Introversion in Surgical Residency: A Risk Factor for Burnout?

Burnout among surgical residents continues to present a critical challenge in graduate medical education. The high demands, long work hours, and intense emotional toll of surgical training make this group especially vulnerable to mental health challenges, including disengagement and exhaustion. Previous research has explored factors such as gender, training level, and work hours; however, the influence of personality traits, specifically introversion and extroversion, on burnout has been underexplored. This study seeks to bridge that gap by examining how personality influences burnout among surgical residents at a major academic institution.

This study surveyed surgical residents from a large academic medical center representing multiple surgical subspecialties and postgraduate years (PGY1-PGY7). Participants were invited to complete the survey via REDCap. The initial invitation was distributed by program directors, and subsequent reminder emails were sent directly to residents. The survey consisted of 38 items, including demographic questions and 3 validated instruments: the Big Five Inventory, a modified Big Five Inventory, and the Oldenburg Burnout Inventory. Burnout was defined as exhaustion or disengagement and classified as high, moderate, or low according to the criteria described by Demerouti et al. All statistical analyses were performed using SAS software.

The survey was distributed to 204 trainees, and 116 responded for a response rate of 57%. Sixty-six percent of the participants identified as females and were evenly distributed across residency years. General surgery residents represented the highest number of participants (n = 20), while obstetrics and gynecology represented the fewest (n = 4). No participants reported "high" burnout on the Oldenburg Burnout Inventory scale. Higher extraversion and agreeableness scores were significantly associated with lower disengagement (r = -0.22, p < 0.05) and were not associated with exhaustion (p = 0.25). Agreeableness showed a statistically significant negative correlation with disengagement (p = 0.028). Female gender was associated with higher burnout (p < 0.01), while PGY year was insignificant. A significant difference in exhaustion and disengagement was observed across specialties (p < 0.01), with obstetrics and gynecology residents reporting the highest levels of burnout (both exhaustion and disengagement). In contrast, vascular surgery residents reported the lowest exhaustion rates, and plastic surgery residents reported the lowest disengagement rates.

Our findings suggest that personality traits, particularly extraversion, may play a substantial role in how surgical residents experience burnout. Introverted residents may be more vulnerable to emotional fatigue and disengagement in high-interaction environments like surgical training. In addition to personality differences, our study also found that female residents reported significantly higher levels of exhaustion than their male peers, independent of personality traits. This gender-based difference echoes prior research highlighting the unique challenges faced by women in surgical training, including microaggressions, work-life balance pressures, imposter syndrome, and underrepresentation in leadership roles. Interestingly, PGY year was not a significant factor for burnout in our analysis, contrasting several earlier studies that reported increased burnout among junior residents. These findings highlight the need for personality-informed wellness interventions and support systems that align with residents' coping styles and psychological needs.

Personality traits are associated with burnout in surgical residency. Specifically, extroversion may be protective against disengagement. Residency programs should consider integrating personality assessments into onboarding and wellness initiatives to better support residents at risk, particularly introverts and female trainees.