Graduate medical education-led continuous assessment of burnout and learning environments to improve residents’ wellbeing
Open accessAbstract
Background: Promoting residents’ wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents’ wellness and learning. Objective: 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’ burnout. Methods: 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. Results: The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents’ positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents’ 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’ perception of impaired personal relationships (p < 0.001), self-defined burnout (p = 0.013), program burn-out support (p = 0.002) and program back-up support (p = 0.028). For the Internal Medicine Residency program, there were statistically significant improvements in all three MBI factors (p < 0.001) and in clinical learning environment measures (p = 0.006 to < 0.001). Interventions introduced during the PDSA cycles included organization-directed interventions (such as: faculty and administrative leadership recruitment, workflow interventions and residents’ schedule optimization), and individual interventions (such as: selfcare, mentoring and resilience training). Conclusion: In our study, for all GME residents, clinical learning environment factors in contrast to MBI factors showed significant improvements. Residents’ 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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Outcome measurements were conducted using various versions of the validated Maslach Burnout Inventory (MBI): 26 studies used the 22-item MBI, 5 used the 9-item MBI, 1 used the 20-item Dutch version, and 1 used the 16-item MBI.
“Outcome measurements were conducted using various versions of the validated MBI. Specifically, 26 studies (78.7%) used the 22-item MBI [44, 45, 47–49, 51, 52, 54, 56, 58, 60–65, 67, 68, 70–76], 5 studies (15.2%) employed the 9-item MBI [50, 53, 55, 59, 69], 1 study (3.0%) used the 20-item Dutch version of the MBI [57], and 1 study (3.0%) utilized the 16-item MBI [66].”
From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [49]
The citation to this paper is attached specifically to the statement that one study used a 16-item MBI. The paper’s Discussion says it used the 22-item MBI, and its Methods list subscales of 9, 5, and 8 items, totaling 22. Page numbers are unavailable in our copy. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn the improved learning environment subgroup, EE and DP were not significantly changed, but PA was significantly improved: EE -0.20 (95% CI -0.61 to 0.21, p = 0.74, I2 = 54.8%), DP -0.07 (95% CI -0.58 to 0.44, p = 0.79, I2 = 69.6%), PA 0.28 (95% CI 0.05 to 0.50, p = 0.02, I2 = 0%).
“Moreover, the subgroup of improved learning environment interventions [48, 49] showed non-statistically significant post-intervention mean score differences in EE (-0.20, 95% CI -0.61 to 0.21, p = 0.74, I2 = 54.8%) and DP (-0.07, 95% CI -0.58 to 0.44, p = 0.79, I2 = 69.6%), but a significant difference in PA (0.28, 95% CI 0.05 to 0.50, p = 0.02, I2 = 0%).”
From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [49]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe majority of studies employed non-randomized, non-concurrent designs, with 9 using historical controls, 13 utilizing self-control studies, and 11 randomized controlled concurrent trials.
“The majority of studies employed non-randomized, non-concurrent designs, with 9 (27.2%) using historical controls [44, 48, 49, 56, 59, 68, 71, 75, 76] and 13 (39.4%) utilizing self-control studies [47, 50, 53, 54, 58, 61, 65–67, 69, 70, 72, 73]. Eleven (33.3%) studies were randomized, controlled, concurrent trials [45, 51, 52, 55, 57, 60–64, 74].”
From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [49]
The Discussion (Limitations; page unavailable) describes this paper as an observational study without control groups, supporting its identification as a non-randomized study. The paper does not report the citing sentence’s totals of 9 historical-control studies, 13 self-control studies, or 11 randomized trials, and our copy does not establish which category the citing authors assigned it to. (LLM, conf=0.80)
Experimental — accuracy not yet measuredOrganizational interventions showed no statistically significant association with any burnout domain (EE, DP, PA).
“In organizational intervention studies [44, 45, 47–49, 73, 76], pooling of post-intervention intervention Cohen’s d SMD yielded non-statistically significant resulted in all outcomes, EE (-0.22, 95% CI -0.47 to 0.04, p = 0.10, I2 = 62.6%) (Fig. 3A), DP (-0.15, 95% CI -0.38 to 0.08, p = 0.21, I2 = 53.0%) (Fig. 3B), and PA (0.12, 95% CI -0.01 to 0.25, p = 0.07; I2 = 0%) (Fig. 3C).”
