As the next step of specialized training after medical school, residents in a variety of specialties frequently work 80 hours a week with regular overnight calls or long shifts in hospitals. Unsurprisingly, many residents report feeling high levels of stress and burnout. A national collaboration led by Indiana University School of Medicine Department of Surgery is working to change that.
The department was recently awarded another $3 million grant from the American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Education (ACGME) to continue studying ways to improve well-being and DEI in surgical residents and faculty across more than 200 hospitals in the United States. The team has been conducting these national studies for a decade, with the first two already completed and the new trial beginning this spring.
Karl Bilimoria, MD, chair of the Department of Surgery and leader of the national Surgical Education Numbered Trials (SENT) group, will present details of the study to 4,000 attendees as the keynote speaker at the annual ACGME conference on March 8, 2024.
“In the FIRST Trial, we tested whether flexibility in residents’ shift lengths impacted patient care, as well as resident education and wellbeing,” Bilimoria said. “We found flexibility in resident duty hours did not adversely affect patient outcomes, but it was much more appreciated by the residents. They wanted flexibility to be able to stay for an important operation, stay for the whole operation or stay to take care of a sick patient.”
The SECOND Trial, which included 215 hospitals across the country, looked at ways to improve the wellbeing, mistreatment and bullying of surgical residents. The team surveyed all residents nationally with high response rates, and then gave each residency program their data showing them their resident well-being compared to all the other programs in the country. Then, each program in the intervention arm of the trial received tools and coaching about how to improve.
“In the baseline data for SECOND, we found 38% of residents in the country were experiencing burnout,” Bilimoria said. “Sexual harassment, gender discrimination, racial discrimination and bullying were also very high and were important drivers of burnout.”
Results from the first two trials were published in the New England Journal of Medicine and led to a new, national policy change by the ACGME to allow for more flexibility in resident hours and changes in surgical culture nationally. The THIRD Trial launches in May 2024 and will be focused on improving the culture of academic surgical departments across the country with a particular focus on improving DEI.
“At IU, we’re proud to be an innovative leader in DEI and wellbeing,” Bilimoria said. “Doing these large-scale pragmatic randomized trials has really been helpful getting our results out into practice and fundamentally changing surgical culture across the country. We’re looking forward to continuing these trials.”
