Surgical Residents Recover From Burnout as Training Progresses, Landmark Mexican Cohort Finds

Burnout among surgical residents has become one of the most talked-about crises in modern medicine, blamed for everything from medical errors to physicians abandoning their careers. But a new study from Mexico is turning that grim narrative on its head. Researchers who surveyed every single general surgery resident at a Mexican academic institution found that burnout does not steadily worsen as training grinds on. Instead, it improves dramatically, with the most junior residents bearing the heaviest psychological burden and the most senior residents emerging remarkably resilient. The findings, published in Global Surgical Education, the journal of the Association for Surgical Education, challenge long-held assumptions about how burnout unfolds across the five grueling years of surgical training.

The research team, led by Alfredo Verastegui of Mayo Clinic Florida and Tecnológico de Monterrey, together with Mauricio Gonzalez-Urquijo, Diego Maldonado, Adolfo Leyva-Alvizo and Mario Rodarte-Shade, set out to answer a deceptively simple question: how do the different dimensions of burnout actually change as residents move from their first to their fifth postgraduate year? Most previous studies have offered only snapshots, measuring burnout at a single point in time or comparing different cohorts of residents. What has been missing, particularly in Latin American contexts where surgical training conditions can differ substantially from those in the United States and Europe, is a complete picture of an entire residency program at every stage of training simultaneously.

To build that picture, the researchers surveyed all 37 general surgery residents at a Mexican academic institution in October 2025, spanning the full range from PGY1 to PGY5. The response rate was a perfect 100 percent, a methodological strength that eliminates the selection bias that plagues most burnout surveys, where the most distressed or the most disengaged residents are often the ones who decline to participate. The residents, whose mean age was 28.9 years, were 54.1 percent female, and 62.2 percent had relocated from other regions to train at the institution, a detail that allowed the team to test whether leaving home for residency shapes psychological outcomes.

Burnout was measured with the Maslach Burnout Inventory, the most widely used instrument in the field, which assesses three distinct domains: emotional exhaustion, the feeling of being drained and depleted by work; depersonalization, the development of cynical, detached attitudes toward patients; and personal accomplishment, the sense of competence and meaningful achievement in one’s work. Because these three dimensions can move in different directions, the researchers treated them separately rather than collapsing them into a single burnout score. They then applied a battery of statistical tests suited to the task: Kruskal-Wallis tests to compare the domains across training years, Jonckheere-Terpstra tests to detect monotonic trends, meaning steady increases or decreases from one year to the next, and linear regression models that examined the relationship between training year and burnout while adjusting for demographic factors and whether a resident was local or non-local.

The results were striking. Personal accomplishment was the only domain that differed significantly across training years in the between-group comparison, with a p-value of 0.023, and the scores climbed steadily from the first year to the fifth. The trend analyses reinforced the pattern with remarkable consistency. Emotional exhaustion showed a significant monotonic decrease across training years, with a correlation coefficient of -0.415 and a p-value of 0.011, while personal accomplishment showed an even stronger monotonic increase, with a coefficient of 0.530 and a p-value below 0.001. In plain terms, the longer residents stayed in the program, the less emotionally drained they felt and the more capable and fulfilled they became.

The prevalence figures tell the story in even more vivid terms. Among first-year residents, 37.5 percent reported high emotional exhaustion, 50 percent reported high depersonalization, and a staggering 75 percent reported low personal accomplishment. By the fifth and final year, those numbers had collapsed to 11.1 percent for emotional exhaustion, 22.2 percent for depersonalization, and exactly zero percent for low personal accomplishment. Not a single senior resident in the cohort reported a diminished sense of professional achievement. For a specialty in which burnout prevalence has been reported as persistently high across institutions and countries, the near-total disappearance of one burnout domain by the end of training is a finding that demands attention.

Equally notable is what the researchers did not find. Resident origin, whether a trainee had come from the local area or relocated from elsewhere, showed no significant association with any burnout domain or with the trajectories across training years. In a country where surgical residency often requires young doctors to move far from their families and support networks, the absence of an origin effect suggests that the program itself, rather than geographic circumstance, is the dominant influence on how residents weather the psychological demands of training.

The authors’ conclusion is deliberately provocative: burnout improves progressively during surgical residency, junior residents are the most vulnerable group, and senior residents demonstrate substantial recovery. This directly challenges the widespread assumption that residency is an unrelenting descent into exhaustion, an assumption embedded in much of the wellness literature and in the design of many burnout interventions. If burnout is not a uniformly worsening trajectory, then one-size-fits-all programs spread evenly across five years of training may be misallocating their resources. The data point instead toward targeted early support, concentrating mental health resources, mentorship and workload adjustments on the first years of training, when distress is at its peak.

The study also raises a subtler question about the nature of surgical training itself. The authors emphasize the importance of preserving the transformative aspects of residency, the demanding process through which medical graduates are forged into autonomous surgeons. Some degree of struggle may be intrinsic to that transformation, and the steady rise in personal accomplishment suggests that residents derive a growing sense of mastery from exactly the challenges that make training so hard. The goal, on this reading, is not to eliminate difficulty but to ensure that junior residents, who are simultaneously absorbing the steepest learning curve and the heaviest emotional load, have the scaffolding they need to get through the most vulnerable phase.

Context matters here. The study is cross-sectional, capturing all five training years at a single moment in October 2025 rather than following the same individuals over time, and it comes from one institution with 37 residents. Those limitations mean the trajectories should be interpreted as strong hypotheses rather than universal laws, and the authors themselves frame the work as a complete cohort analysis of a single Latin American program. Yet the 100 percent participation rate, the use of validated trend statistics, and the adjustment for demographics and resident origin give the findings unusual credibility for a study of this size. As residency programs expand across Mexico and Latin America, and as the global conversation about physician well-being intensifies, this complete snapshot from Monterrey offers something the field has lacked: evidence that the arc of surgical training may bend toward recovery, not ruin, and that the most effective interventions may be the ones aimed at the residents who need them most, in their earliest and hardest years.

Subject of Research: Burnout trajectories across the five years of general surgery residency in a Latin American training program

Article Title: Burnout trajectories across general surgery residency: a complete cohort analysis from a Latin American Institution

Article References: Verastegui, A., Gonzalez-Urquijo, M., Maldonado, D., Leyva-Alvizo, A., & Rodarte-Shade, M. (2026). Burnout trajectories across general surgery residency: a complete cohort analysis from a Latin American Institution. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 150. https://doi.org/10.1007/s44186-026-00557-9

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00557-9

Keywords: burnout, surgical residency, general surgery, medical education, resident wellness, Maslach Burnout Inventory, emotional exhaustion, depersonalization, personal accomplishment, Latin America, Mexico, physician well-being