A. R. Dahlke1, J. K. Johnson1,3, C. C. Greenberg4, R. Love1, L. Kreutzer1, D. B. Hewitt1,5, C. M. Quinn1, K. Engelhardt1,6, K. Y. Bilimoria1,2 1Northwestern University- Feinberg School Of Medicine, Surgical Outcomes And Quality Improvement Center (SOQIC),Department Of Surgery,Chicago, IL, USA 2American College Of Surgeons,Chicago, IL, USA 3Northwestern University-Feinberg School Of Medicine,Center For Healthcare Studies In The Institute For Public Health And Medicine,Chicago, IL, USA 4Wisconsin Surgical Outcomes Research (WiSOR) Program,Department Of Surgery,Madison, WI, USA 5Thomas Jefferson University Hospital,Department Of Surgery,Philadelphia, PA, USA 6Medical University Of South Carolina,Department Of Surgery,Charleston, SC, USA
Introduction: As the number of women in surgical residency programs continues to increase, there is a growing recognition that women and men may enter, experience, and even leave residency programs differently. Recent studies have shown that up to 65% of surgical residents experience some amount of burnout and challenges to their wellbeing. Our objective is to (1) assess differences in how male and female general surgery residents utilize duty hour regulations and experience burnout and psychological wellbeing and (2) examine reasons why women and men may have differing experiences with duty hours, aspects of burnout, and issues with psychological wellbeing.
Methods: 7,395 surgical residents completed a survey (99% response rate) regarding how often and why they exceeded 2011 standard duty hour limits, as well as about aspects of burnout and psychological wellbeing. Hierarchical logistic regression models were developed to examine the association between gender and each of the resident outcomes. 98 semi-structured interviews were completed with 42 faculty and 56 residents. Transcripts were analyzed thematically using a constant comparative approach.
Results: Female residents reported more frequently staying in the hospital >28 hours or violating the 80 hour work week maximum ≥3 times in a month, as well as more frequently feeling fatigued and burned out from their work (P<0.001). Females also reported less frequently treating patients as “impersonal objects” or “not caring” what happens to patients (P<0.001). Women reported more often: losing sleep due to worry, being unable to make decisions, feeling constantly under strain, being unable to overcome difficulties, feeling unhappy or depressed, feeling a loss of self-confidence, or thinking of themselves as worthless (P<0.01). In adjusted analyses, all associations remained significant. Themes identified in the qualitative analysis as possible contributory factors to gender differences in residency include: lack of mentorship/leadership roles by women surgeons, dual role responsibilities (surgeon and family), the inability of co-workers to understand gender differences (gender blindness), and gender-based differences regarding pressures and challenges, as well as in approaches to patient care.
Conclusion: Our study found that women report working extended shifts more often than men and experience worse contributing factors to burnout and poor psychological wellbeing. This mixed-methods study adds to the existing literature on resident wellbeing, and calls for a closer look into how gender schemas drive the differences in the way male and female surgeons work, behave, and ultimately cope during residency. Focusing future research on the differences in how women and men navigate residency and their social, emotional, and mentoring needs may help us develop policy recommendations as well as specific programmatic or cultural interventions.