Most general surgery residents are stressed by their work environments, a Yale study found.
In what researchers say is likely the largest study of its kind, general surgery residents indicated a distinct lack of satisfaction with more intangible aspects of their experiences as residents, such as poor support systems and anxieties about their financial prospects, despite an 85.2 percent approval rating of their programs.
The study, which was conducted by 10 researchers from the Yale School of Public Health and the Yale School of Medicine, also found younger postgraduates were more likely to have considered leaving their programs than more senior counterparts were, and women expressed more concern about feeling supported than men did. The results were based on a survey of over 4,000 general surgery residents from 248 out of 249 residencies in the nation, and were published in the latest issue of the Journal of the American Medical Association.
Heather Yeo, lead author of the study and surgical resident in her fourth year, embarked on a study about the quality of life and satisfaction of surgery residents after interviewing residents who she knew were qualified and enthusiastic about surgery but had abandoned their residency programs.
Yeo initially hypothesized that medical students were unaware of the intensity of general surgery residencies before applying, but found that this was incorrect. Instead, Yeo said her interviews showed residents were, for the most part, aware of the demanding nature of surgery residencies but simply found them frustrating.
General surgery residencies truly are “this incredible boot camp,” said Leslie Curry, one of the senior authors on the study and a researcher at the School of Public Health.
“They’re worried about hurting their patients; they’re hesitant to ask for help from colleagues,” she said, citing the grievances residents referenced in interviews. “There is this sort of vulnerable subgroup that feels strained by the demands of training.”
Yeo, for instance, said the program’s grueling pace means she often runs on 1 to 2 hours of sleep a night during the week.
Tobias Carling, assistant professor of surgery at Yale, said the results could be taken as representative of general opinion among the surgical community. The study, he said, was well-conducted and had an impressively high response rate of ,82.4 percent.
Carling attributed the intensity of the residency to its requirements of both retaining a breadth of information and refining complex operating techniques. But Robert Bell, assistant professor of surgery, suggested that this degree of stress “comes with the profession.” “If you’re not stressed, maybe you’re simply too detached as a caregiver,” he said.
Yeo’s personal conclusion is that mentorship programs and creating a community-oriented environment within a residency program can make a big difference. Kurt Roberts, assistant professor of surgery, agreed that mentorship matters.
“Making residents comfortable depends a lot on how the attending [physician] behaves in the operating room,” he said. “It’s about trying to make somebody comfortable to perform to their maximum ability versus trying to make somebody anxious and beating on them.”
In reference to the study’s distinctly gendered results, Yeo said, as a mother, she did not feel singled out in her program, where three out of the five postgraduates are women with their own children.
But Bell said woman residents with children tend to serve double-duty, by having to take on both professional and domestic roles.
“It’s harder for women,” he said, of the residency experience. “You’re always the mom.”
Still, recent reforms have made the quality of life for residents better than it used to be, Roberts, who did his residency at Johns Hopkins starting in 2000, said. He said he recalls working 100 to 120 hours a week, with only one day off. While residents generally work up to 12 hours straight at a time, Roberts said the longest he worked was 60 hours straight.
But Yale surgeons say the University has a reputation for having one of the more welcoming surgical residency programs. From creating places for residents to nurse their babies to encouraging town hall meetings for residents to voice their concerns away from the faculty, Yale is “very supportive,” Yeo said.
Bell called it one of the “kindest, gentlest programs,” and Carling, who trained at Yale before taking a job, said there is a unique sense of “camaraderie” in New Haven.
Yeo, a recipient of the Robert Wood Johnson Clinical Foundation scholarship, said the research was aimed at the “betterment of medicine.”
Curry said she hopes this study will help change the way medicine is run.
“The premise is to develop physicians who have [an] awareness of policy implications of clinical research,” she said of Yeo’s scholarship. The whole … philosophy is about making a change.”