Trends in Resident Trainee Humor Styles and Burnout During Residency Training

Trends in Resident Trainee Humor Styles and Burnout During Residency Training | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trends in Resident Trainee Humor Styles and Burnout During Residency Training Meagan Rosenberg, Anam J Furrukh, Aixa Perez Coulter, Michael V Tirabassi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8554720/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose : Humor is crucial for stress management and team dynamics among medical professionals. While positive humor aids with stress coping, little is known about how humor styles evolve during residency or relate to burnout. This study examines the prevalence of four humor styles (affiliative, self-enhancing, aggressive, and self-defeating) among residents and correlation with burnout. Methods : This study surveyed residents from eleven specialties at a single institution. In the first month of the academic year, residents completed surveys using the Short Work-related Humor Styles Questionnaire (Sw-HSQ) and Burnout Assessment Tool (BAT). Demographic data, specialty, and training level were collected. Descriptive analysis, Student’s t-test, and Pearson’s correlation were used to assess humor style prevalence, changes, and burnout associations. Results : A total of 107 residents completed the survey. No significant differences in humor styles or burnout scores were found by training year, preliminary status, or prior career experience. There was no correlation between age and humor style (p=0.24). Male residents had higher positive humor scores (p=0.002). Female residents had higher burnout scores (p=0.016). Residents with clinical training interruptions adopted more positive humor (p=0.01). Overall, there was a significant correlation between greater positive humor style use and lower burnout scores (r=-0.22, p=0.026). Conclusion : This study establishes a small but significant correlation between higher positive humor scores and lower burnout scores. Although these findings require validation in larger cohorts, preliminary findings offer insight into the protective effects of positive humor against burnout in general surgery training. Figures Figure 1 Introduction Humor is linked to increased resilience, reduced stress, and improved relationships [ 1 – 3 ]. As studies into humor have grown more nuanced, there has been sub-categorization of types of humor. The regular employment of different humor styles has differing impacts on a person’s emotional health. These sub-categories are defined as affiliative, self-enhancing, aggressive, and self-defeating [ 4 – 5 ]. The first two are considered positive subtypes, while the latter two are negative subtypes. Affiliative humor facilitates interpersonal relationships and diffuses interpersonal tension through shared laughter. Self-enhancing humor focuses more on self than others, finding the humorous side of current life situations. Aggressive humor is targeted at others and at their expense, often in the form of teasing or disparaging comments. Self-defeating humor is targeted at oneself at one’s own expense, such as disparaging oneself for the amusement of others. Positive subtypes are associated with all the touted positive health benefits of humor. The negative sub-types, however, correlate with negative mental health, poor stress coping, and decreased social support [ 4 , 6 ]. Humor often plays a role in workplace interactions and stress management of physicians, however there is scant literature to quantitatively support this claim. Most existing literature consists of opinion pieces on the ethical and moral aspects of humor in medicine with limited objective evaluation [ 7 – 9 ]. There is no research on current literature review that investigates the humor styles present in resident trainees and ways in which expression of humor may change during the course of training as a representation of changes in mental health, attempts to manage unprecedented stress and discomfort, and efforts to blend into a tight-knit milieu of other medical providers. This study aimed to establish baseline humor style patterns among residents at a single institution. We further planned to correlate our findings with demographic and training data as well as burnout as a surrogate for the mental health impacts of the training environment. We hypothesized that negative humor style would correlate with higher levels of burnout and, conversely, that more use of positive humor styles would correlate with lower levels of burnout. Thus, observing the humor style in trainees could serve as a rapid check-in regarding resident well-being. Methods A cross-sectional survey was conducted across eleven residency programs at a single institution. Institutional Review Board approval (IRBNet #2175980-2) was obtained prior to survey distribution, as well as approval from the Graduate Medical Education committee. A survey was distributed to all residents in training at the hosting institution. Collected data included demographics (age, gender, race), prior career information, post-graduate year (PGY) of training, training specialty, preliminary versus categorical status, and gaps in training (including maternity/paternity leave and research fellowship). Humor styles were scored using the validated Short Work-related Humor Styles Questionnaire (Sw-HSQ). Positive humor style is defined as the combined score of the affiliative and self-enhancing question scores. Negative humor style is defined as the combined score of the aggressive and self-defeating question scores. Burnout was assessed using the 12-question Burnout Assessment Tool (BAT). Electronic surveys were distributed in July 2024, immediately following on-boarding of the new resident cohort. Two reminders were sent out over the course of 4 weeks to maximize response. Survey responses were anonymous. Consent was obtained for participation on the cover page of the electronic survey. Included were all residents in training at the hosting hospital system. Excluded were those residents who did not complete the survey in its entirety. Initial data analysis described baseline characteristics with summary statistics on demographic data, training, experience, and specialty. All continuous variables were checked for normality using skewness statistics including Shapiro Wilk with the null hypothesis being that the data is normally distributed. Continuous measures are reported using means and standard deviations (SD) for normally distributed continuous variables and medians and interquartile interval (IQI) for skewed continuous data. Categorial data is described in frequency and percentages. Student t-test was used for continuous variables, and Spearman’s and Pearson’s correlation was used to describe the relationship between humor styles and burnout scores. One way analysis of variance (ANOVA) was used when necessary for post-hoc analysis. Statistical significance was defined as an alpha of 0.05. Data were analyzed using STATA 18 (StataCorp, College Station, TX). Results Cohort Demographics and Training Data In total, 315 residents across 11 specialties were invited to participate in the survey. 