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. Second, programs lack access to readily available strategies to make improvements.
The SECOND Trial will be a prospective, pragmatic cluster-randomized trial examining how we can improve the learning environment and well-being of residents. All programs will receive a Program Specific Report of their residents' well-being metrics. Intervention programs will also receive:
The Program-Specific Report will provide each program, both control and intervention arms, with
data on its residents' well-being (i.e., burnout, thoughts of attrition, and suicidal thoughts),
benchmarked against other programs in the country.
Program-Specific Reports will be provided as quartiles (e.g., for burnout, your program ranks in the fourth (worst) quartile of programs in the country).
Learning Environment Report
The Learning Environment Report will provide intervention programs with their performance
on various metrics about the learning environment, benchmarked against other programs in the country.
These metrics are currently under development.
Once intervention programs have decided what areas to focus on, they may choose from a variety of potential interventions in the Wellness Toolkit, other sources, or develop their own interventions. Potential interventions in the toolkit will be developed from lessons learned during Program Tours, from available literature, and from best practice guidelines. Programs have complete autonomy to decide what, if any, interventions to implement and how they implement them. Programs will have to do some tailoring of the interventions in the toolkit to adapt to their specific local environment and needs.
We will provide Implementation Support to help programs tailor the interventions they have selected within their local environments. Implementation Support may include coaching calls, establishment of topic-specific learning collaboratives, and in-person meetings.