Paper Type

Doctoral Dissertation


College of Education and Human Services

Degree Name

Doctor of Education in Educational Leadership (EdD)


Leadership, School Counseling & Sport Management

First Advisor

Dr. Marcia Lamkin

Second Advisor

Dr. Pam Chally

Third Advisor

Dr. Joyce T. Jones

Fourth Advisor

Dr. Paul Eggen


Medical residency is a time of high stress, long hours, high case loads, fatigue, and lack of free time. Burnout rates among residents have been reported to be between 25-76%. Scant literature exists in regard to resident stress and its impact on learning and attrition during residency. The theory of margin posits that a healthy margin is necessary for adults to learn. Healthy margin exists when a person’s ratio of burdens over resources creates a surplus of energy. This study sought to determine if there was a difference between emergency medicine (EM) residents’ margin in life scores and remediation, at risk for remediation, and those considering leaving their emergency medicine residency training.

Volunteer EM residents (n = 279) completed the Margin in Life Scale for Emergency Medicine (MILS EM) questionnaire, which measures six life areas: Health/Body, Religion/Spirituality, Self-Confidence, Interdependence, Parenting, and EM Work. Residents self-reported if they were considering leaving EM training and program directors provided remediation, at risk for remediation, and attrition rates.

The mean MILS EM score among the 273 included EM residents was .64, which is within the recommended healthy range of .30 to .80. Additionally, all mean subscale scores fell within the healthy range. Only 13% of residents were reported as being on remediation, MILS EM (M=.63) with no statistically significant differences between those on remediation versus those not. Only 6% of residents were reported as being in jeopardy of remediation, MILS EM (M=.63) versus those not at risk (M=.64). Finally, only 5% of EM residents self-reported considering leaving EM training and no residents left their training program. Women scored lower on the MILS EM, and the life areas Health/Body (p

Results of this study suggest that EM residents appear to have sufficient margin overall and in each of the life areas. Few were on or at risk for remediation and even fewer reported they were considering leaving EM residency training. As females scored lower in some of the life areas, further investigation is needed to determine if there are characteristics in the work environment that affect women differently than men.

Included in

Education Commons