111 residents started the survey, of whom 107 completed both the humor and burnout instruments, for a response rate of 34%. Participants were 58.6% female, 38.7% male, 1.8% non-binary, and 0.9% gender-fluid. One resident matched into a preliminary position, while all remaining residents matched into categorical residency positions. Among the respondents, 69.4% did not have another career prior to starting residency training, while 30.6% reported having a prior career. Of the 34 residents with prior career experience, 61.8% had a medically related career, and 38.2% reported a non-medical prior career. Additionally, 8 residents (7.2%) reported interruptions in their clinical training. On average (SD), the training disruption was 16 (12.6) months. By residency specialty, there were: 17.8% general surgery, 15.9% emergency medicine, 13.1% pediatrics, 12.1% medicine pediatrics, 9.3% anesthesia, 7.5% obstetrics-gynecology, 6.5% family medicine, 5.6% internal medicine, 3.7% pathology, 3.7% psychiatry, 3.7% radiology, and 0.9% did not denote their specialty. By year of training there were: 28.8% PGY-1, 28.8% PGY-2, 27% PGY-3, 11.7% PGY-4, and 3.6% PGY-5. Humor Styles and Burnout Scores Overall, the average (SD) positive humor score was 30.7 (5.67) and the average (SD) negative humor score was 21.2 (6.49). By individual humor sub-category, affiliative humor was 16.6 (3.22), self-enhancing was 13.75 (3.57), aggressive was 9.06 (3.32), and self-defeating was 12.1 (4.01). Positive and negative humor scores, as well as the four individual sub-categories, were compared by residency specialty with no difference based on specialty (Table 1 ) (Fig. 1). The average (SD) total burnout score for the cohort was 2.41 (0.57), again without significant difference based on specialty (Table 2 ). Using Pearson’s correlation, both positive humor score and negative humor score were compared with burnout. A significant correlation was found between positive humor score and lower burnout score (p = 0.026, r=-0.22). There was no correlation between negative humor score and burnout score (p = 0.31). Using Spearman's correlation, no significant associations were found between age and positive humor styles (p = 0.24) or age and negative humor styles (p = 0.41). There was also no correlation between age and total burnout score (p = 0.65). Spearman’s correlation by training year similarly showed no significant relationship with positive humor styles (p = 0.88) or negative humor styles (p = 0.51). There was no correlation between training year and total burnout scores (p = 0.32). Male residents reported significantly higher positive humor scores compared to female residents with an average (SD) of 32.3 (5.12) versus 29.1 (5.7) (p = 0.002). Female residents had significantly higher total burnout scores with an average (SD) of 2.5 (0.5) versus 2.25 (0.5) (p = 0.016). Due to the small sample size for the non-binary and gender fluid respondents, meaningful statistical analysis could not be performed. There was no significant difference in negative humor scores between male and female residents with average (SD) scores of 20.2 (6.6) versus 22.9 (6.2) (p = 0.16) Residents with training interruptions had higher positive humor scores (p = 0.01) but no significant differences in negative humor or burnout (p = 0.32, p = 0.32). Those with prior career experience before residency showed no significant differences in positive humor styles (p = 0.41), negative humor styles (p = 0.89), or total burnout scores (p = 0.47). When analyzing whether the prior career was medicine-related, no significant associations were found with positive humor styles (p = 0.51), negative humor styles (p = 0.35), or total burnout scores (p = 0.53). Discussion This study sought to evaluate the relationship between humor styles and burnout among resident physicians, hypothesizing that negative humor styles would correlate with higher levels of burnout, while positive humor styles would correlate with lower burnout scores. Our findings partially support this hypothesis, demonstrating an inverse correlation between positive humor scores and burnout, suggesting that residents who employ more positive humor styles—affiliative and self-enhancing—experience lower levels of burnout. However, no correlation was observed between negative humor styles and burnout, challenging the assumption that aggressive or self-defeating humor contribute directly to higher burnout levels. These findings highlight humor’s potential role in mitigating resident burnout. Positive humor may serve as a protective factor, suggesting its role in resilience-building. This design of this study, however, cannot establish causation. Incorporating humor-based strategies into wellness initiatives may provide residents with additional tools to navigate stress and maintain emotional well-being. In addition to this primary finding, several secondary associations emerged. Male residents exhibited greater use of positive humor, which may reflect differences in coping styles or social interactions within residency. The role of humor in fostering camaraderie and psychological safety in male-dominated environments warrants further exploration. Meanwhile, the higher burnout levels reported by female residents align with broader trends in physician burnout, potentially linked to unique stressors such as greater administrative burdens, distinct social expectations, and challenges related to work-life integration [ 10 ]. Recognizing these disparities is crucial for developing targeted burnout interventions. Interestingly, residents with interruptions in clinical training demonstrated significantly higher positive humor scores, suggesting that time away from direct clinical duties may influence the adoption of humor as a coping mechanism. The association between training interruptions and higher positive humor scores suggests that humor may be an adaptive mechanism for reintegration into residency. Residents who step away from clinical training—whether for research, personal leave, or other reasons—may rely on positive humor to re-establish social connections and manage the challenges of re-entry. This finding supports the potential of humor-based interventions to ease transitions and foster resilience. No significant differences in humor styles or burnout scores were observed across specialties, indicating that these relationships may be more strongly tied to individual factors rather than specialty-specific training environments. Humor and coping with stress are intimately interlinked concepts [ 11 ]. Likewise, working in the medical field and stress are closely correlated, with physician stress levels and burnout rates recently emphasized by the COVID-19 pandemic [ 12 – 13 ]. The pandemic illuminated the emotional toll of medical training and practice, with studies highlighting the psychological burden on healthcare workers and the coping mechanisms they employ. A large Italian survey study found that healthcare workers with greater exposure to COVID-19 patients reported higher perceived stress levels; however, those who engaged in humor-based coping strategies exhibited lower stress levels than their peers [ 14 ]. This aligns with our findings that positive humor may serve as a protective factor against burnout. Similarly, a U.S.