A Longitudinal National Study Exploring Impact of the Learning Environment on Medical Student Burnout, Empathy, and Career Regret

Purpose: Previous studies have shown that medical student mistreatment and burnout are common. 1,2 Studies suggest that factors within the learning environment are associated with burnout, decline in empathy, and career regret among learners (i.e., medical students and residents). 1 Mistreatment, poor feedback, insufficient autonomy, high faculty demands, inadequate role models, and high workload are among likely contributing factors. 1,3,4 However, little longitudinal data exist to describe how mistreatment and other learning environment experiences relate to subsequent burnout and other student characteristics. 1,5 We conducted this study to examine the association between mistreatment and perceptions of the learning environment and subsequent burnout, empathy, and career regret. Methods: We conducted a cohort study that analyzed data from 2014–2106 Association of American Medical Colleges (AAMC) second-year survey (Y2Q) and 2016–2018 AAMC Graduation Questionnaire (GQ). We performed multiple linear or logistic regression analysis to evaluate associations of the independent variables, measured during year 2 of medical school, with exhaustion, disengagement, empathy, and career regret, measured during year 4 of medical school. All models included mistreatment, Medical School Learning Environment Survey subscale (faculty, emotional climate, and student–student interactions) scores, Oldenburg Burnout Inventory (exhaustion and/or disengagement scores), Interpersonal Reactivity Index score, quality of life score, stress score, and demographics as measured during year 2 of medical school. The model for career regret during year 4 of medical school also included career regret during year 2 of medical school as an independent variable. Medical students who responded to both AAMC surveys were included in the analysis. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: Data from 14,126 medical students were analyzed: 52% were women and mean age was 27.7 at graduation. Mistreatment reported by 22.9% on the Y2Q. In multivariable analysis adjusted for Y2Q measures, mistreatment reported on the Y2Q was associated with higher exhaustion score (referent: never; once, coeff. 0.66 [95% CI: 0.51, 0.81]; more than once, coeff. 1.74 [95% CI: 1.59, 1.90]; overall P < .0001), higher disengagement score (referent: never; once, coeff. 0.29 [95% CI: 0.20, 0.39]; more than once, coeff. 0.71 [95% CI: 0.61, 0.81]; overall P < .0001), and higher odds of career regret (referent: never; once OR 1.35 [95% CI: 1.12, 1.63]; more than once OR 1.87 [95% CI: 1.56, 2.23]; overall P < .0001) on the GQ. More positive emotional climate reported on the Y2Q was associated with lower exhaustion score (for each 1 point, coeff. –0.05 [95% CI: –0.08, –0.02]) and lower disengagement score (for each 1 point, coeff. –0.04 [95% CI: –0.06, –0.02]) on the GQ. More positive faculty interactions on the Y2Q were associated with higher empathy score on the GQ (for each 1 point, coeff. 0.02 [95% CI: 0.001, 0.05]). Better student–student interactions were associated with lower odds of career regret during year 4 of medical school (for each 1 point, OR 0.97 [95% CI: 0.95, 1.00]). Discussion: Medical students who experienced mistreatment and who perceived the learning environment less favorably were more likely to subsequently develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret in comparison with medical students with more positive experiences. Strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment and improve the learning environment. Significance: Medical students who experienced mistreatment and who perceived the learning environment less favorably were more likely to subsequently develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret in comparison to medical students with more positive experiences. Our findings suggest strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment, optimize faculty–student interactions, build peer support, and enhance students’ self-efficacy. Acknowledgments: Additional review of the manuscript was performed by David Matthew, PhD, at the Association of American Medical Colleges, Washington, DC. He was not compensated for his contribution.