背景:丰富的学习环境是居民健康和教育不可或缺的一部分。综合血管(VS)和普外科(GS)居民在研究生1-3(PGY1-3)期间共享18个月的核心GS轮换;他们的经验差异可能有助于确定实际的变化杠杆。
方法:我们使用了收敛混合方法设计。横断面调查是在2020年美国外科培训考试委员会和血管外科培训考试之后进行的,评估学习环境和居民健康的八个领域。多变量逻辑回归模型确定了与GS和VS计划的57个机构的分类PGY1-3居民之间的流失想法相关的因素。居民焦点小组在2022年血管年会期间进行,以引出有关学习环境体验的更多细节。使用归纳和演绎逻辑分析转录本,直到达到主题饱和。
结果:调查由205名VS和1198名GSPGY1-3居民完成(VS的回复率为76.8%,GS的回复率为82.5%)。根据居民人口统计进行调整后,PGY液位,和程序类型,GS居民比VS同龄人更有可能考虑离开他们的项目(优势比[OR]:2.61,95%置信区间[CI]:1.37-4.99)。在调整了对学习环境的感知差异后,这一发现并没有持续下去。具体来说:GS居民受到虐待的几率更高(OR:1.99,95%CI:1.36-2.90),工作与生活的融合较差(OR:2.88,95%CI:1.41-5.87),居民友情较少(OR:3.51,95%CI:2.26-5.45),工作意义降低(OR:2.94,95%CI:1.80-4.83)。定性数据提供了对共享学习环境的不同看法的见解:(1)血管学员表示,早期专业化和较小,更多投入的教师允许早期手术暴露的学徒模式,动手指导,频繁的反馈,因此,早期技能获取(在工作中的含义);(2)较小的计划有利于与共同居民和教职员工建立更紧密的关系,越来越熟悉(友情和工作生活一体化);和(3)由于对项目领导的熟悉程度增加,血管学员感到更舒适的报告虐待,允许迅速回应(虐待)。
结论:尽管共享学习环境,VS和GS住院医师体验培训不同,有助于不同的减员思想。这些差异可能归因于集成训练范式的内在特征,这些特征不容易被GS程序复制,例如,由于早期专业化,计划规模较小,教师投资较高。应考虑补偿这些固有差异的替代策略(例如,结构化的操作委托计划和教师激励)。
BACKGROUND: An enriching learning environment is integral to resident wellness and education. Integrated vascular (VS) and general surgery (GS) residents share 18 months of core GS rotations during the postgraduate years 1-3 (PGY1-3); differences in their experiences may help identify practical levers for change.
METHODS: We used a convergent mixed-methods design. Cross-sectional surveys were administered after the 2020 American Board of Surgery In-Training Examination and Vascular Surgery In-Training Examination, assessing eight domains of the learning environment and resident wellness. Multivariable logistic regression models identified factors associated with thoughts of attrition between categorical PGY1-3 residents at 57 institutions with both GS and VS programs. Resident focus groups were conducted during the 2022 Vascular Annual Meeting to elicit more granular details about the experience of the learning environment. Transcripts were analyzed using inductive and deductive logics until thematic saturation was achieved.
RESULTS: Surveys were completed by 205 VS and 1198 GS PGY1-3 residents (response rates 76.8% for VS and 82.5% for GS). After adjusting for resident demographics, PGY level, and program type, GS residents were more likely than their VS peers to consider leaving their programs (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.37-4.99). This finding did not persist after adjusting for differences in perceptions of the learning environment, specifically: GS residents had higher odds of mistreatment (OR: 1.99, 95% CI: 1.36-2.90), poorer work-life integration (OR: 2.88, 95% CI: 1.41-5.87), less resident camaraderie (OR: 3.51, 95% CI: 2.26-5.45), and decreased meaning in work (OR: 2.94, 95% CI: 1.80-4.83). Qualitative data provided insight into how the shared learning environment was perceived differently: (1) vascular trainees expressed that early specialization and a smaller, more invested faculty allow for an apprenticeship model with early operative exposure, hands-on guidance, frequent feedback, and thus early skill acquisition (meaning in work); (2) a smaller program is conducive to closer relationships with co-residents and faculty, increasing familiarity (camaraderie and work-life integration); and (3) due to increased familiarity with program leadership, vascular trainees feel more comfortable reporting mistreatment, allowing for prompt responses (mistreatment).
CONCLUSIONS: Despite sharing a learning environment, VS and GS residents experience training differently, contributing to differential thoughts of attrition. These differences may be attributable to intrinsic features of the integrated training paradigm that are not easily replicated by GS programs, such as smaller program size and higher faculty investment due to early specialization. Alternative strategies to compensate for these inherent differences should be considered (eg, structured operative entrustment programs and faculty incentivization).