Abstract：
OBJECTIVE: To provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training.
UNASSIGNED: General surgery (GS) interns are at highest risk for burnout and attrition. Maslach frames burnout as resulting from a mismatch between workplace expectations and reality. Occupational science demonstrates workplace demand, control, and support (DCS) as strong influencers of job strain. GS interns\' realistic expectations of demands are associated with decreased likelihood of attrition, but their expectations regarding this factor are poorly understood.
METHODS: Semi-structured interviews were conducted with 14 incoming surgical residents at UCSF: University of California, San Francisco (57% women, 71% non-White), exploring expectations regarding workplace DCS. Transcripts were uploaded to analytic software and coded in dyads using an iterative approach to consensus. Transcripts were thematically analyzed using inductive and deductive reasoning, applying job-demand-resource theory frameworks, and following a published 6-step approach.
RESULTS: Four main themes emerged: past experiences, expected rewards, anticipated challenges, and the desire to belong. Past experiences describes the expectation to successfully cope with future stressors via self-reliance. Rewards such as professional mastery, personal growth, and sense of meaning were expected outcomes seen as balancing anticipated challenges. Anticipated challenges included low control, toxic cultural elements, and discrimination. Desire to belong (i.e., earned recognition as a peer, inclusion in an elite culture) emerged as a powerful motivator, with survival connotations for women and non-Whites.
CONCLUSIONS: Our results suggest incoming interns overestimate the efficacy of self-reliance for coping; count on specific rewards; express realistic expectations regarding challenges; and see inclusion among surgeons as an aspiration that off-sets prolonged effort. Further study is warranted to understand expectation-reality mismatch and potential interventions to target dissonance.
CONCLUSIONS: In this institutional study of general surgery interns, we provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training, and how we might target \"expectations-reality\" mismatch and the \"desire to belong\" as a means of mitigating burnout and minimizing attrition from training.
UNASSIGNED: General surgery (GS) interns are at highest risk for burnout and attrition. Maslach frames burnout as resulting from a mismatch between workplace expectations and reality. Occupational science demonstrates workplace demand, control, and support (DCS) as strong influencers of job strain. GS interns\' realistic expectations of demands are associated with decreased likelihood of attrition, but their expectations regarding this factor are poorly understood.
METHODS: Semi-structured interviews were conducted with 14 incoming surgical residents at UCSF: University of California, San Francisco (57% women, 71% non-White), exploring expectations regarding workplace DCS. Transcripts were uploaded to analytic software and coded in dyads using an iterative approach to consensus. Transcripts were thematically analyzed using inductive and deductive reasoning, applying job-demand-resource theory frameworks, and following a published 6-step approach.
RESULTS: Four main themes emerged: past experiences, expected rewards, anticipated challenges, and the desire to belong. Past experiences describes the expectation to successfully cope with future stressors via self-reliance. Rewards such as professional mastery, personal growth, and sense of meaning were expected outcomes seen as balancing anticipated challenges. Anticipated challenges included low control, toxic cultural elements, and discrimination. Desire to belong (i.e., earned recognition as a peer, inclusion in an elite culture) emerged as a powerful motivator, with survival connotations for women and non-Whites.
CONCLUSIONS: Our results suggest incoming interns overestimate the efficacy of self-reliance for coping; count on specific rewards; express realistic expectations regarding challenges; and see inclusion among surgeons as an aspiration that off-sets prolonged effort. Further study is warranted to understand expectation-reality mismatch and potential interventions to target dissonance.
CONCLUSIONS: In this institutional study of general surgery interns, we provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training, and how we might target \"expectations-reality\" mismatch and the \"desire to belong\" as a means of mitigating burnout and minimizing attrition from training.
摘要：
目的：为了更细致地了解普外科实习生对工作场所需求的期望，control,在开始培训之前提供支持。
■普外科（GS）实习生的倦怠和减员风险最高。Maslach将职业倦怠归因于工作场所期望与现实之间的不匹配。职业科学证明了工作场所的需求，control,和支持(DCS)作为工作压力的强大影响者。GS实习生对需求的现实期望与减员可能性的降低有关，但是他们对这个因素的期望却知之甚少。
方法：对加州大学旧金山分校14名手术住院医师进行了半结构化访谈，旧金山（57%为女性，71%非白人)，探索对工作场所DCS的期望。成绩单被上传到分析软件，并使用迭代方法进行编码以达成共识。使用归纳推理和演绎推理对成绩单进行了主题分析，应用工作-需求-资源理论框架，并遵循已发布的6步方法。
结果：出现了四个主要主题：过去的经验，预期奖励,预期的挑战，和归属感的欲望。过去的经验描述了通过自力更生成功应对未来压力的期望。诸如专业掌握之类的奖励，个人成长,意义感是预期的结果，被视为平衡预期的挑战。预期的挑战包括低控制，有毒的文化元素，和歧视。渴望归属(即，赢得了同行的认可，融入精英文化)成为一种强大的动力，具有女性和非白人的生存内涵。
结论：我们的研究结果表明，来袭的实习生高估了自力更生应对的功效；指望具体的奖励；对挑战表达现实的期望；并且认为纳入外科医生是一种愿望，会抵消长期的努力。有必要进行进一步的研究，以了解期望与现实的不匹配以及针对不和谐的潜在干预措施。
结论：在这项对普外科实习生的机构研究中，我们更详细地了解普外科实习生对工作场所需求的期望，control,在开始培训之前提供支持，以及我们如何将“期望-现实”不匹配和“归属感”作为减轻职业倦怠和最大程度地减少训练减员的手段。
■普外科（GS）实习生的倦怠和减员风险最高。Maslach将职业倦怠归因于工作场所期望与现实之间的不匹配。职业科学证明了工作场所的需求，control,和支持(DCS)作为工作压力的强大影响者。GS实习生对需求的现实期望与减员可能性的降低有关，但是他们对这个因素的期望却知之甚少。
方法：对加州大学旧金山分校14名手术住院医师进行了半结构化访谈，旧金山（57%为女性，71%非白人)，探索对工作场所DCS的期望。成绩单被上传到分析软件，并使用迭代方法进行编码以达成共识。使用归纳推理和演绎推理对成绩单进行了主题分析，应用工作-需求-资源理论框架，并遵循已发布的6步方法。
结果：出现了四个主要主题：过去的经验，预期奖励,预期的挑战，和归属感的欲望。过去的经验描述了通过自力更生成功应对未来压力的期望。诸如专业掌握之类的奖励，个人成长,意义感是预期的结果，被视为平衡预期的挑战。预期的挑战包括低控制，有毒的文化元素，和歧视。渴望归属(即，赢得了同行的认可，融入精英文化)成为一种强大的动力，具有女性和非白人的生存内涵。
结论：我们的研究结果表明，来袭的实习生高估了自力更生应对的功效；指望具体的奖励；对挑战表达现实的期望；并且认为纳入外科医生是一种愿望，会抵消长期的努力。有必要进行进一步的研究，以了解期望与现实的不匹配以及针对不和谐的潜在干预措施。
结论：在这项对普外科实习生的机构研究中，我们更详细地了解普外科实习生对工作场所需求的期望，control,在开始培训之前提供支持，以及我们如何将“期望-现实”不匹配和“归属感”作为减轻职业倦怠和最大程度地减少训练减员的手段。