-based survey study identified camaraderie, teamwork, and shared humor as key elements in reducing stress during the pandemic’s first wave, reinforcing the notion that humor fosters resilience in high-pressure environments [ 15 ]. Additionally, Babore et al. demonstrated that proactive coping strategies, including seeking social support and maintaining a positive outlook, helped mitigate stress, whereas avoidance strategies were linked to increased distress [ 16 ]. Our study builds upon this literature by demonstrating that humor style is not only a response to acute stressors, such as the pandemic, but also a trait associated with long-term burnout risk in medical trainees. The correlation between positive humor and lower burnout suggests that humor may act as a buffering mechanism throughout residency, reinforcing the broader role of humor in physician well-being. Understanding these connections can help inform interventions that leverage humor as a tool to foster resilience and emotional endurance in the medical field. Study strengths include the use of validated instruments to assess both humor styles and burnout, ensuring the reliability of our findings. Additionally, with a response rate of 34%, our participation level is strong compared to similar surveys conducted among resident physicians, enhancing the generalizability of our results within our institution. However, some limitations should be considered. The study's relatively small sample size and single-institution design may limit the broader applicability of our findings to other residency programs. Furthermore, the cross-sectional nature of the data prevents an assessment of how humor styles and burnout evolve over time, highlighting the need for longitudinal studies to better understand these dynamics. While our use of a validated humor scale strengthens the study, humor remains an inherently subjective trait that can be influenced by individual perception and cultural factors. Finally, given that burnout itself can reduce participation in voluntary surveys, it is possible that residents experiencing the highest levels of burnout were underrepresented in our sample, leading to an underestimation of the true prevalence and severity of burnout in this population. Future research will build on these findings by incorporating longitudinal tracking of the PGY1 class to assess how humor styles and burnout evolve throughout residency. This approach will provide valuable insight into whether humor serves as a stable trait or adapts in response to the demands of training. Expanding to a multicenter study would also enhance generalizability by capturing variations across different institutions and specialties. Additionally, piloting this research with attending physicians could offer a broader perspective on the role of humor in mitigating burnout beyond residency, shedding light on whether humor-based coping mechanisms persist throughout a physician’s career. In conclusion, higher positive humor scores on the sw-HSQ correlated with lower burnout scores. While broader studies are needed to validate these findings outside of a single institution, positive humor may offer protective effects against the stress of medical residency training. Abbreviations PGY Post-graduate year Sw-HSQ Short Work-related Humor Styles Questionnaire BAT Burnout Assessment Tool Standard deviation SD Interquartile interval IQI References Kuiper, N. A. Humor and resiliency: Towards a process model of coping and growth. Eur. J. Psychol . 2012;8(3), 475–491. https://doi.org/10.5964/ejop.v8i3.464. Abel, M. H. Humor, stress, and coping strategies. Humor: International Journal of Humor Research . 2002;15(4), 365–381. https://doi.org/10.1515/humr.15.4.365. Cann, A., Calhoun, L. G., Banks, J. S. On the role of humor in interpersonal attraction: It’s no joking matter. Humor . 1997;10, 77–90. Martin, R. A., Puhlik-Doris, P., Larsen, G., Gray, J., Weir, K. Individual differences in uses of humor and their relation to psychological well-being: Development of the Humor Styles Questionnaire. J. Res. Pers. 2003;37(1), 48–75. https://doi.org/10.1016/S0092-6566(02)00534-2. Tsukawaki, R., Imura, T. The light and dark side of self-directed humor: The development and initial validation of the Dual Self-Directed Humor Scale (DSDHS). Pers. Individ. Differ. 2020;157. https://doi.org/10.1016/j.paid.2020.109835. Napp, T. The medicine of memes: An exploration of humor styles, memes, and dark humor. Digital Commons @ ACU, Electronic Theses and Dissertations. 2023;595. Schweikart, S. J. Could humor in health care become malpractice? AMA J Ethics. 2020;22(7):E596-601. https://doi.org/10.1001/amajethics.2020.596. Hardy, C. Humor and sympathy in medical practice. Med. Health Care Philos. 2020;23:179-190. https://doi.org/10.1007/s11019-019-09928-0. Tomlinson, T. Humor in medicine: Nasty, dark, and shades of grey. MSU Bioethics: Center for Bioethics and Social Justice at Michigan State University. 2015. Hoff, T., Lee, D. R. Burnout and physician gender: What do we know? Med. Care. 2021;59(8):711-720. https://doi.org/10.1097/MLR.0000000000001584. Lefcourt, H. M., Martin, R. A. (1986). Humor and life stress: Antidote to adversity. New York, NY: Springer. Linzer, M., Stillman, M., Brown, R., Taylor S., Nankivil, N., Poplau, S., Goelz, E., Sinsky, C. Preliminary report: US physician stress during the early days of the COVID-19 pandemic. MCP:IQ&O. 2021;5(1)127-136. https://doi.org/ 10.1016/j.mayocpiqo.2021.01.005. Amanullah, S., Shankar, R. R. Impact of COVID-19 on physician burnout globally: A review. Healthc. 2020; 8(4):421. https://doi.org/10.3390/healthcare8040421. Canestrari, C., Bongelli, R., Fermani, A., Riccioni, I., Bertolazzi, A., Muzi, M., Burro, R. Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor. Front. Psychol . 2021;11:601574. https://doi.org/10.3389/fpsyg.2020.601574. Rose, S., Hartnett, J., Pillai, S. Healthcare worker's emotions, perceived stressors and coping mechanisms during the COVID-19 pandemic. PloS One . 2021;16(7):e0254252. https://doi.org/10.1371/journal.pone.0254252. Babore, A., Lombardi, L., Viceconti, M. L., Pignataro, S., Marino, V., Crudele, M., Candelori, C., Bramanti, S. M., Trumello, C. (2020). Psychological effects of the COVID-2019 pandemic: Perceived stress and coping strategies among healthcare professionals. Psychiatry Res . 2020;293:113366. https://doi.org/10.1016/j.psychres.2020.113366. Tables Table 1: Humor sub-category score compared by training specialty. Specialty GS Anes Path EM Ped IM Psy Med-Ped Rad OBGYN FM Total P-value Affiliative mean (sd) 16.56 (3.57) 17.10 (4.48) 14.00 (3.37) 16.59 (2.92) 15.36 (3.93) 14.25 (1.71) 17.25 (1.26) 16.31 (2.66) 17.75 (2.50) 18.00 (1.93) 18.57 (1.90) 16.55 (3.22) 0.29 Self-enhancing mean (sd) 13.82 (3.32) 14.70 (4.19) 12.25 (3.59) 14.53 (3.56) 13.14 (2.74) 9.00 (4.32) 15.25 (6.02) 13.62 (2.60) 12.75 (4.72) 14.50 (3.93) 14.29 (2.87) 13.75 (3.57) 0.15 Total positive mean (sd) 30.18 (6.01) 31.80 (8.08) 26.25 (6.70) 31.12 (5.27) 28.50 (4.62) 23.25 (5.80) 32.50 (6.61) 29.92 (4.11) 30.50 (5.07) 32.50 (5.35) 32.86 (3.29) 30.27 (5.67) 0.17 Aggressive mean (sd) 9.67 (3.22) 10.40 (3.27) 9.75 (3.86) 9.82 (3.26) 8.79 (3.77) 5.25 (3.30) 7.25 (2.22) 8.00 (2.61) 8.75 (4.11) 9.50 (4.28) 8.71 (1.60) 9.06 (3.32) 0.33 Self-defeating mean (sd) 12.17 (3.71) 12.60 (3.50) 10.00 (5.16) 13.29 (4.07) 12.00 (4.42) 7.50 (4.20) 12.00 (5.48) 11.54 (3.82) 12.50 (3.51) 12.00 (4.47) 13.29 (3.09) 12.10 (4.01) 0.55 Total negative mean (sd) 21.83 (5.99) 23.00 (5.73) 19.75 (8.34) 23.12 (6.56) 20.79 (7.46) 12.75 (5.38) 19.25 (7.54) 19.54 (5.24) 21.25 (7.14) 21.50 (8.21) 22.00 (4.12) 21.16 (6.49) 0.38 Table 1: Individual humor type scores and positive/negative categorization compared by residency training specialty. Table 2: Burnout component and total score by training specialty. Specialty GS Anes Path EM Ped IM Psy Med-Ped Rad OBGYN FM Total P-value Exhaustion mean (sd) 3.43 (0.83) 3.07 (0.58) 3.33 (1.15) 3.16 (0.81) 3.03 (0.88) 3.00 (0.72) 2.33 (0.27) 3.38 (0.78) 2.58 (0.50) 3.58 (0.85) 2.94 (0.57) 3.17 (0.80) 0.22 Mental distance mean (sd) 2.37 (0.59) 2.37 (0.74) 2.42 (1.52) 2.14 (0.69) 2.29 (1.06) 2.25 (0.32) 1.42 (0.17) 2.46 (0.71) 2.17 (0.43) 2.42 (1.04) 2.17 (0.62) 2.27 (0.78) 0.73 Cognitive impairment mean (sd) 2.17 (0.50) 2.33 (0.57) 2.67 (1.56) 2.25 (0.55) 2.64 (0.89) 2.17 (0.33) 2.08 (0.17) 2.31 (0.40) 2.08 (0.42) 2.33 (0.84) 2.50 (0.59) 2.33 (0.65) 0.69 Emotional impairment mean (sd) 1.85 (0.67) 1.63 (0.60) 2.67 (1.41) 1.84 (0.54) 1.82 (0.57) 1.75 (0.63) 1.58 (0.17) 2.08 (0.71) 1.50 (0.43) 2.08 (0.83) 1.67 (0.67) 1.86 (0.68) 0.32 Total Burnout Score mean (sd) 2.45 (0.45) 2.35 (0.49) 2.77 (1.38) 2.35 (0.46) 2.42 (0.75) 2.29 (0.38) 1.85 (0.12) 2.56 (0.48) 2.08 (0.33) 2.60 (0.79) 2.32 (0.32) 2.41 (0.57) 0.53 Table 2: Individual Burnout Assessment Tool (BAT) component scores and overall BAT score compared by residency training specialty. 