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A National Survey

Heather Yeo, MD, MHSR; Kate Viola, MD; David Berg, PhD; Zhenqiu Lin, PhD; Marcella Nunez-Smith, MD, MS; Cortland Cammann, PhD; Richard H. Bell Jr, MD; Julie Ann Sosa, MD, MA; Harlan M. Krumholz, MD, SM; Leslie A. Curry, PhD, MPH

JAMA. 2009;302(12):1301-1308.

Context  General surgery residency programs are facing multiple pressures, including attracting and retaining residents. Despite the importance of resident perspectives in designing effective responses to these pressures, understanding of residents' views is limited.

Objective  To profile US general surgery residents; characterize resident attitudes, experiences, and expectations regarding training; and examine differences by sex and training year.

Design, Setting, and Participants  Cross-sectional study of all general surgery residents completing a survey in January 2008 following administration of the American Board of Surgery In-Training Examination.

Main Outcome Measures  Resident satisfaction; perceived supports, strains and concern; career motivations; and professional expectations.

Results  Of 5345 categorical general surgery residents, 4402 (82.4%) responded, representing 248 of 249 surgical residency programs. Most respondents expressed satisfaction with training (3686 [85.2%]; 95% confidence interval [CI], 84.1%-86.3%) and supportive peer relationships (3433 [84.2%]; 95% CI, 83.1%-85.3%). However, residents also reported unmet needs and apprehensions about training and careers. Worry that they will not feel confident performing procedures independently was reported by 1185 (27.5%; 95% CI, 26.2%-28.8%), while 2681 (63.8%; 95% CI, 62.4%-65.3%) reported that they must complete specialty training to be competitive. Perceptions of program support differ, with men more likely than women to report that their program provides support (2188 [74.5%] vs 895 [65.6%]; P < .001), and that they can turn to faculty when having difficulties (2193 [74.5%] vs 901 [66.4%]; P < .001). Reports of having considered leaving training in the prior year differed significantly across years (P < .001), highest in postgraduate year 2 (19.2%) and lowest in postgraduate year 5 (7.2%).

Conclusions  General surgery residents' attitudes, experiences, and expectations regarding training reflect both high levels of satisfaction and sources of strain. These factors vary by sex and training year.

Author Affiliations: Division of Surgery (Dr Yeo); Robert Wood Johnson Clinical Scholars Program (Drs Viola, Nunez-Smith, Krumholz, and Curry); Section of General Internal Medicine (Dr Nunez-Smith); Divisions of Endocrine Surgery and Surgical Oncology (Dr Sosa); Section of Cardiovascular Medicine (Dr Krumholz); Division of Health Policy and Administration, School of Public Health (Dr Curry); Department of Psychiatry (Dr Berg), Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krumholz and Lin); Capella University, Minneapolis, Minnesota (Dr Cammann); and American Board of Surgery Inc, Philadelphia, Pennsylvania (Dr Bell).

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