Perception of Shared Learning Environment Differs Between Vascular Surgery and General Surgery Residents

INTRODUCTION:An enriching learning environment is integral to resident wellness and education. Integrated vascular (VS) and general surgery (GS) residents share 18 months of core general surgery rotations during the post graduate year (PGY) 1-3 years; differences in their experiences may help identify practical levers for change. METHODS:We used a convergent mixed-methods design. Cross-sectional surveys were administered after the 2020 ABSITE and VSITE, assessing eight domains of the learning environment and resident wellness. Multivariable logistic regression models identified factors associated with thoughts of attrition between categorical PGY1-3 residents at 57 institutions with both GS and VS of programs. Resident focus groups were conducted during the 2022 Vascular Annual Meeting to elicit more granular details about the experience of the learning environment. Transcripts were analyzed using inductive and deductive logics until thematic saturation was achieved. RESULTS:Surveys were completed by 205 VS and 1198 GS PGY1-3 residents (response rates 76.8% VS, 82.5% GS). After adjusting for resident demographics, PGY level, and program type, GS residents were more likely than their VS peers to consider leaving their programs (OR 2.61, 95% CI 1.37-4.99). This finding did not persist after adjusting for differences in perceptions of the learning environment, specifically: GS residents had higher odds of Mistreatment (OR 1.99, 95% CI 1.36-2.90), poorer Work-Life Integration (OR 2.88, 95% CI 1.41-5.87), less Resident Camaraderie (OR 3.51, 95% CI 2.26-5.45), and decreased Meaning in Work (OR 2.94, 95% CI 1.80-4.83). Qualitative data provided insight into how the shared learning environment was perceived differently: (1) vascular trainees expressed that early specialization and a smaller, more invested faculty allows for an apprenticeship model with early operative exposure, hands-on guidance, frequent feedback, and thus early skill acquisition (Meaning in Work); (2) a smaller program is conducive to closer relationships with co-residents and faculty, increasing familiarity (Camaraderie, Work-Life Integration); (3) due to increased familiarity with program leadership, vascular trainees feel more comfortable reporting mistreatment, allowing for prompt responses (Mistreatment). CONCLUSIONS:Despite sharing a learning environment, VS and GS residents experience training differently, contributing to differential thoughts of attrition. These differences may be attributable to intrinsic features of the integrated training paradigm that are not easily replicated by GS programs, such as smaller program size and higher faculty investment due to early specialization. Alternative strategies to compensate for these inherent differences should be considered (e.g. structured operative entrustment programs, faculty incentivization).