","DOI":"10.1177\/2374289519851233","author":"MC Saint Martin","year":"2019","unstructured":"Saint Martin MC, DeChristopher PJ, Sweeney RP. A Strategy for Wellness in a Pathology Residency Program: Enhancing Chances of Success During an Epidemic of Burnout. Acad Pathol Published online. 2019. https:\/\/doi.org\/10.1177\/2374289519851233.","journal-title":"Acad Pathol Published online"},{"key":"3366_CR15","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-019-1756-y","author":"S Mari","year":"2019","unstructured":"Mari S, Meyen R, Kim B. Resident-led organizational initiatives to reduce burnout and improve wellness. BMC Med Educ Published online. 2019. https:\/\/doi.org\/10.1186\/s12909-019-1756-y.","journal-title":"BMC Med Educ Published online"},{"key":"3366_CR16","doi-asserted-by":"publisher","unstructured":"Aggarwal R, Deutsch JK, Medina J, Kothari N. Resident Wellness: An Intervention to Decrease Burnout and Increase Resiliency and Happiness. MedEdPORTAL J Teach Learn Resour. Published online 2017. doi:https:\/\/doi.org\/10.15766\/mep_2374-8265.10651","DOI":"10.15766\/mep_2374-8265.10651"},{"key":"3366_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/children5040054","author":"H McClafferty","year":"2018","unstructured":"McClafferty H, Brooks A, Chen M-K, et al. Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents. Children Published online. 2018. https:\/\/doi.org\/10.3390\/children5040054.","journal-title":"Children Published online"},{"issue":"1","key":"3366_CR18","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1111\/medu.14351","volume":"55","author":"BM Wong","year":"2021","unstructured":"Wong BM, Headrick LA. Application of continuous quality improvement to medical education. Med ED. 2021;55(1):72\u201381.","journal-title":"Med ED"},{"key":"3366_CR19","doi-asserted-by":"publisher","unstructured":"D Choi A Cedfeldt C Flores K Irish P Brunett D Girard Resident wellness: institutional trends over 10 years since 2003 Adv Med Educ Pract Published online 2017doi:https:\/\/doi.org\/10.2147\/amep.s138770","DOI":"10.2147\/amep.s138770"},{"key":"3366_CR20","doi-asserted-by":"publisher","unstructured":"Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians a systematic review. JAMA - J Am Med Assoc. Published online 2018. doi:https:\/\/doi.org\/10.1001\/jama.2018.12777","DOI":"10.1001\/jama.2018.12777"},{"key":"3366_CR21","doi-asserted-by":"publisher","unstructured":"Dyrbye LN, Burke SE, Hardeman RR, et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA - J Am Med Assoc. Published online 2018. doi:https:\/\/doi.org\/10.1001\/jama.2018.12615","DOI":"10.1001\/jama.2018.12615"},{"key":"3366_CR22","doi-asserted-by":"crossref","unstructured":"Busis NA, Shanafelt TD, Keran CM, et al. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology. Published online 2017. doi:10.1212\/WNL.0000000000003640","DOI":"10.1212\/WNL.0000000000003640"},{"key":"3366_CR23","doi-asserted-by":"publisher","DOI":"10.4300\/jgme-d-09-00054.1","author":"WW IsHak","year":"2009","unstructured":"IsHak WW, Lederer S, Mandili C, et al. Burnout During Residency Training: A Literature Review. J Grad Med Educ Published online. 2009. https:\/\/doi.org\/10.4300\/jgme-d-09-00054.1.","journal-title":"J Grad Med Educ Published online"},{"key":"3366_CR24","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-200601000-00020","author":"IM Rosen","year":"2006","unstructured":"Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med Published online. 2006. https:\/\/doi.org\/10.1097\/00001888-200601000-00020.","journal-title":"Acad Med Published online"},{"key":"3366_CR25","doi-asserted-by":"publisher","DOI":"10.4300\/JGME-D-16-00554.1","author":"AN Bird","year":"2017","unstructured":"Bird AN, Martinchek M, Pincavage AT. A Curriculum to Enhance Resilience in Internal Medicine Interns. J Grad Med Educ Published online. 