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08:14:59","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60080,"visible":true,"origin":"","legend":"","description":"","filename":"GSEDD26000020structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8554720/v1/db6c3140fdca4ca1ed42d0f6.xml"},{"id":100864095,"identity":"ef0643f3-7d4d-4701-a941-a02358adb9bc","added_by":"auto","created_at":"2026-01-22 08:14:58","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67698,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8554720/v1/f06b2193de21bc16544cf64d.html"},{"id":100864088,"identity":"f40c631f-1b9a-4e41-9870-12e09c7d32ea","added_by":"auto","created_at":"2026-01-22 08:14:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":487906,"visible":true,"origin":"","legend":"\u003cp\u003eAverage Humor Style Score by Training Specialty\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFig 1\u003c/strong\u003e Humor sub-category score compared by training specialty\u003c/p\u003e","description":"","filename":"ResidenthumorFig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8554720/v1/58658aff6054965c7d3b2885.png"},{"id":101203397,"identity":"9c8695ed-6cca-42cb-8bbd-07919bc29903","added_by":"auto","created_at":"2026-01-27 09:39:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1061453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8554720/v1/4817880d-ae22-4cb3-b74b-a3d7aedcccc3.pdf"}],"financialInterests":"","formattedTitle":"Trends in Resident Trainee Humor Styles and Burnout During Residency Training","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHumor is linked to increased resilience, reduced stress, and improved relationships [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As studies into humor have grown more nuanced, there has been sub-categorization of types of humor. The regular employment of different humor styles has differing impacts on a person\u0026rsquo;s emotional health. These sub-categories are defined as affiliative, self-enhancing, aggressive, and self-defeating [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The first two are considered positive subtypes, while the latter two are negative subtypes. Affiliative humor facilitates interpersonal relationships and diffuses interpersonal tension through shared laughter. Self-enhancing humor focuses more on self than others, finding the humorous side of current life situations. Aggressive humor is targeted at others and at their expense, often in the form of teasing or disparaging comments. Self-defeating humor is targeted at oneself at one\u0026rsquo;s own expense, such as disparaging oneself for the amusement of others. Positive subtypes are associated with all the touted positive health benefits of humor. The negative sub-types, however, correlate with negative mental health, poor stress coping, and decreased social support [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHumor often plays a role in workplace interactions and stress management of physicians, however there is scant literature to quantitatively support this claim. Most existing literature consists of opinion pieces on the ethical and moral aspects of humor in medicine with limited objective evaluation [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There is no research on current literature review that investigates the humor styles present in resident trainees and ways in which expression of humor may change during the course of training as a representation of changes in mental health, attempts to manage unprecedented stress and discomfort, and efforts to blend into a tight-knit milieu of other medical providers.\u003c/p\u003e \u003cp\u003eThis study aimed to establish baseline humor style patterns among residents at a single institution. We further planned to correlate our findings with demographic and training data as well as burnout as a surrogate for the mental health impacts of the training environment. We hypothesized that negative humor style would correlate with higher levels of burnout and, conversely, that more use of positive humor styles would correlate with lower levels of burnout. Thus, observing the humor style in trainees could serve as a rapid check-in regarding resident well-being.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA cross-sectional survey was conducted across eleven residency programs at a single institution. Institutional Review Board approval (IRBNet #2175980-2) was obtained prior to survey distribution, as well as approval from the Graduate Medical Education committee. A survey was distributed to all residents in training at the hosting institution. Collected data included demographics (age, gender, race), prior career information, post-graduate year (PGY) of training, training specialty, preliminary versus categorical status, and gaps in training (including maternity/paternity leave and research fellowship). Humor styles were scored using the validated Short Work-related Humor Styles Questionnaire (Sw-HSQ). Positive humor style is defined as the combined score of the affiliative and self-enhancing question scores. Negative humor style is defined as the combined score of the aggressive and self-defeating question scores. Burnout was assessed using the 12-question Burnout Assessment Tool (BAT). Electronic surveys were distributed in July 2024, immediately following on-boarding of the new resident cohort. Two reminders were sent out over the course of 4 weeks to maximize response. Survey responses were anonymous. Consent was obtained for participation on the cover page of the electronic survey. Included were all residents in training at the hosting hospital system. Excluded were those residents who did not complete the survey in its entirety.\u003c/p\u003e \u003cp\u003eInitial data analysis described baseline characteristics with summary statistics on demographic data, training, experience, and specialty. All continuous variables were checked for normality using skewness statistics including Shapiro Wilk with the null hypothesis being that the data is normally distributed. Continuous measures are reported using means and standard deviations (SD) for normally distributed continuous variables and medians and interquartile interval (IQI) for skewed continuous data. Categorial data is described in frequency and percentages. Student t-test was used for continuous variables, and Spearman\u0026rsquo;s and Pearson\u0026rsquo;s correlation was used to describe the relationship between humor styles and burnout scores. One way analysis of variance (ANOVA) was used when necessary for post-hoc analysis. Statistical significance was defined as an alpha of 0.05. Data were analyzed using STATA 18 (StataCorp, College Station, TX).