Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois.
J Surg Educ. 2022 Nov-Dec;79(6):e1-e11. doi: 10.1016/j.jsurg.2022.05.004. Epub 2022 Jun 2.
Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors.
We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved.
Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n = 3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities.
Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.
住院医师倦怠在普通外科中非常普遍。倦怠越来越被认为是工作场所缺乏支持的症状。本研究的目的是描述住院医师对项目响应能力的看法，并确定相关因素。
我们使用了一种收敛性混合方法设计。在美国普通外科住院医师完成 2020 年 ABSITE 后，对所有住院医师进行了横断面调查，询问他们对学习环境（包括项目响应能力）、倦怠、离职和自杀想法以及职业满意度的看法。调整项目/住院医师特征的多变量逻辑回归模型评估了项目响应能力与学习环境和住院医师健康相关方面的关联。在对 15 个住院医师培训计划进行现场访问期间，对住院医师和教师进行了 366 次访谈和 27 次焦点小组讨论。使用归纳和演绎逻辑对转录本进行主题分析，直到达到主题饱和。
在完成调查的 323 个项目的 7233 名临床活跃住院医师中（85.5%的应答率），5256 名住院医师有所有感兴趣结局的可用数据。72.1%（n=3791）报告对项目响应能力感到满意。与报告 80 小时工作周违规（优势比[OR]0.22，95%置信区间[CI]0.18-0.26）、倦怠（OR 0.47，95%CI 0.41-0.53）、离职想法（OR 0.32，95%CI 0.27-0.38）和自杀念头（OR 0.52，95%CI 0.41-0.65）的住院医师相比，这些住院医师的可能性明显更低。他们对职业选择、个人生活和工作生活平衡的满意度明显更高（均 p<0.001）。与提高项目响应能力的看法相关的因素包括较大的项目规模（50+ vs. <23 名住院医师；OR 1.48，95%CI 1.01-2.19）、有教师指导（OR 2.64，95%CI 2.22-3.14）、对呼叫和休假安排有有意义的投入（OR 3.31，95%CI 2.74-4.00）和敢于直言（OR 4.20，95%CI 3.47-5.09）。我们进行了定性分析，以确定项目响应能力的以下组成部分：（1）核心价值观反映了居民在塑造培训经验和项目方面的声音的重要性的共同理解，包括居民和教师之间的相互信任和尊重、透明度和沟通、居民团结以及居民参与和拥有项目改进；（2）反映和支持响应能力的结构构建；（3）支持居民代理的机制，包括资源和领导力支持、教师倡导以及居民领导机会。
外科住院医师培训中的项目响应能力与改善住院医师健康状况有关。各机构应制定正式渠道来收集和具体解决住院医师的关切问题，为住院医师提供代表机会，并赋予住院医师灵活性和自主权，以做出支持自己教育和健康的决策。
