Invisible Work: Advanced Practice Providers’ Role in the Education of Surgeons

Rosenblatt, Audrey; Ballard, Heather A; Amórtegui, Daniela; Yuce, Tarik K.; Bilimoria, Karl Y.; Johnson, Julie K.; Hu, Yue-Yung

doi:10.1016/j.jsurg.2022.06.015

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…These quantitative findings were explained by the qualitative analysis: although productivity-based incentives, the complexity of modern surgery, patient safety regulations, and expanding hospital systems create barriers to residents’ autonomy, they may be counteracted by strong interpersonal faculty-resident and resident-resident relationships, as well as the presence of clinical support staff. Although their purposes were not to study factors associated with resident autonomy, other studies have suggested these mechanisms for improving autonomy previously 5,31,32 . Our study provides additional detail on the processes by which these factors support or hinder residents’ acquisition of autonomy.…”

Section: Discussionmentioning

confidence: 88%

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See One, Do One, Improve One’s Wellness

Abahuje,

Smith,

Amortegui

et al. 2023

Annals of Surgery

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Objective: We sought to examine the factors associated with resident perceptions of autonomy and to characterize the relationship between resident autonomy and wellness. Summary Background Data: Concerns exist that resident autonomy is decreasing, impacting competence. Methods: Quantitative data were collected through a cross-sectional survey administered following the 2020 ABSITE. Qualitative data were collected via interviews and focus groups with residents and faculty at 15 programs. Results: 7233 residents (85.5% response rate) from 324 programs completed the survey. Of 5139 residents with complete data, 4424 (82.2%) reported appropriate autonomy, and these residents were less likely to experience burnout (OR 0.69; 95% CI 0.58-0.83), suicidality (OR 0.69; 95% CI 0.54-0.89), and thoughts of leaving their programs (OR 0.45; 95% CI 0.37-0.54). Women were less likely to report appropriate autonomy (OR 0.81; 95% CI 0.68-0.97). Residents were more likely to report appropriate autonomy if they also reported satisfaction with their workload (OR 1.65; 95% CI 1.28-2.11), work-life balance (OR 2.01; 95% CI 1.57-2.58), faculty engagement (OR 3.55; 95% CI 2.86-4.35), resident camaraderie (OR 2.23; 95% CI, 1.78-2.79), and efficiency and resources (OR 2.37; 95% CI 1.95-2.88). Qualitative data revealed that (1) autonomy gives meaning to the clinical experience of residency, (2) multiple factors create barriers to autonomy, and (3) autonomy is not inherent to the training paradigm, requiring residents to learn behaviors to “earn” it. Conclusion: Autonomy is not considered an inherent part of the training paradigm such that residents can assume that they will achieve it. Resources to function autonomously should be allocated equitably to support all residents’ educational growth and wellness.

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Section: Discussionmentioning

confidence: 88%

“…Although their purposes were not to study factors associated with resident autonomy, other studies have suggested these mechanisms for improving autonomy previously. 5,31,32 Our study provides additional detail on the processes by which these factors support or hinder residents' acquisition of autonomy.…”

Section: Discussionmentioning

confidence: 92%

See One, Do One, Improve One’s Wellness

Abahuje,

Smith,

Amortegui

et al. 2023

Annals of Surgery

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“…During the exploratory phase of the SECOND trial (between March 6, 2019, and March 12, 2020), 2-day site visits were performed at 15 general surgery programs. Site selection was previously described …”

Section: Methodsmentioning

confidence: 99%

“…Site selection was previously described. 13 During the 15 site visits, 366 individual interviews and 27 focus groups were conducted with residents, faculty, and staff. Each 45-to 60-minute semistructured interview was conducted by a pair containing at least 1 surgeon or surgical resident.…”

Section: Site Visits and Interviewsmentioning

confidence: 99%

Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff

Foote,

Rosenblatt,

Amortegui

et al. 2024

JAMA Netw Open

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ImportanceLabor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized.ObjectiveTo understand experiences with unionization among general surgery residents and residency program faculty and staff.Design, Setting, and ParticipantsThis 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.Main Outcomes and MeasuresThe 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.ResultsA 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.Conclusions and RelevanceIn 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.

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