Testing Self-determination theory in residency: a multi-site path model of leadership, motivation, and burnout
Abstract
Background: Resident burnout persists in graduate medical education (GME), yet many wellness initiatives emphasize individual coping rather than the supervisory practices and learning environments that shape residents’ daily work. Self-determination theory (SDT) suggests that autonomy-supportive leadership (ASL)—behaviours such as acknowledging perspectives, providing meaningful rationales, offering guidance, and conveying respect—may support residents’ psychological needs and foster more self-determined motivation. Objective: To examine an SDT-informed pathway linking residents’ perceptions of ASL with psychological need satisfaction, motivational quality, and well-being/ill-being. Method: In Spring 2023, residents and fellows across 15 teaching hospitals within a U.S. healthcare system completed an anonymous online survey assessing ASL, basic psychological need satisfaction, motivational quality, and indicators of well-being and ill-being. Pearson correlations and path analysis with 10,000 bootstrap samples were used to examine relationships among study variables. Results: A total of 278 trainees responded (16.8%). ASL was positively associated with need satisfaction and motivational quality and negatively associated with ill-being. The hypothesized path model showed good fit (χ² (3) = 2.04, p = .56, CFI = 1.00, RMSEA < .001, SRMR = .013). ASL predicted greater need satisfaction, which predicted higher motivational quality. Both were associated with greater well-being and lower ill-being. The model explained 46% of the variance in well-being and 35% in ill-being. Conclusions: Autonomy-supportive leadership was associated with more adaptive motivational functioning and better resident well-being, suggesting a potentially modifiable target for faculty development and learning climate improvement. These findings provide integrated, context-specific support for SDT processes in residency training.