A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender

Liselotte N. Dyrbye, Colin P. West, Jeph Herrin, John Dovidio, Brooke Cunningham, Mark Yeazel, Veronica Lam, Ivuoma N. Onyeador, Natalie M. Wittlin, Sara E. Burke, Sharonne N. Hayes, Sean M. Phelan, Michelle van Ryn

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


OBJECTIVE: To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender.

METHODS: From April 7 to August 2, 2016, and May 26 to August 5, 2017, we surveyed residents in their second (R2) and third (R3) postgraduate year. The survey included a negative interpersonal experiences scale (score range 1 to 7 points, higher being worse) assessing psychological safety and bias, inclusion, respect, and justice; an unfair treatment scale (score range 1 to 5 points, higher being worse), and two items from the Maslach Burnout Inventory. Individual responses to the R2 and R3 surveys were linked.

RESULTS: The R2 survey was completed by 3588 of 4696 (76.4%) residents; 3058 of 3726 (82.1%) residents completed the R3 survey; and 2888 residents completed both surveys. Women reported more negative interpersonal experiences (mean [SD], 3.00 [0.83] vs 2.90 [0.85], P<.001) and unfair treatment (66.5% vs. 58.7%, P<.001) than men at R2. On multivariable analysis, women at R3 were more likely than their male counterparts to have burnout (odds ratio, 1.23; 95% CI, 1.02 to 1.48; P=.03). Both men and women who reported more negative interpersonal experiences at R2 were more likely to have burnout at R3 (odds ratio, 1.32; 95% CI, 1.14 to 1.52; P<.001). The factors contributing to burnout did not vary in effect magnitude by gender.

CONCLUSION: These findings indicate women residents are more likely to have burnout relative to men in the third year of residency. Negative culture predicted subsequent burnout 1 year later among both men and women. Differences in burnout were at least partly due to differing levels of exposure to negative interactions for men versus women rather than a negative interaction having a differential impact on the well-being of men versus women.

Original languageEnglish (US)
Pages (from-to)2168-2183
Number of pages16
JournalMayo Clinic Proceedings
Issue number8
StatePublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021


  • Adult
  • Burnout, Professional/epidemiology
  • Education, Medical
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Internship and Residency
  • Male
  • Retrospective Studies
  • Sex Distribution
  • Sex Factors
  • Students, Medical/psychology
  • Surveys and Questionnaires
  • United States/epidemiology

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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