A multi-method assessment of the vascular surgery program director experience in creating effective training environments

Abstract

Objectives: Surgical training has received significant attention in recent years with efforts to improve trainee wellness. Vascular surgery training is subject to unique challenges, and vascular program directors (PDs) are tasked with providing learning environments that produce effective and competent surgeons. The aim of this study is to examine the experience of vascular surgery PDs in promoting effective learning environments for vascular trainees.

Methods: Data was collected from confidential, voluntary surveys of vascular surgery residency PDs with multiple choice and free response questions as part of the SECOND Trial. PDs were asked about their use of wellness interventions, resources available through their institution, and resources still required. PDs indicated the most rewarding and challenging aspects of their role. Program-level wellness data was aggregated from trainee responses to an annual survey of trainee wellness. Associations between program wellness metrics and number of interventions used by PDs were assessed with Wilcoxon rank-sum tests. Qualitative data was analyzed with inductive reasoning to identify themes.

Results: Of 33 program directors who participated in the survey (76.7% of programs enrolled in the Vascular SECOND Trial), most PDs had opportunities to engage with other faculty (N=27, 81.8%), support from Graduate Medical Education (N=27, 81.8%), and administrative support from program coordinators (N=26, 78.8%). Many PDs reported a need for additional salary/stipend support to incentivize program leadership (N=23, 69.7%), funded protected effort to decrease clinical responsibilities (N=18, 54.6%), and discretionary educational funds (N=13, 39.4%). The trainee-related issues most frequently encountered by PDs were performance challenges (N=15, 45.5%) and interpersonal issues between trainees and ancillary staff (N=9, 27.3%). The most common institutional-level issues were incongruence between hospital administration goals and clinical priorities (N=9, 27.3%), and protected time for administrative responsibilities (N=8, 24.2%). There were no significant associations between trainee wellness and perception of program responsiveness or resources needed or available to PDs. Themes of the most rewarding aspects of the PD job were participating in trainee growth, training the next generation, and interpersonal relationships. Themes of most challenging aspects were generational differences, interpersonal challenges, lack of resources, and administrative tasks.

Conclusions: Vascular surgery PDs assume a challenging role with unique responsibilities. Certain barriers and facilitators of wellness may be experienced by a majority of PDs, which allows for identification of potentially widely effective interventions. Ultimately, supporting PD efforts should focus on improving resources like funded protected efforts and reducing administrative burden.

Keywords: Vascular surgery training; burnout; integrated vascular surgery residency; program director; wellness.