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eCohort Demographics and Training Data\u003c/h2\u003e\n \u003cp\u003eIn total, 315 residents across 11 specialties were invited to participate in the survey. 111 residents started the survey, of whom 107 completed both the humor and burnout instruments, for a response rate of 34%. Participants were 58.6% female, 38.7% male, 1.8% non-binary, and 0.9% gender-fluid. One resident matched into a preliminary position, while all remaining residents matched into categorical residency positions. Among the respondents, 69.4% did not have another career prior to starting residency training, while 30.6% reported having a prior career. Of the 34 residents with prior career experience, 61.8% had a medically related career, and 38.2% reported a non-medical prior career. Additionally, 8 residents (7.2%) reported interruptions in their clinical training. On average (SD), the training disruption was 16 (12.6) months.\u003c/p\u003e\n \u003cp\u003eBy residency specialty, there were: 17.8% general surgery, 15.9% emergency medicine, 13.1% pediatrics, 12.1% medicine pediatrics, 9.3% anesthesia, 7.5% obstetrics-gynecology, 6.5% family medicine, 5.6% internal medicine, 3.7% pathology, 3.7% psychiatry, 3.7% radiology, and 0.9% did not denote their specialty. By year of training there were: 28.8% PGY-1, 28.8% PGY-2, 27% PGY-3, 11.7% PGY-4, and 3.6% PGY-5.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2 class=\"Heading\"\u003e\u003cem\u003eHumor Styles and Burnout Scores\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eOverall, the average (SD) positive humor score was 30.7 (5.67) and the average (SD) negative humor score was 21.2 (6.49). By individual humor sub-category, affiliative humor was 16.6 (3.22), self-enhancing was 13.75 (3.57), aggressive was 9.06 (3.32), and self-defeating was 12.1 (4.01). Positive and negative humor scores, as well as the four individual sub-categories, were compared by residency specialty with no difference based on specialty (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) (Fig. 1). The average (SD) total burnout score for the cohort was 2.41 (0.57), again without significant difference based on specialty (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Using Pearson\u0026rsquo;s correlation, both positive humor score and negative humor score were compared with burnout. A significant correlation was found between positive humor score and lower burnout score (p\u0026thinsp;=\u0026thinsp;0.026, r=-0.22). There was no correlation between negative humor score and burnout score (p\u0026thinsp;=\u0026thinsp;0.31).\u003c/p\u003e\n\u003cp\u003eUsing Spearman\u0026apos;s correlation, no significant associations were found between age and positive humor styles (p\u0026thinsp;=\u0026thinsp;0.24) or age and negative humor styles (p\u0026thinsp;=\u0026thinsp;0.41). There was also no correlation between age and total burnout score (p\u0026thinsp;=\u0026thinsp;0.65). Spearman\u0026rsquo;s correlation by training year similarly showed no significant relationship with positive humor styles (p\u0026thinsp;=\u0026thinsp;0.88) or negative humor styles (p\u0026thinsp;=\u0026thinsp;0.51). There was no correlation between training year and total burnout scores (p\u0026thinsp;=\u0026thinsp;0.32).\u003c/p\u003e\n\u003cp\u003eMale residents reported significantly higher positive humor scores compared to female residents with an average (SD) of 32.3 (5.12) versus 29.1 (5.7) (p\u0026thinsp;=\u0026thinsp;0.002). Female residents had significantly higher total burnout scores with an average (SD) of 2.5 (0.5) versus 2.25 (0.5) (p\u0026thinsp;=\u0026thinsp;0.016). Due to the small sample size for the non-binary and gender fluid respondents, meaningful statistical analysis could not be performed. There was no significant difference in negative humor scores between male and female residents with average (SD) scores of 20.2 (6.6) versus 22.9 (6.2) (p\u0026thinsp;=\u0026thinsp;0.16)\u003c/p\u003e\n\u003cp\u003eResidents with training interruptions had higher positive humor scores (p\u0026thinsp;=\u0026thinsp;0.01) but no significant differences in negative humor or burnout (p\u0026thinsp;=\u0026thinsp;0.32, p\u0026thinsp;=\u0026thinsp;0.32). Those with prior career experience before residency showed no significant differences in positive humor styles (p\u0026thinsp;=\u0026thinsp;0.41), negative humor styles (p\u0026thinsp;=\u0026thinsp;0.89), or total burnout scores (p\u0026thinsp;=\u0026thinsp;0.47). When analyzing whether the prior career was medicine-related, no significant associations were found with positive humor styles (p\u0026thinsp;=\u0026thinsp;0.51), negative humor styles (p\u0026thinsp;=\u0026thinsp;0.35), or total burnout scores (p\u0026thinsp;=\u0026thinsp;0.53).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study sought to evaluate the relationship between humor styles and burnout among resident physicians, hypothesizing that negative humor styles would correlate with higher levels of burnout, while positive humor styles would correlate with lower burnout scores. Our findings partially support this hypothesis, demonstrating an inverse correlation between positive humor scores and burnout, suggesting that residents who employ more positive humor styles\u0026mdash;affiliative and self-enhancing\u0026mdash;experience lower levels of burnout. However, no correlation was observed between negative humor styles and burnout, challenging the assumption that aggressive or self-defeating humor contribute directly to higher burnout levels. These findings highlight humor\u0026rsquo;s potential role in mitigating resident burnout. Positive humor may serve as a protective factor, suggesting its role in resilience-building. This design of this study, however, cannot establish causation. Incorporating humor-based strategies into wellness initiatives may provide residents with additional tools to navigate stress and maintain emotional well-being.\u003c/p\u003e \u003cp\u003eIn addition to this primary finding, several secondary associations emerged. Male residents exhibited greater use of positive humor, which may reflect differences in coping styles or social interactions within residency. The role of humor in fostering camaraderie and psychological safety in male-dominated environments warrants further exploration. Meanwhile, the higher burnout levels reported by female residents align with broader trends in physician burnout, potentially linked to unique stressors such as greater administrative burdens, distinct social expectations, and challenges related to work-life integration [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Recognizing these disparities is crucial for developing targeted burnout interventions.\u003c/p\u003e \u003cp\u003eInterestingly, residents with interruptions in clinical training demonstrated significantly higher positive humor scores, suggesting that time away from direct clinical duties may influence the adoption of humor as a coping mechanism. The association between training interruptions and higher positive humor scores suggests that humor may be an adaptive mechanism for reintegration into residency. Residents who step away from clinical training\u0026mdash;whether for research, personal leave, or other reasons\u0026mdash;may rely on positive humor to re-establish social connections and manage the challenges of re-entry. This finding supports the potential of humor-based interventions to ease transitions and foster resilience. No significant differences in humor styles or burnout scores were observed across specialties, indicating that these relationships may be more strongly tied to individual factors rather than specialty-specific training environments.