From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [49]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
1 retracted
Dyrbye, L. N., Burke, S. E., Hardeman, R. R., Herrin, J., Wittlin, N. M., Yeazel, M., Dovidio, J. F., Cunningham, B., White, R. O., Phelan, S. M., et al. (2018) · JAMA · doi:10.1001/jama.2018.12615 · Cited by 468 · see citing works
RetractedMaslach, C., Schaufeli, W. B., & Leiter, M. P. (2001) · Annual Review of Psychology · doi:10.1146/annurev.psych.52.1.397 · Cited by 12,852 · see citing works
Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis
West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31279-x · Cited by 2,362 · see citing works
Prevalence of Burnout Among Physicians: A Systematic Review
Rotenstein, L. S., Torre, M., Ramos, M. A., Rosales, R. C., Guille, C., Sen, S., & Mata, D. A. (2018) · JAMA · doi:10.1001/jama.2018.12777 · Cited by 1,904 · see citing works
Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis
Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., Dawson, S., van Marwijk, H., Geraghty, K., & Esmail, A. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.7674 · Cited by 1,395 · cited 1× · see citing works
“This is in agreement with previous reports showing that organization directed interventions in comparison to individual interventions were associated with a meaningful reduction in emotional exhaustion and depersonalization scores [11, 28, 29].”
ResultA narrative review on burnout experienced by medical students and residents
Dyrbye, L., & Shanafelt, T. (2016) · Medical Education · doi:10.1111/medu.12927 · Cited by 1,134 · see citing works
Burnout During Residency Training: A Literature Review
IsHak, W. W., Lederer, S., Mandili, C., Nikravesh, R., Seligman, L., Vasa, M., Ogunyemi, D., & Bernstein, C. A. (2009) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-09-00054.1 · Cited by 643 · see citing works
Self-citationRosen, I. M., Gimotty, P. A., Shea, J. A., & Bellini, L. M. (2006) · Academic Medicine · doi:10.1097/00001888-200601000-00020 · Cited by 495 · see citing works
Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis
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., et al. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16091479 · Cited by 415 · see citing works
Burnout, career satisfaction, and well-being among US neurologists in 2016
Busis, N. A., Shanafelt, T. D., Keran, C. M., Levin, K. H., Schwarz, H. B., Molano, J. R. V., Vidic, T. R., Kass, J. S., Miyasaki, J. M., Sloan, J. A., et al. (2017) · Neurology · doi:10.1212/wnl.0000000000003640 · Cited by 260 · see citing works
Eckleberry-Hunt, J., Dyke, A. V., Lick, D., & Tucciarone, J. (2009) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-09-00026.1 · Cited by 206 · see citing works
Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review
DeChant, P. F., Acs, A., Rhee, K. B., Boulanger, T. S., Snowdon, J. L., Tutty, M. A., Sinsky, C. A., & Thomas Craig, K. J. (2019) · Mayo Clinic Proceedings: Innovations, Quality & Outcomes · doi:10.1016/j.mayocpiqo.2019.07.006 · Cited by 192 · see citing works
A Review on Strategies to Manage Physician Burnout
Patel, R. S., Sekhri, S., Bhimanadham, N. N., Imran, S., & Hossain, S. (2019) · Cureus · doi:10.7759/cureus.4805 · Cited by 156 · see citing works
Naji, L., Singh, B., Shah, A., Naji, F. N., Dennis, B. B., Kavanagh, O. V., Banfield, L. E., Alyass, A., Razak, F. A., Samaan, Z., et al. (2021) · CMAJ Open · doi:10.9778/cmajo.20200068 · Cited by 104 · see citing works
Resident Wellness: An Intervention to Decrease Burnout and Increase Resiliency and Happiness
Aggarwal, R., Deutsch, J. K., Medina, J., & Kothari, N. (2017) · MedEdPORTAL · doi:10.15766/mep_2374-8265.10651 · Cited by 86 · see citing works
The learning environment and resident burnout: a national study
van Vendeloo, S. N., Prins, D. J., Verheyen, C. C. P. M., Prins, J., van den Heijkant, F., der Heijden, F. M. M. A. V., & Brand, P. L. P. (2018) · Perspectives on Medical Education · doi:10.1007/s40037-018-0405-1 · Cited by 75 · see citing works
