The General Surgery Residency Experience: A Multicenter Study of Differences in Wellbeing by Race/Ethnicity

Anya L Greenberg; Jenny R Cevallos; Feyisayo M Ojute; Denise L Davis; Wendy R Greene; Carter C Lebares

doi:10.1097/AS9.0000000000000187

The General Surgery Residency Experience: A Multicenter Study of Differences in Wellbeing by Race/Ethnicity

Ann Surg Open. 2022 Jul 18;3(3):e187. doi: 10.1097/AS9.0000000000000187. eCollection 2022 Sep.

Authors

Anya L Greenberg¹, Jenny R Cevallos¹, Feyisayo M Ojute¹, Denise L Davis², Wendy R Greene³, Carter C Lebares¹

Affiliations

¹ From the Department of Surgery, University of California San Francisco, San Francisco, CA.
² Department of Medicine, University of California San Francisco, San Francisco, CA.
³ Department of Surgery, Emory University College of Medicine, Atlanta, GA.

Abstract

Objectives: We explored differences by race/ethnicity in regard to several factors that reflect or impact wellbeing.

Background: Physician wellbeing has critical ramifications for the US healthcare system, affecting clinical outcomes, patient experience, and healthcare economics. Within surgery, literature examining the association between race/ethnicity and wellbeing has been limited and inconclusive.

Methods: Residents at 16 academic General Surgery training programs completed an online questionnaire. Racial/ethnic identity, gender identity, post-graduate year (PGY) level, and gap years were self-reported. Differences by race/ethnicity in flourishing (global wellbeing) as well as factors reflecting resilience (mindfulness, personal accomplishment, workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, stress, anxiety, workplace demand) were assessed.

Results: Of 300 respondents (response rate 34%), 179 (60%) were non-male, 123 (41%) were residents of color (ROC), and 53 (18%) were from racial/ethnic groups that are underrepresented in medicine (UIM). Relative to White residents, ROC have significantly lower flourishing and higher anxiety, and these remain significant when adjusting for gender, PGY level, and gap years. Relative to residents overrepresented in medicine (OIM), UIM residents have significantly lower emotional exhaustion and depersonalization after adjusting for gender, PGY level and gap years.

Conclusions: Disparities in resident wellbeing based on race/ethnicity and UIM/OIM status exist. However, the experience of ROC is not homogeneous. As part of the transformative process to address systemic racism, eliminate disparities in surgical training, and reconceptualize wellbeing as a fundamental asset for optimal surgeon performance, further understanding the specific contributors and detractors of wellbeing among different individuals and groups is critical.

Keywords: differences in wellbeing by race/ethnicity; distress; flourishing; job strain; mindfulness for surgeons; surgical education; surgical resident wellbeing.