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Life sciences · Journal article
Medical Education Online · June 12, 2026
Encouraging direction, but not yet definitive.
This cross-sectional survey of 266 residents across three US teaching sites found that programmatic openness and individual belonging were both independently protective against perceived mistreatment and burnout, with a compensatory interaction effect wherein openness was most protective for residents with low belonging. The study provides observational evidence for ecological systems theory applied to trainee wellbeing but does not establish causal relationships or test interventions.
Cross-sectional anonymous online survey with latent moderation analysis and confirmatory factor analysis. Graduate medical education residents at three large US teaching sites; eligible trainees were those enrolled in the 62 participating GME programs. Intervention: Perceived programmatic openness (measured construct, not an intervention) and individual belonging as predictors in observational analysis. n = 266. Three large US teaching sites (specific locations not detailed beyond 'US').
Response rate was 266 of 675 eligible trainees (39.4%) Both programmatic openness and belonging were protective against perceived mistreatment, which was strongly associated with burnout Moderation analyses revealed that programmatic openness most strongly buffered mistreatment among trainees with low belonging, with diminished effects at higher belonging levels
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Program directors and training institutions should recognize that fostering both programmatic openness and individual trainee belonging are complementary strategies for reducing mistreatment and burnout. The finding that openness most strongly protects residents with low belonging suggests targeted efforts to strengthen program climate may be especially valuable for vulnerable subpopulations.
Cross-sectional survey with latent moderation analysis demonstrates protective associations between programmatic openness, belonging, and reduced mistreatment/burnout, but lacks causal inference and relies on trainee perceptions in a single measurement timepoint.
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Program directors and training institutions should recognize that fostering both programmatic openness and individual trainee belonging are complementary strategies for reducing mistreatment and burnout. The finding that openness most strongly protects residents with low belonging suggests targeted efforts to strengthen program climate may be especially valuable for vulnerable subpopulations.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Medical trainee mistreatment remains a widespread challenge in graduate medical education, contributing to burnout, depression, and workforce attrition. Graduate medical education programs have sought to create safer learning environments by fostering programmatic openness-climates perceived as transparent, welcoming, and supportive. Yet it remains unclear how such programmatic conditions interact with individual experiences of belonging to shape wellbeing. Drawing on ecological systems theory, we examine how programmatic openness and trainee belonging interact to mitigate trainee mistreatment during residency.Methods. We conducted an anonymous online survey (Dec 2023-Jan 2024) at three large US teaching sites with 62 GME programs. Scales with robust validity evidence measured perceived programmatic openness, individual belonging, perceived mistreatment, burnout, and social support. We built a latent moderation model, encompassing both confirmatory factor analysis and latent interaction effects. We examined how programmatic openness moderated trainee perceived mistreatment while controlling for social support and trainee demographics.Results. Of 675 eligible trainees, 266 responded (39.4%). Measurement models demonstrated good fit, supporting construct validity. Both programmatic openness and belonging were protective against perceived mistreatment, which was strongly associated with burnout. Residents' belonging to the training program was significantly associated with low burnout, even after accounting for social support. Moderation analyses revealed that programmatic openness most strongly buffered mistreatment among trainees who experienced low belonging, with diminished effects at higher belonging levels.Conclusion. Findings revealed a compensatory effect, suggesting the beneficial effects of programmatic openness were especially crucial among trainees who experienced low individual belonging. This finding aligns with the ecological system theory, which posits that supportive environments may mitigate individual-level vulnerabilities. Both burnout and perceived mistreatment were at its lowest when programmatic openness and individual belonging were both present. This underscores the need for residency programs to foster both openness and belonging as core strategies to support trainee wellbeing.
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