A Longitudinal Study of Associations Between Surgical Resident Learner Autonomy, Burnout, and Competency Learning Outcomes

• In Event: 69.028 - Assessment of Behavioral and Noncognitive Competencies: Where Are We and Where Are We Going?

Abstract

Objectives:
With the principle rational that personal abilities of learners can affect to affective and behavioral processes and outcomes, the purpose of this study was to determine whether prior learner autonomy of surgical residents may affect to their burnout, and longitudinal outcomes of competency learning and development, in order to hypothesize exploratory pathways.

Theoretical Framework:
According to Bandura’s social cognitive theory (1986), human behavior both influences and is influenced by personal and environmental factors. Learner autonomy or self-direction is known as a key personal attribute of adult learners, which affects learning behaviors (Brockett & Hiemstra, 1991). Burnout is a known issue in residency workplace learning environment (Ripp et. al., 2010; Thomas, 2004). In pursuing excellence in practice-based learning settings like graduate medical education (ACGME, 2012), it is important to understand about connections and processes underlying resident learning and development experiences across training years. Therefore, focused on learner autonomy, the researcher explored the associations with burnout, and three longitudinal outcomes of competency learning and development focused on cumulated improvement, level achievement, and demonstration in a professional license examination.

Methods:
This study was approved by [blind] Institutional Review Board. The researcher monitored resident longitudinal data between 2012 Fall- 2016 Spring of a tertiary surgical residency program in Otolaryngology - Head & Neck Surgery (OHNS).

In a prospective cohort design, OHNS residents from first to seventh post-graduate year (PGY) responded to the Learner Autonomy Profile (LAP)-Short Form (Confessore, & Park, 2004) at the beginning of the study. LAP assesses behavioral intentions and likelihood habitual tendency to engage in learning actions autonomously, focused on 22 component skills (e.g., resolving conflict) under four constructs. After six months, residents, then, responded to Maslach Burnout Inventory-Human Services (MBI-HS) (Maslach, Jackson, & Leiter, 1996), which assesses three burnout domains in emotional exhaustion, depersonalization, and lack of personal accomplishment. Meanwhile, the researcher monitored faculty-observed resident competency scores with six-month intervals, and residents’ specialty board examination score. Faculty utilized an objective structured assessment form (Ishman et al., 2012) to assess four overall competencies including critical thinking.

Results:
Forty-seven residents consist more male (68%), single (53%), and PGY 4-7 (51%). Their average age was 31. Their responses to LAP-Short Form and MBI-HS showed internal-consistency reliabilities (Cronbach’s Alpha 0.97 and 0.81 respectively). Multiple years of Faculty ratings showed Cronbach’s Alpha between 0.74 and 0.85.

Total LAP were not significantly different by gender, domestic status, PGY, or age. There were significant correlations (Table 1), which highlighted those between LAP and burnout (emotional exhaustion r=-.42, depersonalization r=-.32, personal A=accomplishment r=.54), critical thinking competency improvement (r=.42), critical thinking competency achievement (r=.46).

A series of multiple regressions suggested an exploratory pathway model of learner autonomy in learning and development of critical thinking competency.

Conclusions:
Learner autonomy may be a significant personal factor of surgical resident success in reducing burnout and developing critical thinking competency. Assessing learner autonomy is suggested to improve competency-based education promoting critical thinking. It is suggested to examine the hypothesized exploratory pathway model in various learning contexts of professions.

Author

• Eunmi Park, USF