■工会是员工倡导的机制,但是它们在手术住院医师健康中的作用并不明显。
■了解普外科住院医师和住院医师计划教职员工的工会经历。
■这项探索性定性研究包括来自基于国家比较数据(第二)试验的有针对性干预措施的外科教育文化优化数据。在第二审判的探索阶段(从2019年3月6日至2020年3月12日),对居民进行了关于健康的半结构化访谈,教员(主治医师),和15个普外科住院医师计划的工作人员(计划管理员)。在采访中,工会被确定为一个紧急主题。数据分析于2019年3月至2023年5月进行。
■主要结果是居民和教师与居民工会的经验。在定性分析中,访谈记录的词汇搜索确定了有关居民工会的内容。归纳开发了码本。成绩单是由二元编码的,使用不断的比较方法,以协商一致方式调和分歧。
■共确定了22份具有相关内容的访谈成绩单。其中,19是对居民进行的个人访谈(n=10),教师(n=4),行政人员(n=1),一名项目主管(n=1),部门主席(n=1),和指定的机构官员(n=2),3人来自居民焦点小组。所有研究生年级的居民,包括专业发展(即,研究)年,代表。受访者在2个计划中讨论了居民工会(1个最近加入工会,1个已有数十年历史)。受访者将缺乏声音和缺乏机构描述为工会化的驱动力(“居民……正试图控制他们的福祉”)。增加工资津贴和/或住房津贴是最具体确定的工会福利。居民和教职员工都描述了工会的意想不到的后果,包括(1)工会谈判的福利与手术居民无关,(2)手术部提供福利的矛盾损失,(3)将居民与教师的关系框架为对抗性。工会高管被认为是非医师管理者,他们参与有关临床教育进展的讨论可能会增加补救居民的时间和精力,和/或减少教育工作者有意义干预的意愿。工会中积极的外科住院医师参与可以了解外科学员的独特需求并减少冲突。
■在这项定性研究中,工会化是居民声音和代理的机制;工会的愿望可能突显了培训环境中缺乏其他此类机制。然而,这些发现表明,工会可能对福利产生了意想不到的后果,灵活性,和教学。有效的宣传,无论是在工会的范围之内还是之外,是由手术居民的参与促进的。未来的研究应该通过包括更多的机构和调查主题随时间的演变来扩展这一探索性研究。
UNASSIGNED: Labor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized.
UNASSIGNED: To understand experiences with unionization among general surgery residents and residency program faculty and staff.
UNASSIGNED: This exploratory qualitative study included data from the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) trial. In the exploratory phase of the SECOND trial (from March 6, 2019, to March 12, 2020), semistructured interviews about wellness were conducted with residents, faculty (attending physicians), and staff (program administrators) at 15 general surgery residency programs. Unionization was identified as an emergent theme in the interviews. Data analysis was performed from March 2019 to May 2023.
UNASSIGNED: The main outcome was resident and faculty experience with resident labor unions. In the qualitative analysis, lexical searches of interview transcripts identified content regarding resident labor unions. A codebook was developed inductively. Transcripts were coded by dyads, using a constant comparative approach, with differences reconciled by consensus.
UNASSIGNED: A total of 22 interview transcripts were identified with relevant content. Of these, 19 were individual interviews conducted with residents (n = 10), faculty (n = 4), administrative staff (n = 1), a program director (n = 1), a department chair (n = 1), and designated institutional officials (n = 2), and 3 were from resident focus groups. Residents from all postgraduate year levels, including professional development (ie, research) years, were represented. Interviewees discussed resident unions at 2 programs (1 recently unionized and 1 with a decades-long history). Interviewees described the lack of voice and the lack of agency as drivers of unionization (\"Residents…are trying to take control of their well-being\"). Increased salary stipends and/or housing stipends were the most concretely identified union benefits. Unanticipated consequences of unionization were described by both residents and faculty, including (1) irrelevance of union-negotiated benefits to surgical residents, (2) paradoxical losses of surgery department-provided benefits, and (3) framing of resident-faculty relationships as adversarial. Union executives were noted to be nonphysician administrators whose participation in discussions about clinical education progression may increase the time and effort to remediate a resident and/or reduce educators\' will to meaningfully intervene. Active surgical resident participation within the union allows for an understanding of surgical trainees\' unique needs and reduced conflict.
UNASSIGNED: In this qualitative study, unionization was a mechanism for resident voice and agency; the desire to unionize likely highlighted the lack of other such mechanisms in the training environment. However, these findings suggest that unionization may have had unintended consequences on benefits, flexibility, and teaching. Effective advocacy, whether within or outside the context of a union, was facilitated by participation from surgical residents. Future research should expand on this exploratory study by including a greater number of institutions and investigating the evolution of themes over time.