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Abstract：
BACKGROUND: System contributors to resident burnout and well-being have been under-studied. We sought to determine factors associated with resident burnout and identify at risk groups.
METHODS: We performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout.
RESULTS: Of 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2\'s (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2\'s reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors.
CONCLUSIONS: These data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2\'s may merit attention first.
METHODS: We performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout.
RESULTS: Of 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2\'s (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2\'s reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors.
CONCLUSIONS: These data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2\'s may merit attention first.
摘要：
背景：对居民倦怠和幸福感的系统贡献者研究不足。我们试图确定与居民倦怠相关的因素，并确定风险人群。
方法：我们在2022年7月15日至2023年4月21日期间对14个机构的36个专业的居民进行了美国全国调查，使用具有三个5个项目分量表的经过验证的MiniReZ调查：1)支持性工作场所，2）工作节奏/电子病历（EMR）压力，和3)居住特定因素(睡眠，同行支持，通过程序识别，中断和员工关系)。497条评论的多层次回归和主题分析确定了与倦怠相关的因素。
结果：在1118名受访者中（约中位数反应率为32％），48%是女性,57%白色，21%亚洲人,6%的拉丁裔和4%的黑人25%PGY1s，25%PGY2s,22％的PGY3。在36个专业中，项目包括内科(15.1%)和家庭医学(11.3%)。女性职业倦怠（42％）较高（男性为51％vs30％，p=0.001)和PGY2(在PGY-1s中为48%和35%，p=0.029)。挑战包括混乱的环境（41％）和睡眠障碍（32％）；有利的方面包括团队合作（94％）。同行支持（93%），员工支持(87%)和项目认可(68%)。女性的工作生活量表始终较低，而PGY-2报告的工作环境最少。与倦怠相关的工作生活挑战包括睡眠障碍(调整后赔率比(aOR)2.82(95%CI=1.94，4.19)，倦怠的绝对风险差异(ARD)15.9%)，工作控制不良(AOR2.25(1.42，3.58)，ARD12.2%)和混沌(AOR1.73(1.22，2.47)，ARD7.9%)；程序识别与较低的倦怠(aOR0.520(0.356，0.760)，ARD9.3%）。这些变量解释了55%的倦怠方差。定性数据证实睡眠障碍，缺乏进度控制，过量的EMR和患者容量作为压力源。
结论：这些数据为解决居住期间的幸福感提供了命名法和系统方法。女性和PGY2的工作条件可能首先值得关注。
方法：我们在2022年7月15日至2023年4月21日期间对14个机构的36个专业的居民进行了美国全国调查，使用具有三个5个项目分量表的经过验证的MiniReZ调查：1)支持性工作场所，2）工作节奏/电子病历（EMR）压力，和3)居住特定因素(睡眠，同行支持，通过程序识别，中断和员工关系)。497条评论的多层次回归和主题分析确定了与倦怠相关的因素。
结果：在1118名受访者中（约中位数反应率为32％），48%是女性,57%白色，21%亚洲人,6%的拉丁裔和4%的黑人25%PGY1s，25%PGY2s,22％的PGY3。在36个专业中，项目包括内科(15.1%)和家庭医学(11.3%)。女性职业倦怠（42％）较高（男性为51％vs30％，p=0.001)和PGY2(在PGY-1s中为48%和35%，p=0.029)。挑战包括混乱的环境（41％）和睡眠障碍（32％）；有利的方面包括团队合作（94％）。同行支持（93%），员工支持(87%)和项目认可(68%)。女性的工作生活量表始终较低，而PGY-2报告的工作环境最少。与倦怠相关的工作生活挑战包括睡眠障碍(调整后赔率比(aOR)2.82(95%CI=1.94，4.19)，倦怠的绝对风险差异(ARD)15.9%)，工作控制不良(AOR2.25(1.42，3.58)，ARD12.2%)和混沌(AOR1.73(1.22，2.47)，ARD7.9%)；程序识别与较低的倦怠(aOR0.520(0.356，0.760)，ARD9.3%）。这些变量解释了55%的倦怠方差。定性数据证实睡眠障碍，缺乏进度控制，过量的EMR和患者容量作为压力源。
结论：这些数据为解决居住期间的幸福感提供了命名法和系统方法。女性和PGY2的工作条件可能首先值得关注。
