SECOND Trial: Resident Well-Being

Resident well-being remains a persistent, concerning issue. Throughout the course of residency, trainees are subject to significant stressors, including heavy workloads, adverse events, an increasingly complex body of knowledge to master, and limited time with family/support structures. Subject to a power differential, they also are susceptible to mistreatment, such as discrimination, harassment, and abuse. This combination of stressors and/or mistreatment result in potentially toxic learning environments that negatively impact resident well-being, leading to adverse outcomes such as burnout, attrition, and suicide. While the issue of poor well-being is well-recognized, residency programs lack granular, comparative data about the specific weaknesses in their learning environments. Moreover, programs do not have access to specific interventions to improve the learning environment, while ensuring adequate training. Through a six-year partnership and funding from the Accreditation Council Graduate Medical Education (ACGME), the American College of Surgeons (ACS), and the American Board of Surgery (ABS), our team created the largest consortium of general surgery programs in the country in order to conduct the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) Trial. This work resulted in numerous high profile publications and spurred the ACGME’s national policy change in resident training across all specialties through the 2017 Common Program Requirements revisions.

To transform the learning environment in general surgery residency, we will again partner with the ACGME, ACS, and ABS, along with the Association of Program Directors in Surgery (APDS) and Society of Surgical Chairs (SSC) to conduct the national Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial. The SECOND Trial is another national, pragmatic, cluster-randomized trial that will randomize the 312 eligible surgical residency programs to “Control” vs. “Intervention” to improve the learning environment and promote resident well-being, leveraging our experience with large-scale improvement initiatives. All programs will receive a Program-Specific Report, containing nationally benchmarked data on a program’s residents’ well-being (e.g., resident-reported burnout rate, suicidal thoughts). Intervention Programs will also have access to (1) additional data on their learning environments, (2) a Wellness Toolkit of ready-to-implement interventions (developed from published best practices, and extensive site visits/observations of surgical programs, IRB approval #STU00208859), (3) implementation support, consisting of process improvement coaching, collaboration networking (i.e., for programs working on similar issues), and topical experts.

Aim: Hypothesis 1a: A pragmatic cluster-randomized trial will demonstrate that access to personalized, nationally-benchmarked data on the learning environment (e.g., program level rates of mistreatment) and resident well-being (e.g., program-level rates of burnout), along with an array of ready-to-implement interventions and implementation assistance, will measurably improve residency culture and wellness. Hypothesis 1b: Improving resident well-being will not negatively impact the quality of resident training (e.g., exam scores, operative experience, technical skills).