2017. https:\/\/doi.org\/10.4300\/JGME-D-16-00554.1.","journal-title":"J Grad Med Educ Published online"},{"issue":"1","key":"3366_CR26","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4300\/JGME-D-19-00358.1","volume":"12","author":"N Arnstead","year":"2020","unstructured":"Arnstead N, Campisis P, Takahashi SG, Hong C, Mok F, Noel CW, Siu J, Wong BM, Monteiro E. Feedback Frequency in Competence by Design: A Quality Improvement Initiative. J Grad Med Educ. 2020;12(1):46\u201350. https:\/\/doi.org\/10.4300\/JGME-D-19-00358.1.","journal-title":"J Grad Med Educ"},{"issue":"2","key":"3366_CR27","doi-asserted-by":"publisher","first-page":"e20153807","DOI":"10.1542\/peds.2015-3807","volume":"139","author":"AE Dunbar 3rd","year":"2017","unstructured":"Dunbar AE 3rd, Cupit M, Vath RJ, Pontiff K, Evans N, Roy M, Bolton M. An Improvement Approach to Integrate Teaching Teams in the Reporting of Safety Events. Pediatrics. 2017;139(2):e20153807. https:\/\/doi.org\/10.1542\/peds.2015-3807 PMID: 28123045.","journal-title":"Pediatrics"},{"key":"3366_CR28","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31279-X","author":"CP West","year":"2016","unstructured":"West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet Published online. 2016. https:\/\/doi.org\/10.1016\/S0140-6736(16)31279-X.","journal-title":"Lancet Published online"},{"key":"3366_CR29","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.7674","author":"M Panagioti","year":"2017","unstructured":"Panagioti M, Panagopoulou E, Bower P, et al. Controlled Interventions to Reduce Burnout in Physicians. JAMA Intern Med Published online. 2017. https:\/\/doi.org\/10.1001\/jamainternmed.2016.7674.","journal-title":"JAMA Intern Med Published online"},{"key":"3366_CR30","doi-asserted-by":"publisher","unstructured":"DeChant PF, Acs A, Rhee KB, et al. Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review. Mayo Clin Proc Innov Qual Outcomes. Published online 2019. doi:https:\/\/doi.org\/10.1016\/j.mayocpiqo.2019.07.006","DOI":"10.1016\/j.mayocpiqo.2019.07.006"},{"issue":"1","key":"3366_CR31","doi-asserted-by":"publisher","first-page":"E189","DOI":"10.9778\/cmajo.20200068.PMID:33688027;PMCID:PMC8034324","volume":"9","author":"L Naji","year":"2021","unstructured":"Naji L, Singh B, Shah A, Naji F, Dennis B, Kavanagh O, Banfield L, Alyass A, Razak F, Samaan Z, Profetto J, Thabane L, Sohani ZN. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. CMAJ Open. 2021;9(1):E189\u2013200. https:\/\/doi.org\/10.9778\/cmajo.20200068.PMID:33688027;PMCID:PMC8034324.","journal-title":"CMAJ Open"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-022-03366-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-022-03366-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-022-03366-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T18:03:30Z","timestamp":1650305010000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmededuc.biomedcentral.com\/articles\/10.1186\/s12909-022-03366-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,18]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["3366"],"URL":"https:\/\/doi.org\/10.1186\/s12909-022-03366-y","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,18]]},"assertion":[{"value":"20 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 April 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"IRB approval was obtained. This was a retrospective study; the informed consent was waived by the Arrowhead Regional Medical Center Institution Review Board (IRB) that approved the study. All methods were carried out in accordance with relevant guidelines and regulations and approved by the Arrowhead Regional Medical Center Institution Review Board: Protocol #: 20\u201345.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable in the declarations section.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"There are no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"292"}}