Well-Being in Residency: A Systematic Review

Abstract

Background: Rates of physician burnout have increased in recent years, and high burnout levels are reported by physicians in training.

Objective: This review of the research on resident well-being seeks to identify factors associated with well-being, summarize well-being promotion interventions, and provide a framework for future research efforts.

Methods: Keywords were used to search PubMed, PsycINFO, and MEDLINE. Studies included were conducted between 1989 and 2014. The search yielded 82 articles, 26 which met inclusion criteria, and were assessed using the Medical Education Research Study Quality Instrument.

Results: Articles measured resident well-being and associated factors, predictors, effects, barriers, as well as interventions to improve well-being. Factors identified in psychological well-being research-autonomy, building of competence, and strong social relatedness-are associated with resident well-being. Sleep and time away from work are associated with greater resident well-being. Perseverance is predictive of well-being, and greater well-being is associated with increased empathy. Interventions focused on health and coping skills appear to improve well-being, although the 3 studies that examined interventions were limited by small samples and single site administration.

Conclusions: An important step in evolving research in this area entails the development of a clear definition of resident well-being and a scale for measuring the construct. The majority (n = 17, 65%) of existing studies are cross-sectional analyses of factors associated with well-being. The literature summarized in this review suggests future research should focus on factors identified in cross-sectional studies, including sleep, coping mechanisms, resident autonomy, building competence, and enhanced social relatedness.

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Review Selection Process and Results Note: Twenty-nine of 82 articles were excluded after review of articles retrieved through database keyword search based on the following inclusion criteria: (1) published in an English-language peer-reviewed journal from January 1989 to January 2014 with study having been conducted since 1989; (2) search words appear in the title and/or abstract; and (3) primary well-being research with residents. Fifty-three full-text articles were assessed and were excluded if focused specifically on the issue of duty hours or burnout due to existing literature reviews that address this. This resulted in a total of 26 articles identified for inclusion.

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Focus Areas of Studies Investigating Resident Well-Being