The Relationship Between Grit, Burnout, and Well‐being in Emergency Medicine Residents
Dam, A., Perera, T., Jones, M. P., Haughy, M., & Gaeta, T. J. (2018) · AEM Education and Training · doi:10.1002/aet2.10311 · Cited by 74 · see citing works
Application of continuous quality improvement to medical education
Wong, B. M., & Headrick, L. A. (2020) · Medical Education · doi:10.1111/medu.14351 · Cited by 71 · see citing works
Resident-led organizational initiatives to reduce burnout and improve wellness
Mari, S., Meyen, R., & Kim, B. (2019) · BMC Medical Education · doi:10.1186/s12909-019-1756-y · Cited by 67 · see citing works
Parsons, M., Bailitz, J. M., Chung, A. S., Mannix, A., Battaglioli, N., Clinton, M., & Gottlieb, M. A. (2020) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2019.11.42961 · Cited by 55 · see citing works
A Curriculum to Enhance Resilience in Internal Medicine Interns
Bird, A.-N., Martinchek, M., & Pincavage, A. T. (2017) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-16-00554.1 · Cited by 43 · see citing works
Creating a Culture of Wellness in Residency
Edmondson, E. K., Kumar, A. A., & Smith, S. M. (2018) · Academic Medicine · doi:10.1097/acm.0000000000002250 · Cited by 43 · see citing works
Puranitee, P., Stevens, F. C. J., Pakakasama, S., Plitponkarnpim, A., Vallibhakara, S. A.-O., Busari, J. O., Heeneman, S., & van Mook, W. (2019) · BMC Medical Education · doi:10.1186/s12909-019-1687-7 · Cited by 40 · see citing works
Strategies to Enhance Wellness in Emergency Medicine Residency Training Programs
Ross, S., Liu, E. L., Rose, C. C., Chou, A., & Battaglioli, N. (2017) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2017.07.007 · Cited by 37 · see citing works
McClafferty, H. H., Brooks, A. J., Chen, M., Brenner, M. G., Brown, M. L., Esparham, A. E., Gerstbacher, D., Golianu, B. J., Mark, J., Weydert, J. A., et al. (2018) · Children · doi:10.3390/children5040054 · Cited by 26 · see citing works
Martin, M. C. S., DeChristopher, P. J., & Sweeney, R. P. (2019) · Academic Pathology · doi:10.1177/2374289519851233 · Cited by 20 · see citing works
An Improvement Approach to Integrate Teaching Teams in the Reporting of Safety Events
Dunbar, A. E., Cupit, M., Vath, R. J., Pontiff, K., Evans, N., Roy, M., & Bolton, M. T. (2017) · PEDIATRICS · doi:10.1542/peds.2015-3807 · Cited by 16 · see citing works
Burnout and clinical learning environment among residents in Tehran: A cross-sectional study
Maghbouli, N., Fatehi, F., Mafinejad, M. K., Pourhassan, S., Sohrabpour, A. A., & Ali, J. H. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e07238 · Cited by 14 · see citing works
Feedback Frequency in Competence by Design: A Quality Improvement Initiative
Arnstead, N., Campisi, P., Takahashi, S. G., Hong, C. J. H., Mok, F., Noel, C. W., Siu, J., Wong, B. M., & Monteiro, E. (2020) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-19-00358.1 · Cited by 11 · see citing works
Resident wellness: institutional trends over 10 years since 2003
Choi, D., Cedfeldt, A. S., Flores, C., Irish, K., Brunett, P. H., & Girard, D. E. (2017) · Advances in Medical Education and Practice · doi:10.2147/amep.s138770 · Cited by 6 · see citing works
Innovative Approaches to Emergency Medical Services Fellowship Challenges
Weston, B. W., Gaither, J. B., Schulz, K., Srinivasan, S., Smith, J., & Colella, M. R. (2020) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2019.10.43830 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Kiratipaisarl, W., Surawattanasakul, V., & Sirikul, W. (2024) · BMC Medical Education · doi:10.1186/s12909-024-06195-3 · Cited by 37 · see citing works
“%) using historical controls [44, 48, 49, 56, 59, 68, 71, 75, 76] and 13 (39.4”
BackgroundMethodInfluentialCook, D. A., Hauer, K. E., Teherani, A., Hunderfund, A. N. L., Durning, S. J., & Colbert‐Getz, J. M. (2025) · Academic Medicine · doi:10.1097/acm.0000000000006072 · Cited by 11 · see citing works
