Ryan J Ellis1,2, D Brock Hewitt1,3, Yue-Yung Hu1, Julie K Johnson1, Ryan P Merkow1,2, Anthony D Yang1, John R Potts4, David B Hoyt2, Jo Buyske5, Karl Y Bilimoria1,2. 1. Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL. 2. American College of Surgeons, Chicago, IL. 3. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA. 4. Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL. 5. American Board of Surgery, Philadelphia, PA.
Abstract
OBJECTIVES: To empirically describe surgical residency program culture and assess program characteristics associated with program culture. SUMMARY BACKGROUND DATA: Despite concerns about the impact of the learning environment on trainees, empirical data have not been available to examine and compare program-level differences in residency culture. METHODS: Following the 2018 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. Survey items were analyzed using principal component analysis to derive composite measures of program culture. Associations between program characteristics and composite measures of culture were assessed. RESULTS: Analysis included 7387 residents at 260 training programs (99.3% response rate). Principal component analysis suggested that program culture may be described by 2 components: Wellness and Negative Exposures. Twenty-six programs (10.0%) were in the worst quartile for both Wellness and Negative Exposure components. These programs had significantly higher rates of duty hour violations (23.3% vs 11.1%), verbal/physical abuse (41.6% vs 28.6%), gender discrimination (78.7% vs 64.5%), sexual harassment (30.8% vs 16.7%), burnout (54.9% vs 35.0%), and thoughts of attrition (21.6% vs 10.8%; all P < 0.001). Being in the worst quartile of both components was associated with percentage of female residents in the program (P = 0.011), but not program location, academic affiliation, size, or faculty demographics. CONCLUSIONS: Residency culture was characterized by poor resident wellness and frequent negative exposures and was generally not associated with structural program characteristics. Additional qualitative and quantitative studies are needed to explore unmeasured local social dynamics that may underlie measured differences in program culture.
OBJECTIVES: To empirically describe surgical residency program culture and assess program characteristics associated with program culture. SUMMARY BACKGROUND DATA: Despite concerns about the impact of the learning environment on trainees, empirical data have not been available to examine and compare program-level differences in residency culture. METHODS: Following the 2018 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. Survey items were analyzed using principal component analysis to derive composite measures of program culture. Associations between program characteristics and composite measures of culture were assessed. RESULTS: Analysis included 7387 residents at 260 training programs (99.3% response rate). Principal component analysis suggested that program culture may be described by 2 components: Wellness and Negative Exposures. Twenty-six programs (10.0%) were in the worst quartile for both Wellness and Negative Exposure components. These programs had significantly higher rates of duty hour violations (23.3% vs 11.1%), verbal/physical abuse (41.6% vs 28.6%), gender discrimination (78.7% vs 64.5%), sexual harassment (30.8% vs 16.7%), burnout (54.9% vs 35.0%), and thoughts of attrition (21.6% vs 10.8%; all P < 0.001). Being in the worst quartile of both components was associated with percentage of female residents in the program (P = 0.011), but not program location, academic affiliation, size, or faculty demographics. CONCLUSIONS: Residency culture was characterized by poor resident wellness and frequent negative exposures and was generally not associated with structural program characteristics. Additional qualitative and quantitative studies are needed to explore unmeasured local social dynamics that may underlie measured differences in program culture.
Authors: Tait D Shanafelt; Charles M Balch; Gerald J Bechamps; Thomas Russell; Lotte Dyrbye; Daniel Satele; Paul Collicott; Paul J Novotny; Jeff Sloan; Julie A Freischlag Journal: Ann Surg Date: 2009-09 Impact factor: 12.969
Authors: Tait D Shanafelt; Charles M Balch; Lotte Dyrbye; Gerald Bechamps; Tom Russell; Daniel Satele; Teresa Rummans; Karen Swartz; Paul J Novotny; Jeff Sloan; Michael R Oreskovich Journal: Arch Surg Date: 2011-01
Authors: Karl Y Bilimoria; Christopher M Quinn; Allison R Dahlke; Rachel R Kelz; Judy A Shea; Ravi Rajaram; Remi Love; Lindsey Kreutzer; Thomas Biester; Anthony D Yang; David B Hoyt; Frank R Lewis Journal: J Am Coll Surg Date: 2016-11-21 Impact factor: 6.113
Authors: Manuel Castillo-Angeles; Ammara A Watkins; Danilo Acosta; Julia L Frydman; Lydia Flier; Alejandro Garces-Descovich; Michael J Cahalane; Sidharta P Gangadharan; Katharyn M Atkins; Tara S Kent Journal: Am J Surg Date: 2016-11-23 Impact factor: 2.565
Authors: Naif Fnais; Charlene Soobiah; Maggie Hong Chen; Erin Lillie; Laure Perrier; Mariam Tashkhandi; Sharon E Straus; Muhammad Mamdani; Mohammed Al-Omran; Andrea C Tricco Journal: Acad Med Date: 2014-05 Impact factor: 6.893
Authors: Karl Y Bilimoria; Jeanette W Chung; Larry V Hedges; Allison R Dahlke; Remi Love; Mark E Cohen; David B Hoyt; Anthony D Yang; John L Tarpley; John D Mellinger; David M Mahvi; Rachel R Kelz; Clifford Y Ko; David D Odell; Jonah J Stulberg; Frank R Lewis Journal: N Engl J Med Date: 2016-02-02 Impact factor: 91.245
Authors: Cary Jo R Schlick; Reiping Huang; Brian C Brajcich; Amy L Halverson; Anthony D Yang; Lindsey Kreutzer; Karl Y Bilimoria; Michael F McGee Journal: Dis Colon Rectum Date: 2022-07-05 Impact factor: 4.412
Authors: Lara Z Vanyo; Deepi G Goyal; Ramnik S Dhaliwal; Randy M Sorge; Lewis S Nelson; Michael S Beeson; Kevin B Joldersma; Jayram Pai; Earl J Reisdorff Journal: AEM Educ Train Date: 2020-10-11