This challenge can result in a high dropout rate of cardiothoracic surgery residents and a persistent low filling rate. Therefore, a multi-faceted approach is required, not only for measuring burnout, but also assessing other possible mediating factors such as work environment, a reliable training supervisor, symptoms of anxiety and depression, grit personality factor, and subsequent outcomes, such as thoughts of leaving the residency program 16, 17.ĭue to the high workload, complexity, high risks of surgery, and increased risks of being involved in a lawsuit, there is a great social reluctance to low participation in the training course for cardiothoracic surgery, which is not limited to Korea 13. The burnout of physicians and residents is complex in nature 15. Although the field’s low filling- and high attrition- rate are global trends, and not limited to South Korea, the need to assess both residency training programs’ situational factors, and cardiothoracic surgery residents’ individual factors, has increased in South Korea 13, 14. Unlike in other countries, in South Korea, one can go for cardiothoracic surgery without a surgical or specialist's license. Thus, in South Korea, one obtains a specialized certificate five years after graduating from medical school. In order to become a cardiothoracic surgeon in South Korea, one has to graduate from medical school, avail a job at a hospital, complete a year-long internship, apply to the department of thoracic and cardiovascular surgery, and then train for four years. Corresponding to this trend, it has been found that cardiothoracic surgery in South Korea faces a major challenge of low numbers of filled residency positions, with a mean filling rate of 45.2% from 2009 to 2018, and the second highest attrition rate of 4.1% from 2017 to 2020 13. Several studies have shown that psychiatric issues are prevalent among up to 30% of residents, especially among those performing surgery, emergency services, or intensive care rotations 9, 10, 11, 12. In particular, excessive training causes poor well-being and burnout at work, which ultimately lead to serious considerations of leaving the training 1, 8. The relatively long training programs are the most vulnerable periods for physicians to burnout, considering that these programs entail limited control over circumstances, tremendous responsibilities, excessive and unpredictable work hours, high degree of work-home imbalance, sleep-impairments, and possible mistreatment at the workplace 5, 6, 7. It has been found that during the training, many trainees faced psychological health issues such as burnout and depression 4. The resultant loss of transition and patients’ confidence, and an unexpected lack of labor due to resignations, cause problems for the remaining residents throughout the training period 2, 3. Thus, leaving the training course midway poses several problems for residents. Residency training is one of the health care system’s important processes, for nurturing competent physicians 1. The program director should be adequately educated to take charge of the training program, oversee the residents’ education and welfare, and perform the roles of role-model and mentor. In order to resolve negative emotions such as burnout and depression, and foster empathy, a human resource development program for the residents’ psychological support must be prepared. The study identified both individual- and systemic-level factors for an effective training environment, to reduce cardiothoracic surgery residents’ tendencies of leaving the residency program, and supporting them for greater satisfaction with their career choice. The study also confirmed that grit and work satisfaction affect turnover intention indirectly, through burnout. Empathy, and the presence of someone to discuss concerns with, also affect turnover intention directly. It has a mediating effect on the influence of depression, grit (sustained interest), and working conditions, over turnover intention. Burnout has the most significant relationship with turnover intention. Descriptive statistical analysis, correlation analysis, and structural equation modeling were used for data analysis. Their levels of depression, anxiety, grit, and empathy, working conditions, the effect of someone’s presence to discuss their concerns with, burnout, and turnover intention were identified as the research variables. Responses by 57 Korean cardiothoracic surgery residents were analyzed. This study analyzes how their turnover intention is related to the training environment, and individual psychological factors. Increasing numbers of cardiothoracic surgery residents are resigning, without completing their training.
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