Izquierdo‐Condoy, J. S., Ruiz-Sosa, C., Tello-De-la-Torre, A., & Ortiz‐Prado, E. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1409471 · Cited by 7 · see citing works
Prevention of burnout syndrome in physicians: a systematic review and meta-analysis
Krebs, L., Jung, L., & Arrich, J. (2026) · Wiener Klinische Wochenschrift · doi:10.1007/s00508-025-02601-y · Cited by 5 · see citing works
Combating Burnout Amongst Residents Through Fostering Resilience: A Systematic Review
Tan, L. X. S., Ding, J., Neo, T. X., Chen, V. S., Lee, C. S. M., Hamid, N. A. B. A., Ong, Y. T., & Krishna, L. K. R. (2025) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091251331150 · Cited by 4 · see citing works
Self-citationResident Flourishing in the Surgical Learning Environment: A Mixed Methods Study
Stanulis, R. N., Pestenariu, J., Zhou, G., Day, E., & Kavuturu, S. (2025) · Journal of Surgical Research · doi:10.1016/j.jss.2025.06.058 · Cited by 4 · see citing works
Covner, A. L., Ekstrom, H., Kalaf, N. C., & Sherman, B. (2022) · Research Square · doi:10.21203/rs.3.rs-1761858/v1 · Cited by 3 · see citing works
Burnout before and during COVID: A systematic review and meta‐analysis of 48 698 trainees
Prentice, S., Dorstyn, D., Massy‐Westropp, N., Benson, J., & Elliott, T. E. (2025) · Medical Education · doi:10.1111/medu.15760 · Cited by 2 · see citing works
Harthi, A. A., Ghafri, T. A., Al-Zidjali, L. M., & Roychoudhury, S. (2026) · Journal of Medical Education Development · doi:10.66224/edcj.19.1.56 · Cited by 1 · see citing works
Integrating Well-Being Into a Health Systems Science Curriculum
Smeraglio, A. C., Schnure, N., DiVeronica, M., McGhee, B., Terndrup, C. P., Domingo, M. S., Tuepker, A., Carney, P. A., Prasad, R. J., & Bonura, E. (2025) · Academic Medicine · doi:10.1097/acm.0000000000005984
Supporting Our Trainees: How Psychiatry Faculty Can Nurture Supervisees’ Well-Being
Bommarito, S., & Tamarelli, C. M. (2025) · Academic Psychiatry · doi:10.1007/s40596-025-02138-2
Mıdık, Ö., Demirören, M., & Baykan, Z. (2025) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580251406010
Well-Being in GME: Finding Meaning in Medicine
Duncan, J. G., & Seashore, E. L. (2026) · Springer eBooks · doi:10.1007/978-3-032-12952-9_26
Wu, M., Li, Z., Wang, X. M., Xu, H., Liu, Y., Li, M., Yuan, W., Peng, H., Wu, Q., & Liu, T. (2026) · Depression and Anxiety · doi:10.1155/da/3424408
Miulli, M., Wong, C., Gonzalez, J., Rao, S. C., Tashjian, V. S., Wang, A., Savla, P., & Miulli, D. E. (2026) · Cureus · doi:10.7759/cureus.108447
Petrie, K. A., Gaschen, P. D., & Petrie, T. A. (2026) · Academia Mental Health and Well-Being · doi:10.20935/mhealthwellb8314
From Benchmarking to Intervention: Using SECOND Trial Data to Improve Residency Culture
Zayed, O., Tuttle, R., Woods, R. J., & Parikh, P. (2026) · The American Surgeon · doi:10.1177/00031348261495999
- Authors
- Ogunyemi, D., Darwish, A. G., Young, G., Cyr, E., Lee, C., Arabian, S., Challakere, K., Lee, T., Wong, S., & Raval, N.
- Affiliations
- Arrowhead Regional Medical Center (US)
- Corresponding author
- Ogunyemi, Dotun
- Venue
- BMC Medical Education
- Published
- 2022-04-18
- Volume
- 22
- Issue
- 1
- Pages
- 292-292
- ISSN
- 1472-6920 (ISSN-L)
- PMC
- PMC9016951
- OpenAlex
- W4224237084
- Cited by
- 17
- References
- 31
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 2 · 2022: 1
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medical Education (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- burnout, graduate medical education, clinical learning environment, clinical supervision, faculty supervision, sleep disorders, interpersonal relationships, PDSA cycle, continuous quality improvement, Maslach Burnout Inventory, resilience training, mentoring, self-care, internal medicine residency, general surgery residency, psychiatry residency, emergency medicine residency
- MeSH terms
- Burnout, Psychological, Burnout, Professional, Education, Medical, Graduate, Emergency Medicine, Humans, Internship and Residency, Surveys and Questionnaires
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
