The SECOND Trial

Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial

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AAS Presidential Address

Well-being continues to be a pressing issue in surgical training. In the Flexibility in duty-hour Requirements for Surgical Trainees (FIRST) Trial we found that 39% of U.S. general surgery residents experienced weekly burnout symptoms and that numerous aspects of the learning environment, not just duty hour issues, drive poor well-being.

Through numerous interviews and focus groups with residents, Program Directors, surgical faculty, wellness experts, and many others, we identified two main issues. First, programs have no data about their performance on these issues compared to others in the country. Thus, programs are uncertain where to focus their efforts to improve well-being. Second, programs lack access to readily available strategies to make improvements.

The SECOND Trial will begin with a national mixed-methods analysis to examine a variety of programs with respect to the learning environment and resident wellness. Along with information from the literature, best practice guidelines, wellness experts, and lessons learned from examining surgical residency programs will be incorporated into a multidimensional Wellness Toolkit that programs can use to identify potential initiatives to improve resident well-being.

The SECOND Trial is a national prospective, pragmatic cluster-randomized trial in which programs will be given a confidential program-specific report of their performance data (e.g., burnout rate) compared to other programs in the country. Programs will then be randomized to a control arm vs. intervention arm. Programs randomized to the intervention arm will receive the Wellness Toolkit along with implementation support to determine how best to improve the learning environment and resident well-being.

All 320 surgical residency programs are eligible to enroll. If you have questions, please contact us at

Overview of the SECOND Trial
Brief PowerPoint explaining SECOND Trial