Surgical resident burnout and job satisfaction: the role of workplace climate and perceived support Nital P. Appelbaum, PhD, a, * Nathaniel Lee, MD, b Michael Amendola, MD, b Kelley Dodson, MD, c and Brian Kaplan, MD b a Virginia Commonwealth University, School of Medicine Dean’s Office, Richmond, Virginia b Virginia Commonwealth University, Department of Surgery, Richmond, Virginia c Virginia Commonwealth University, Department of Otolaryngology, Richmond, Virginia article info Article history: Received 24 April 2018 Received in revised form 30 July 2018 Accepted 18 August 2018 Available online xxx Keywords: Perceived organizational support Workplace climate Graduate medical education Burnout Job satisfaction Resident well-being abstract Background: Surgical residents train under immense stress, often manifesting into poor well- being. While recent research identifies methods of coping with stress, few studies empiri- cally investigate the role of the environment on surgical resident well-being. We aimed to assess surgical resident perceptions of workplace climate, organizational support, burnout, and job satisfaction to test a mediation model identifying antecedents to well-being. Materials and methods: A convenience sampling of program directors from general surgery within the Eastern region of the United States were emailed to request either agenda time to collection data via paper survey or to forward an electronic survey link to their residents between March 2016 and June 2016. The survey included scales demonstrating validity evidence on well-being, climate, and perceptions of support. Results: Based on 160 general surgery residents (out of 557; 29% response rate) across 19 training programs, our mediation model found that job satisfaction was significantly predicted by workplace climate directly (direct effect ¼ 0.37, 95% CI [0.19, 0.55]) and indi- rectly (specific indirect effect ¼ 0.07, 95% CI [0.01, 0.13]) through perceived organizational support and burnout, while controlling for training year and gender, F(5,147) ¼ 53.76, P < 0.001, Rsq. ¼ 0.65. Conclusions: Medical education requires an additional focus on how the clinical learning environment affects surgical resident well-being. Health systems and training programs will need to collaborate on workplace innovations to improve workplace climate for trainees to address the concerns of well-being with a modern surgical workforce. ª 2018 Elsevier Inc. All rights reserved. Introduction Healthcare systems and national medical education groups are expanding their focus from the Triple Aim to the Quadruple Aim in the United States, 1 adding provider well- being as a core component to improving patient care. Despite this increased attention, research on surgical resident well-being is often limited to coping strategies or attempts to increase provider resilience, which limits interventions to address the symptomsdnot the causedof poor work envi- ronments. However, organizational science may offer a com- plementary perspective on provider well-being by introducing empirical evidence on how the clinical learning environment may affect surgical residents’ well-being. * Corresponding author. Virginia Commonwealth University, School of Medicine, Office of Assessment, Evaluation and Scholarship, P.O. Box 980466, Richmond, VA. Tel.: þ(804) 827-1856; fax: þ(804) 827 0957. E-mail address: nital.appelbaum@vcuheath.org (N.P. Appelbaum). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  february 2019 (234) 20 e25 0022-4804/$ e see front matter ª 2018 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2018.08.035