Development of a conceptual model for understanding the learning environment and surgical resident well-being

Lindsey M. Zhang, Elaine O. Cheung, Joshua S. Eng, Meixi Ma, Caryn Diane Etkin, Gaurava Agarwal, Tait D. Shanafelt, Taylor S. Riall, Thomas Nasca, Karl Y. Bilimoria, Yue Yung Hu, Julie K. Johnson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Surgeon burnout is linked to poor outcomes for physicians and patients. Several conceptual models exist that describe drivers of physician wellness generally. No such model exists for surgical residents specifically. Methods: A conceptual model for surgical resident well-being was adapted from published models with input gained iteratively from an interdisciplinary team. A survey was developed to measure residents’ perceptions of their program. A confirmatory factor analysis (CFA) tested the fit of our proposed model construct. Results: The conceptual model outlines eight domains that contribute to surgical resident well-being: Efficiency and Resources, Faculty Relationships and Engagement, Meaning in Work, Resident Camaraderie, Program Culture and Values, Work-Life Integration, Workload and Job Demands, and Mistreatment. CFA demonstrated acceptable fit of the proposed 8-domain model. Conclusion: Eight distinct domains of the learning environment influence surgical resident well-being. This conceptual model forms the basis for the SECOND Trial, a study designed to optimize the surgical training environment and promote well-being.

Original languageEnglish (US)
JournalAmerican journal of surgery
StateAccepted/In press - 2020


  • Burnout
  • Conceptual model
  • Surgical education
  • Surgical residents
  • Well-being
  • Wellness

ASJC Scopus subject areas

  • Surgery

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