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Silver CM, Yuce TK, Clarke CN, Schlick CJR, Khorfan R, Amortegui D, Nussbaum M, Turner PL, Bilimoria KY, Hu YY. Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness. JAMA Surg 2024; 159:687-695. [PMID: 38568609 PMCID: PMC10993162 DOI: 10.1001/jamasurg.2024.0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 04/06/2024]
Abstract
Importance Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. Objectives To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. Design, Setting, and Participants A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Exposure Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Main Outcomes and Measures Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. Results A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. Conclusions and Relevance One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.
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Affiliation(s)
- Casey M. Silver
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Tarik K. Yuce
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | | | - Cary Jo R. Schlick
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Rhami Khorfan
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | | | | | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
- American College of Surgeons, Chicago, Illinois
| | - Yue-Yung Hu
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Nasca BJ, Cheung EO, Eng JS, Zhang L, Smink DS, Greenberg JA, Bilimoria KY, Hu YY. National Comparison of Program Director Perceptions vs. Resident Reports of the Learning Environment and Well-Being. JOURNAL OF SURGICAL EDUCATION 2023; 80:72-80. [PMID: 36207254 DOI: 10.1016/j.jsurg.2022.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Our research objectives were to (1) assess the correlation between PD perceptions and their residents' reported experiences and (2) identify PD and program characteristics associated with alignment between PD perceptions and their residents' reports. DESIGN, SETTING, PARTICIPANTS A survey was administered to US general surgery residents following the 2019 American Board of Surgery In-Training Examination (ABSITE) to study wellness (burnout, thoughts of attrition, and suicidality) and mistreatment (gender discrimination, sexual harassment, racial/ethnic/religious discrimination, bullying). General surgery program directors (PDs) were surveyed about the degree to which they perceived mistreatment and wellness within their programs. Concordance between PDs' perceptions and their residents' reports was assessed using Spearman correlations. Multivariable logistic regression models examined factors associated with alignment between PDs and residents. RESULTS Of 6,126 residents training at SECOND Trial-enrolled programs, 5,240 (85.5%) responded to the ABSITE survey. All 212 PDs of programs enrolled in the SECOND Trial (100%) responded to the PD survey. Nationally, the proportion of PDs perceiving wellness issues was similar to the proportion of residents reporting them (e.g., 54.9% of PDs perceive that burnout is a problem vs. 40.1% of residents experience at least one burnout symptom weekly); however, the proportion of PDs perceiving mistreatment vastly underestimated the proportion of residents reporting it (e.g., 9.3% of all PDs perceive vs. 65.9% of all residents report bullying). Correlations between PDs' perceptions of problems within their program and their residents' reports were weak for racial/ethnic/religious discrimination (r = 0.176, p = 0.019), sexual harassment (r = 0.180, p = 0.019), burnout (r = 0.198, p = 0.007), and thoughts of attrition (r = 0.193, p = 0.007), and non-existent for gender discrimination, bullying, or suicidality. Multivariable regression models did not identify any program or PD characteristics that were consistently associated with improved resident-program director alignment. CONCLUSIONS Resident and PD perceptions were generally disparate regarding mistreatment, burnout, thoughts of attrition, and suicidality. Reconciling this discrepancy is critical to enacting meaningful change to improve the learning environment and resident well-being.
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Affiliation(s)
- Brian J Nasca
- Albany Medical College, Department of Surgery, Albany, New York; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elaine O Cheung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana
| | - Lindsey Zhang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacob A Greenberg
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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