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Gender Differences in Utilization of Duty-hour Regulations, Aspects of Burnout, and Psychological Well-being Among General Surgery Residents in the United States

Dahlke, Allison R., MPH*; Johnson, Julie K., MSPH, PhD*,‡; Greenberg, Caprice C., MD, MPH§; Love, Remi, MPPA*; Kreutzer, Lindsey, MPH*; Hewitt, Daniel B., MD*,¶; Quinn, Christopher M., MS*; Engelhardt, Kathryn E., MD*,||; Bilimoria, Karl Y., MD, MS*,†

doi: 10.1097/SLA.0000000000002700

Objective: The aim of the study was to (1) assess differences in how male and female general surgery residents utilize duty-hour regulations and experience aspects of burnout and psychological well-being, and (2) to explore reasons why these differing experiences exist.

Background: There may be differences in how women and men enter, experience, and leave residency programs.

Methods: A total of 7395 residents completed a survey (response rate = 99%). Logistic regression models were developed to examine the association between gender and resident outcomes. Semistructured interviews were conducted with 42 faculty and 56 residents. Transcripts were analyzed thematically using a constant comparative approach.

Results: Female residents reported more frequently staying in the hospital >28 hours or working >80 hours in a week (≥3 times in a month, P < 0.001) and more frequently feeling fatigued and burned out from their work (P < 0.001), but less frequently “treating patients as impersonal objects” or “not caring what happens” to them (P < 0.001). Women reported more often having experienced many aspects of poor psychological well-being such as feeling unhappy and depressed or thinking of themselves as worthless (P < 0.01). In adjusted analyses, associations remained significant. Themes identified in the qualitative analysis as possible contributory factors to gender differences include a lack of female mentorship/leadership, dual-role responsibilities, gender blindness, and differing pressures and approaches to patient care.

Conclusions: Female residents report working more, experiencing certain aspects of burnout more frequently, and having poorer psychological well-being. Qualitative themes provide insights into possible cultural and programmatic shifts to address the concerns for female residents.

*Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL

American College of Surgeons, Chicago, IL

Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

§Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, WI

Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA

||Department of Surgery, Medical University of South Carolina, Charleston, SC.

Reprints: Karl Y. Bilimoria, MD, MS, Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL 60611. E-mail:

Authors acknowledge receipt of funding by the American Board of Surgery, the American College of Surgeons, and the Accreditation Council for Graduate Medical Education.

The authors report no conflicts of interest.

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