“We were excited that more than 200 hospitals from across the country joined us in the SECOND Trial to leverage quality improvement approaches to reduce physician burnout and mistreatment (discrimination, harassment, and bullying). We hope that this data-driven approach coupled with tools to support improvement will result in a meaningful improvement!”

- Yue-yung Hu, MD and Karl Bilimoria, MD

dr. hu dr. bilimoria

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 had 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 lacked access to readily available strategies to make improvements. This study was designed to address these two main issues.

The SECOND Trial is a national prospective, pragmatic cluster-randomized trial that seeks to improve the learning environment, and resident well-being.

In fall of 2019, programs were randomized to control vs. intervention. Programs randomized to control are given an annual program-specific report on their residents’ burnout, thoughts of attrition, suicidal ideation, benchmarked against other programs in the country, as well as access to protocols for addressing suicide. Programs randomized to intervention receive a Learning Environment and Resident Well-Being Report detailing their performance in eight domains, described by our Surgical Resident Well-Being Conceptual Model.

Intervention programs also receive access to our interactive Wellness Toolkit along with implementation support to facilitate their efforts on improving the learning environment and well-being of their residents. Our Wellness Toolkit incorporates data from the literature, best practice guidelines, advice from wellness experts, and lessons learned from visiting surgical residency programs across the country. To date, 212 general surgery programs are enrolled.

If you are interested in learning more about the project, please reach out to our team at SENTteam@iu.edu

Learn More


NEJM Paper
AAS Presidential Address

Dr. Bilimoria examines resident burnout in this keynote lecture

summary image
SECOND Trial Fact Sheet