Vaa Stelling, Brianna E

Abstract Purpose Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition. Method The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data. Results Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF. Conclusions Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.

Abstract Purpose To examine associations of social support and social isolation with burnout, program satisfaction, and organization satisfaction among a large population of U.S. residents and fellows and to identify correlates of social support and social isolation. Method All residents and fellows enrolled in graduate medical education programs at Mayo Clinic sites were surveyed in February 2019. Survey items measured social support (emotional and tangible), social isolation, burnout, program satisfaction, and organization satisfaction. Factors of potential relevance to social support were collected (via the survey, institutional administrative records, and interviews with program coordinators and/or program directors) and categorized as individual, interpersonal, program, or work-related factors (duty hours, call burden, elective time, vacation days used before survey administration, required away rotations, etc.). Multivariable regression analyses were conducted to examine relationships between variables. Results Of 1,146 residents surveyed, 762 (66%) from 58 programs responded. In adjusted models, higher emotional and tangible support were associated with lower odds of burnout and higher odds of program and organization satisfaction, while higher social isolation scores were associated with higher odds of burnout and lower odds of program satisfaction and organization satisfaction. Independent predictors of social support and/or social isolation included age, gender, relationship status, parental status, postgraduate year, site, ratings of the program leadership team, ratings of faculty relationships and faculty professional behaviors, satisfaction with autonomy, and vacation days used before survey administration. Conclusions This study demonstrates that social support and social isolation are strongly related to burnout and satisfaction among residents and fellows. Personal and professional relationships, satisfaction with autonomy, and vacation days are independently associated with social support and/or social isolation, whereas most program and work-related factors are not. Additional studies are needed to determine if social support interventions targeting these factors can improve well-being and enhance satisfaction with training.

Problem Distress, depression, and burnout are common during medical training. Stigma surrounding seeking help for mental illness during medical training may involve fear of negative peer perceptions, academic jeopardy, and adverse future career consequences. Faculty disclosure of personal mental health illness may reduce stigma surrounding mental health disorders and reassure and encourage trainees to seek help when needed. Approach The authors aimed to assess the impact of faculty disclosure of mental health issues on stigma toward help-seeking during training, self-reflection about mental health, and resident physician awareness of mental health resources. Three self-selected faculty members shared their personal experiences with depression and mental health during a confidential noon conference intended for internal medicine residents at Mayo Clinic Rochester as part of their core curriculum in December 2016. Institutional and community mental health resources were provided. After the conference, attendees completed an anonymous survey assessing self-reported knowledge, attitudes, and behaviors surrounding mental health during medical training. Outcomes One hundred percent of residents (39/39) agreed that they enjoyed the conference. Thirty-five of 39 (89.7%) respondents agreed that their knowledge of available mental health resources increased and 33/39 (84.6%) agreed they were more likely to pursue mental health resources after attending the conference. Thirty-eight of 39 (97.4%) residents agreed that faculty sharing their personal struggles destigmatizes mental health issues during training, and the same percentage reported engaging in postconference self-reflection regarding their own mental health and well-being. Next Steps Resident conference sessions during which faculty self-disclose personal mental health experiences may help decrease the stigma of mental health issues during medical training and increase the likelihood residents will seek assistance when needed. The authors encourage further study of longer-term outcomes and actual help-seeking behaviors across learner levels and training environments.

Purpose To evaluate the relationship between help-seeking concerns and attitudes and burnout among residents. Method In 2019, all residents across the 4 Mayo Clinic sites were surveyed. The survey included 2 items from the Maslach Burnout Inventory, an item from the National Comorbidity Survey Replication about likelihood of seeking professional help for a serious emotional problem, and items developed to explore residents’ help-seeking behaviors and concerns. Multivariable logistic regression was conducted for each outcome variable and included age, gender, specialty, postgraduate year, site, and burnout. Results Of the 1,146 residents to whom surveys were sent, 762 (66.5%) responded. Nearly half (342/747, 45.8%) were concerned about negative consequence to their career if they went on medical leave, and one-third (247/753, 32.8%) were reluctant to seek professional help for a serious emotional concern. Of the 437 residents who had never attended a personal health appointment during scheduled work, 34.6% (151) thought it would be difficult to tell a supervising physician they needed to miss work due to a scheduled appointment. On multivariable analysis, burnout was independently associated with reporting it would be difficult to tell a supervising physician of a need to attend an appointment (odds ratio [OR] 2.32; 95% confidence interval [CI] 1.46, 3.67; P < .001), being concerned about negative consequence to their career if they went on medical leave (OR 2.09; 95% CI 1.49, 2.93; P < .001), and reluctance to seek professional care for a serious emotional problem (OR 1.65; 95% CI 1.17, 2.34; P = .004). Conclusions Barriers to self-care and help-seeking are common among residents and may be worse among those with burnout. Strategies to reduce stigma and promote a culture of well-being are needed.

Purpose To explore the relationship between residents’ perceptions of residency program leadership team behaviors and resident burnout and satisfaction. Method In February 2019, the authors surveyed all residents across the 77 graduate medical education training programs at Mayo Clinic’s multiple sites. Survey items measured residents’ perceptions of program director and associate program director behaviors (using a composite residency program leadership team score), resident burnout, and resident satisfaction with the program and organization. Multivariable logistic regression was performed to evaluate relationships between these variables at the individual resident (adjusting for age, sex, postgraduate training year, program location, and specialty) and program (including only programs with at least 5 respondents) levels. Results Of the 1,146 residents surveyed, 762 (66.5%) responded. At the individual resident level, higher composite leadership team scores were associated with lower emotional exhaustion and depersonalization and higher overall satisfaction with the residency program and organization (all P < .001). In adjusted logistic regression models, each 1-point gain in composite leadership team score was associated with 9% lower odds of burnout, 20% higher odds of program satisfaction, and 19% higher odds of satisfaction with the organization (all P < .001). At the residency program level, higher mean composite leadership team scores were associated with a lower rate of burnout (r = −0.35, P = .03) and higher program and organization satisfaction (r = 0.67 and 0.74, respectively, both P < .001). Conclusions The behaviors of residency program leadership teams influence residents’ burnout and satisfaction. Additional studies are needed to determine if leadership training results in improved resident well-being and satisfaction.