\u003c/p\u003e \u003cp\u003eHumor and coping with stress are intimately interlinked concepts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Likewise, working in the medical field and stress are closely correlated, with physician stress levels and burnout rates recently emphasized by the COVID-19 pandemic [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The pandemic illuminated the emotional toll of medical training and practice, with studies highlighting the psychological burden on healthcare workers and the coping mechanisms they employ. A large Italian survey study found that healthcare workers with greater exposure to COVID-19 patients reported higher perceived stress levels; however, those who engaged in humor-based coping strategies exhibited lower stress levels than their peers [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This aligns with our findings that positive humor may serve as a protective factor against burnout. Similarly, a U.S.-based survey study identified camaraderie, teamwork, and shared humor as key elements in reducing stress during the pandemic\u0026rsquo;s first wave, reinforcing the notion that humor fosters resilience in high-pressure environments [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, Babore et al. demonstrated that proactive coping strategies, including seeking social support and maintaining a positive outlook, helped mitigate stress, whereas avoidance strategies were linked to increased distress [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study builds upon this literature by demonstrating that humor style is not only a response to acute stressors, such as the pandemic, but also a trait associated with long-term burnout risk in medical trainees. The correlation between positive humor and lower burnout suggests that humor may act as a buffering mechanism throughout residency, reinforcing the broader role of humor in physician well-being. Understanding these connections can help inform interventions that leverage humor as a tool to foster resilience and emotional endurance in the medical field.\u003c/p\u003e \u003cp\u003eStudy strengths include the use of validated instruments to assess both humor styles and burnout, ensuring the reliability of our findings. Additionally, with a response rate of 34%, our participation level is strong compared to similar surveys conducted among resident physicians, enhancing the generalizability of our results within our institution.\u003c/p\u003e \u003cp\u003eHowever, some limitations should be considered. The study's relatively small sample size and single-institution design may limit the broader applicability of our findings to other residency programs. Furthermore, the cross-sectional nature of the data prevents an assessment of how humor styles and burnout evolve over time, highlighting the need for longitudinal studies to better understand these dynamics. While our use of a validated humor scale strengthens the study, humor remains an inherently subjective trait that can be influenced by individual perception and cultural factors. Finally, given that burnout itself can reduce participation in voluntary surveys, it is possible that residents experiencing the highest levels of burnout were underrepresented in our sample, leading to an underestimation of the true prevalence and severity of burnout in this population.\u003c/p\u003e \u003cp\u003eFuture research will build on these findings by incorporating longitudinal tracking of the PGY1 class to assess how humor styles and burnout evolve throughout residency. This approach will provide valuable insight into whether humor serves as a stable trait or adapts in response to the demands of training. Expanding to a multicenter study would also enhance generalizability by capturing variations across different institutions and specialties. Additionally, piloting this research with attending physicians could offer a broader perspective on the role of humor in mitigating burnout beyond residency, shedding light on whether humor-based coping mechanisms persist throughout a physician\u0026rsquo;s career.\u003c/p\u003e \u003cp\u003eIn conclusion, higher positive humor scores on the sw-HSQ correlated with lower burnout scores. While broader studies are needed to validate these findings outside of a single institution, positive humor may offer protective effects against the stress of medical residency training.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePGY Post-graduate year\u003c/p\u003e\n\u003cp\u003eSw-HSQ Short Work-related Humor Styles Questionnaire\u003c/p\u003e\n\u003cp\u003eBAT Burnout Assessment Tool\u003c/p\u003e\n\u003cp\u003eStandard deviation SD\u003c/p\u003e\n\u003cp\u003eInterquartile interval IQI\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKuiper, N. A. Humor and resiliency: Towards a process model of coping and growth. \u003cem\u003eEur. J. Psychol\u003c/em\u003e. 2012;8(3), 475\u0026ndash;491. https://doi.org/10.5964/ejop.v8i3.464.\u003c/li\u003e\n\u003cli\u003eAbel, M. H. Humor, stress, and coping strategies. \u003cem\u003eHumor: International Journal of Humor Research\u003c/em\u003e. 2002;15(4), 365\u0026ndash;381. https://doi.org/10.1515/humr.15.4.365.\u003c/li\u003e\n\u003cli\u003eCann, A., Calhoun, L. G., Banks, J. S. On the role of humor in interpersonal attraction: It\u0026rsquo;s no joking matter. \u003cem\u003eHumor\u003c/em\u003e. 1997;10, 77\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eMartin, R. A., Puhlik-Doris, P., Larsen, G., Gray, J., Weir, K. Individual differences in uses of humor and their relation to psychological well-being: Development of the Humor Styles Questionnaire. \u003cem\u003eJ. Res. Pers.\u003c/em\u003e 2003;37(1), 48\u0026ndash;75. https://doi.org/10.1016/S0092-6566(02)00534-2.\u003c/li\u003e\n\u003cli\u003eTsukawaki, R., Imura, T. The light and dark side of self-directed humor: The development and initial validation of the Dual Self-Directed Humor Scale (DSDHS). \u003cem\u003ePers. Individ. Differ. \u003c/em\u003e2020;157. https://doi.org/10.1016/j.paid.2020.109835.\u003c/li\u003e\n\u003cli\u003eNapp, T. The medicine of memes: An exploration of humor styles, memes, and dark humor. Digital Commons @ ACU, \u003cem\u003eElectronic Theses and Dissertations. \u003c/em\u003e2023;595.\u003c/li\u003e\n\u003cli\u003eSchweikart, S. J. Could humor in health care become malpractice? \u003cem\u003eAMA J Ethics. \u003c/em\u003e2020;22(7):E596-601. https://doi.org/10.1001/amajethics.2020.596.\u003c/li\u003e\n\u003cli\u003eHardy, C. Humor and sympathy in medical practice. \u003cem\u003eMed. Health Care Philos.\u003c/em\u003e 2020;23:179-190. https://doi.org/10.1007/s11019-019-09928-0.\u003c/li\u003e\n\u003cli\u003eTomlinson, T. Humor in medicine: Nasty, dark, and shades of grey. \u003cem\u003eMSU Bioethics: Center for Bioethics and Social Justice at Michigan State University.\u003c/em\u003e 2015.\u003c/li\u003e\n\u003cli\u003eHoff, T., Lee, D. R. Burnout and physician gender: What do we know? \u003cem\u003eMed. Care.\u003c/em\u003e 2021;59(8):711-720. https://doi.org/10.1097/MLR.0000000000001584.\u003c/li\u003e\n\u003cli\u003eLefcourt, H. M., Martin, R. A. (1986). Humor and life stress: Antidote to adversity. New York, NY: Springer.\u003c/li\u003e\n\u003cli\u003eLinzer, M., Stillman, M., Brown, R., Taylor S., Nankivil, N., Poplau, S., Goelz, E., Sinsky, C. Preliminary report: US physician stress during the early days of the COVID-19 pandemic. \u003cem\u003eMCP:IQ\u0026amp;O. \u003c/em\u003e2021;5(1)127-136. https://doi.org/ 10.1016/j.mayocpiqo.2021.01.005.