title: Lack of association between resident doctors' well-being and medical knowledge.
abstract: OBJECTIVE
  Resident doctors' (residents) well-being impacts on the medical care they provide. Despite the high prevalence of resident doctors' distress, the relationship between their well-being and the specific competencies defined by the Accreditation Council for Graduate Medical Education is poorly understood. We evaluated the association of resident well-being with medical knowledge as assessed on both a standardised test of general medical knowledge and at the end of web-based courses on a series of focused topics.
  
  
  METHODS
  We conducted a repeated cross-sectional study of associations between well-being and medical knowledge scores over time for internal medicine residents from July 2004 to June 2007. Well-being measures included linear analogue self-assessment (LASA) scales measuring quality of life (including overall quality of life, mental, physical and emotional well-being, and fatigue), the Medical Outcome Study Eight-Item Short Form Health Survey (SF-8) assessment of mental and physical well-being, the Maslach Burnout Inventory and the PRIME-MD two-item depression screen. We also measured empathy using the perspective taking and empathic concern subscales of the Interpersonal Reactivity Index. Medical knowledge measures included scores on web-based learning module post-tests and scores on the national Internal Medicine In-Training Examination (IM-ITE). As data for each association were available for at least 126 residents, this study was powered to detect a small-to-moderate effect size of 0.3 standard deviations.
  
  
  RESULTS
  No statistically significant associations were observed between well-being and either web-based learning module post-test score or IM-ITE score. Parameter estimates of the association of well-being variables with knowledge scores were uniformly small. For all well-being metrics, meaningful differences were associated with knowledge score difference estimates of < 1 percentage point.
  
  
  CONCLUSIONS
  Resident well-being appears to have limited association with competence in medical knowledge as assessed following web-based courses on specific topics or using standardised general medical examinations.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. west.colin@mayo.edu
authors.forename: Colin P
authors.initials: CP
authors.lastname: West
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003430:Cross-Sectional Studies; D004521:Educational Measurement / Q000379:methods; D004645:Empathy; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D010820:Physicians / Q000523:psychology* / Q000592:standards; D011594:Psychometrics; D011788:Quality of Life