Sense of Belonging Among Medical Students, Residents, and Fellows: Associations With Burnout, Recruitment Retention, and Learning Environment

Andrea N Leep Hunderfund; Bahar Saberzadeh Ardestani; Shannon K Laughlin-Tommaso; Barbara L Jordan; Valerie A Melson; Monique M Montenegro; Danielle E Brushaber; Colin P West; Liselotte N Dyrbye

doi:10.1097/ACM.0000000000005892

Sense of Belonging Among Medical Students, Residents, and Fellows: Associations With Burnout, Recruitment Retention, and Learning Environment

Acad Med. 2024 Sep 30. doi: 10.1097/ACM.0000000000005892. Online ahead of print.

Authors

Andrea N Leep Hunderfund¹, Bahar Saberzadeh Ardestani², Shannon K Laughlin-Tommaso³, Barbara L Jordan⁴, Valerie A Melson⁵, Monique M Montenegro⁶, Danielle E Brushaber⁷, Colin P West⁸, Liselotte N Dyrbye⁸

Affiliations

¹ A.N. Leep Hunderfund is associate professor of neurology and medical director, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7784-504X.
² B. Saberzadeh Ardestani was a postdoctoral researcher, Gastrointestinal Research Unit, Mayo Clinic, Rochester, Minnesota, at the time of writing and is now a resident physician, Department of Internal Medicine, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-7244-1839.
³ S.K. Laughlin-Tommaso is professor of obstetrics and gynecology and associate dean, Office for Education Diversity, Equity, and Inclusion, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota.
⁴ B.L. Jordan is assistant professor of health care administration and administrator, Office for Education Diversity, Equity, and Inclusion, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
⁵ V.A. Melson was a medical student, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, at the time of writing and is now a resident physician, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁶ M.M. Montenegro was a neurology headache fellow, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota, at the time of writing and is now assistant professor of neurology, University of Minnesota, Minneapolis, Minnesota.
⁷ D.E. Brushaber is a statistician, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
⁸ C.P. West is professor of medicine, biostatistics, and medical education, assistant dean of GME scholarship, and medical director of employee well-being, Mayo Clinic, Rochester, Minnesota.

PMID: 39348173
DOI: 10.1097/ACM.0000000000005892

Abstract

Purpose: This study examines sense of belonging (belongingness) in a large population of medical students, residents, and fellows and associations with learner burnout, organizational recruitment retention indicators, and potentially modifiable learning environment factors.

Method: All medical students, residents, and fellows at Mayo Clinic sites were surveyed between October and November 2020 with items measuring sense of belonging in 3 contexts (school or program, organization, and surrounding community), burnout (2 Maslach Burnout Inventory items), recruitment retention indicators (likelihood of recommending the organization and accepting a job offer), potentially modifiable learning environment factors, and demographic factors (age, gender, race and ethnicity, LGBTQ+ identification, disability, and socioeconomic background).

Results: Of 2,257 learners surveyed, 1,261 (56%) responded. The number of learners reporting a somewhat or very strong sense of belonging was highest in the school or program (994 of 1,227 [81%]) followed by the organization (957 of 1,222 [78%]) and surrounding community (728 of 1,203 [61%]). In adjusted analyses, learners with very strong organization belongingness had lower odds of burnout (odds ratio [OR], 0.05; 95% CI, 0.02-0.12) and higher odds of being likely to recommend the organization (OR, 505.23; 95% CI, 121.54-2,100.18) and accept a job offer (OR, 38.68; 95% CI, 15.72-95.15; all P < .001). School or program and community belongingness were also strongly associated with these outcomes. In multivariable analyses, social support remained associated with higher odds of belongingness in school or program, organization, and surrounding community, favorable ratings of faculty relationships and leadership representation with higher odds of school or program and organization belongingness, and favorable ratings of diversity, equity, and inclusion learning climate with higher odds of community belongingness.

Conclusions: Belongingness among medical students, residents, and fellows varies across contexts, strongly correlates with learner burnout and organizational recruitment retention indicators, and is associated with multiple potentially modifiable learning environment factors.