\u003c/li\u003e\n\u003cli\u003eAmanullah, S., Shankar, R. R. Impact of COVID-19 on physician burnout globally: A review. \u003cem\u003eHealthc. \u003c/em\u003e2020; 8(4):421. https://doi.org/10.3390/healthcare8040421.\u003c/li\u003e\n\u003cli\u003eCanestrari, C., Bongelli, R., Fermani, A., Riccioni, I., Bertolazzi, A., Muzi, M., Burro, R. Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor. \u003cem\u003eFront. Psychol\u003c/em\u003e. 2021;11:601574. https://doi.org/10.3389/fpsyg.2020.601574.\u003c/li\u003e\n\u003cli\u003eRose, S., Hartnett, J., Pillai, S. Healthcare worker\u0026apos;s emotions, perceived stressors and coping mechanisms during the COVID-19 pandemic. \u003cem\u003ePloS One\u003c/em\u003e. 2021;16(7):e0254252. https://doi.org/10.1371/journal.pone.0254252.\u003c/li\u003e\n\u003cli\u003eBabore, A., Lombardi, L., Viceconti, M. L., Pignataro, S., Marino, V., Crudele, M., Candelori, C., Bramanti, S. M., Trumello, C. (2020). Psychological effects of the COVID-2019 pandemic: Perceived stress and coping strategies among healthcare professionals. \u003cem\u003ePsychiatry Res\u003c/em\u003e. 2020;293:113366. https://doi.org/10.1016/j.psychres.2020.113366.\u003c/li\u003e\n\u003c/ol\u003e\n"},{"header":"Tables","content":"\u003cp\u003eTable 1: Humor sub-category score compared by training specialty.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"126%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMed-Ped\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRad\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOBGYN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffiliative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e16.56 (3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e17.10 (4.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14.00 (3.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e16.59 (2.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e15.36 (3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14.25 (1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e17.25 (1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e16.31 (2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e17.75 (2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e18.00 (1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e18.57 (1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e16.55 (3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-enhancing\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e13.82 (3.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14.70 (4.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.25 (3.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14.53 (3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e13.14 (2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e9.00 (4.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e15.25 (6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e13.62 (2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.75 (4.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14.50 (3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e14.29 (2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e13.75 (3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal positive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e30.18 (6.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e31.80 (8.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e26.25 (6.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e31.12 (5.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e28.50 (4.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e23.25 (5.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e32.50 (6.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e29.92 (4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e30.50 (5.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e32.50 (5.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e32.86 (3.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e30.27 (5.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAggressive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e9.67 (3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e10.40 (3.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e9.75 (3.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e9.82 (3.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8.79 (3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e5.25 (3.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7.25 (2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8.00 (2.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8.75 (4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e9.50 (4.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8.71 (1.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e9.06 (3.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-defeating\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.17 (3.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.60 (3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e10.00 (5.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e13.29 (4.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.00 (4.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7.50 (4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.00 (5.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e11.54 (3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.50 (3.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.00 (4.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e13.29 (3.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.10 (4.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal negative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e21.83 (5.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e23.00 (5.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e19.75 (8.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e23.12 (6.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20.79 (7.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e12.75 (5.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e19.25 (7.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e19.54 (5.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e21.25 (7.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e21.50 (8.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22.00 (4.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e21.16 (6.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1: Individual humor type scores and positive/negative categorization compared by residency training specialty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Burnout component and total score by training specialty.