The mediating role of residents’ wellbeing between program leadership and quality of care: A cross-sectional study

BACKGROUND: Research has shown that organizational leadership and support affect organizational outcomes in several sectors, including healthcare. However, less is known about how organizational leadership might influence the wellbeing of clinical trainees as well as the quality of their patient care practices. OBJECTIVES: This study examined the mediating effects of burnout and engagement between program director-resident relationship quality and residents’ reported quality of care, and the moderating effect of perceived departmental support. METHODS: The authors conducted a cross-sectional study in September 2020, using a 41-item questionnaire, among 20 residency programs in an academic medical center in Lebanon. Measures included program director-resident relationship quality, perceived departmental support, burnout subcomponents, engagement, and self-reported quality of care. Ordinary least squares regression was used to conduct parallel mediation and moderated mediation analyses using SPSS macro-PROCESS, to assess the strength and direction of each of the proposed associations. RESULTS: A total of 95/332 (28.6%) residents responded. Results revealed that program director-resident relationship quality had a significant indirect effect on residents’ suboptimal patient care practices and attitudes towards patients, through at least one of the wellbeing dimensions (p < .05). Perceived departmental support did not play a dominant role over program director-resident relationship quality, and thus did not influence any of the mediated relationships. CONCLUSION: Our study adds a new dimension to the body of literature suggesting that program director-resident relationship quality plays an important role in promoting residents’ wellbeing and achieving important clinical health outcomes. Such findings imply that the quality of program director-resident relationship could be an important component of residents’ wellbeing and patient safety. If further research confirms these associations, it will become imperative to determine what interventions might improve the quality of relationships between program directors and residents.