Upholding Our PROMISE: National Survey of Pediatrics Residents' Experiences with Discrimination, Burnout, Belonging, Professional Fulfillment, and Career Plans.

Abstract

To explore associations between pediatrics residents' experiences with discrimination, burnout, belonging, professional fulfillment, and career plans, including interest in remaining at their training institution. Between October 2020 and January 2021, a national, cross-sectional study titled PROMISE (PROmoting Med-Ed Insight into Supportive Environments) used a 23-item survey of pediatrics residents through the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network. Descriptive, association, and mediation analyses were conducted for underrepresented in medicine (UIM), Asian and Asian American (AAA), and White residents using multilevel regression and structural equation models. The study included 799 pediatrics residents (20% UIM) from 24 residency programs. UIM and AAA residents experienced higher discrimination. Among UIM residents, staff discrimination was associated with greater interpersonal disengagement (P = .02), work exhaustion (P < .01), and lower professional fulfillment (P = .04). UIM (P < .01) and AAA (P = .01) residents reported lower belonging even after adjusting for discrimination. Greater belonging was associated with higher likelihood of wanting to remain at one's institution (B = 0.46, 95% CI 0.34-0.57; P < .001). Belonging and professional fulfillment mediated associations between discrimination and intent to stay among UIM residents; for AAA residents, only belonging was a significant mediator. UIM and AAA pediatric residents reported disproportionately higher discrimination, which was associated with increased burnout and reduced belonging. Institutional efforts to address discrimination are critical for promoting resident well-being and retention in academic medicine.