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"126%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMed-Ped\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRad\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOBGYN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExhaustion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.43 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.07 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.33 (1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.16 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.03 (0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.00 (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.33 (0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.38 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.58 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.58 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.94 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3.17 (0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental distance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.37 (0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.37 (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.42 (1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.14 (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.29 (1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.25 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.42 (0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.46 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.17 (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.42 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.17 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.27 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive impairment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.17 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.33 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.67 (1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.25 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.64 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.17 (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.08 (0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.31 (0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.08 (0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.33 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.50 (0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.33 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional impairment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.85 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.63 (0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.67 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.84 (0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.82 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.75 (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.58 (0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.08 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.50 (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.08 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.67 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.86 (0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Burnout Score\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.45 (0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.35 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.77 (1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.35 (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.42 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.29 (0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1.85 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.56 (0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.08 (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.60 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.32 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2.41 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2: Individual Burnout Assessment Tool (BAT) component scores and overall BAT score compared by residency training specialty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"global-surgical-education-journal-of-the-association-for-surgical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"GSED","sideBox":"Learn more about [Global Surgical Education - Journal of the Association for Surgical Education](https://link.springer.com/journal/44186)","snPcode":"44186","submissionUrl":"https://www.editorialmanager.com/gsed/default1.aspx","title":"Global Surgical Education - Journal of the Association for Surgical Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8554720/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8554720/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Humor is crucial for stress management and team dynamics among medical professionals. While positive humor aids with stress coping, little is known about how humor styles evolve during residency or relate to burnout. This study examines the prevalence of four humor styles (affiliative, self-enhancing, aggressive, and self-defeating) among residents and correlation with burnout.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This study surveyed residents from eleven specialties at a single institution. In the first month of the academic year, residents completed surveys using the Short Work-related Humor Styles Questionnaire (Sw-HSQ) and Burnout Assessment Tool (BAT). Demographic data, specialty, and training level were collected. Descriptive analysis, Student’s t-test, and Pearson’s correlation were used to assess humor style prevalence, changes, and burnout associations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 107 residents completed the survey. No significant differences in humor styles or burnout scores were found by training year, preliminary status, or prior career experience. There was no correlation between age and humor style (p=0.24). Male residents had higher positive humor scores (p=0.002). Female residents had higher burnout scores (p=0.016). Residents with clinical training interruptions adopted more positive humor (p=0.01). Overall, there was a significant correlation between greater positive humor style use and lower burnout scores (r=-0.22, p=0.026).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study establishes a small but significant correlation between higher positive humor scores and lower burnout scores. Although these findings require validation in larger cohorts, preliminary findings offer insight into the protective effects of positive humor against burnout in general surgery training.\u003c/p\u003e","manuscriptTitle":"Trends in Resident Trainee Humor Styles and Burnout During Residency Training","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 08:14:49","doi":"10.21203/rs.3.rs-8554720/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-01-21T19:05:03+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-19T14:55:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Global Surgical Education - Journal of the Association for Surgical Education","date":"2026-01-17T06:43:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-12T07:19:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Global Surgical Education - Journal of the Association for Surgical Education","date":"2026-01-08T14:40:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"global-surgical-education-journal-of-the-association-for-surgical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"GSED","sideBox":"Learn more about [Global Surgical Education - Journal of the Association for Surgical Education](https://link.springer.com/journal/44186)","snPcode":"44186","submissionUrl":"https://www.editorialmanager.com/gsed/default1.aspx","title":"Global Surgical Education - Journal of the Association for Surgical Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e9076618-0cb5-4e76-98c4-5560505971a6","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T11:17:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 08:14:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8554720","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8554720","identity":"rs-8554720","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}