Search

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 p0.001). 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.

As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs.Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus.During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.

Burnout among general surgery residents is prevalent. Guidance on how program directors (PDs) can effectively intervene on general surgery resident wellness is lacking. In this study, we explore how PDs learn about burnout among their residents and support their well-being.Semi-structured interviews were conducted with PDs. Interviews were transcribed and coded by study team dyads who utilized an inductive coding approach, and then reconciled via consensus. Interpretive description was the qualitative analytical method.Program tours to 15 general surgery programs during the exploratory phase of the SECOND Trial.Fifteen general surgery PDs.PDs identified the utility of contextual information in understanding resident wellness and implementing program-specific resident wellness initiatives. Three themes relating to PD awareness of resident burnout and well-being were identified: (1) PDs used conventional and novel methods to collect data from multiple information sources, including residents, faculty, staff, institutional representatives, and anonymous parties. (2) These contextualized data inspired the development of responsive strategies to effect programmatic changes that improved education and wellness. (3) Barriers to acquiring and utilizing information exist, requiring careful analysis, creative problem solving, as well as persistence and dedication to resident wellness.Qualitative analysis of general surgery residency PDs yielded insightful knowledge about gathering and responding to information to support resident wellness, including successful strategies and areas of caution. The experience of these PDs can guide others in evaluating their wellness goals and initiatives for their own residents.

IMPORTANCE: Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored. OBJECTIVE: To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers. DESIGN, SETTING, AND PARTICIPANTS: A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education–accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination. MAIN OUTCOMES AND MEASURES: Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity. RESULTS: A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P

Background Despite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. Objective This study assessed barriers and facilitators to HKTP implementation preparation. Methods Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. Results Forty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders' focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients' transplant education needs. Implementation barriers included: stakeholders' perceptions that Hispanics' health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. Discussion and conclusions Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations' implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.

Introduction: Because apolipoprotein L1 ( APOL1) risk variants may contribute to live donors’ kidney failure postdonation, professional guidelines suggest informing potential donors with African ancestry about the availability of APOL1 genotyping. This study assessed African American (AA) donors’ perceptions of APOL1 genetic testing and how APOL1 may affect ethnic identity. Methods/Approach: Four focus groups were conducted with AA donors about their decision-making for and perceptions of APOL1 genetic testing and donation to inform a new culturally targeted educational brochure on APOL1 genetic testing. Qualitative data were analyzed by thematic analysis. Findings: Seventeen donors participated (47% participation rate). Four major themes emerged. (1) In hypothetical scenarios, most participants would have undergone APOL1 testing during donor evaluation to make a more informed decision, but many would have still donated. (2) Participants desired information about how having 2 APOL1 risk variants affects the donor’s and the recipient’s health. (3) Participants referred to diversity of genetic ancestry and cultural constructions of racial/ethnic identity to question the population at risk for APOL1 risk variants and recommended that all potential donors undergo genetic testing and receive education about APOL1. (4) Participants worried that out-of-pocket costs would deter APOL1 testing and that APOL1 could become a preexisting condition and discriminate against AAs. Discussion: Our findings suggest that AA donors desire APOL1 testing to foster informed consent. Transplant clinicians should be aware of these responses to APOL1 testing and be sensitive to historical issues of distrust and discrimination.