Can the Culture of Surgical Residency Be Measured? An Empirical National Assessment of the Learning Environment
Ryan J. Ellis*1, D. Brock Hewitt*1, Yue-Yung Hu*1, Shelby Parilla*1, Julie Johnson*1, Ryan P. Merkow*1, Anthony D. Yang*1, David B Hoyt2, Jo Buyske3, Karl Y Bilimoria1
1Northwestern University, Chicago, IL;2American College of Surgeons, Chicago, IL;3American Board of Surgery, Philadelphia, PA
OBJECTIVE(S): Concerns persist about the impact of resident wellbeing (burnout, duty hour violations) and mistreatment (harassment, verbal abuse) on residency culture and the learning environment. However, empirical data have not been available to examine and compare national program-level differences in residency culture. Our objectives were (1) to empirically compare program-level surgical residency culture and (2) to assess program characteristics associated with poor program culture.
METHODS: Following the 2018 American Board of Surgery In-Training Examination, a cross-sectional national survey was administered to all U.S. general surgery residents. Program-level culture was analyzed using principal component analysis which allowed a combined assessment of duty hour violations, burnout, thoughts of attrition, sexual harassment, and verbal abuse.
RESULTS: Surveys were completed by 7,391 residents at 260 training programs (99.3% response rate). Twenty-five programs (9.6%) were identified by principal component analysis as having poor culture. These programs had significantly higher rates of duty hour violations (24.6% vs 11.9%), burnout (20.2% vs 12.1%), thoughts of attrition (20.7% vs 12.0%), sexual harassment (34.2% vs 18.2%), and verbal abuse (43.0% vs 27.5%; all P<0.001). Poor culture was not associated with program type (academic vs non-academic, P=0.317), size (P=0.389), location (P=0.234), program director demographics (P=0.632), department chair demographics (P=0.340), or faculty demographic composition (P=0.179).
CONCLUSIONS: Poor culture was characterized by resident mistreatment, duty hour violations, and poor resident wellness/burnout. However, poor culture was not associated with program characteristics. Poor environments are likely driven by local culture, and targeted interventions, as planned in the upcoming SECOND Trial, may improve trainee wellness.
* By Invitation
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