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. Second, programs lacked access to readily available strategies to make improvements.
The SECOND Trial is a prospective, pragmatic cluster-randomized trial examining how we can improve the learning environment and well-being of residents. All programs receive a Program Specific Report of their residents' well-being metrics. Additionally, intervention arm programs also receive:
The Program-Specific Report provides 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 are provided as quartiles (e.g., for burnout, your program ranks in the fourth (worst) quartile of programs in the country).
Control Arm: Program Specific Report
Well-Being & Learning Environment Report
The Well-Being and Learning Environment Report provides intervention arm programs with their performance on various metrics about the learning environment, benchmarked against other programs in the country. These metrics are described in our Surgical Resident Well-Being Conceptual Model.1
Intervention Arm: Well-Being & Learning Environment Report
Surgical Resident Well-Being Conceptual Model
With data from their Reports, programs are able to decide what areas to focus on and choose from a variety of potential interventions from the Wellness Toolkit (or from other sources, or develop their own interventions). Interventions in the toolkit were 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 often tailor the interventions from the Toolkit to adapt to their specific local environment and needs.
We provide Implementation Support to help programs tailor the interventions they have selected within their local environments. Implementation Support includes expert led webinars and conferences, office hours to review personalized data and potential interventions with our PIs/team, and topic-specific learning collaborative.