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Resident Flourishing in the Surgical Learning Environment: A Mixed Methods Study
Randi N Stanulis1, John Pestenariu2, Guoli Zhou3
1Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan.
Background:
The surgical clinical learning environment (CLE) is associated with resident well-being and professional development. This study examines how general surgery residents experience their clinical learning environment through the lens of flourishing.
Materials And Methods:
One hundred and twelve general surgery residents from four community-based university-affiliated programs were recruited to voluntarily complete a survey distributed by residency coordinators. We obtained a 66% response rate. Quantitative data were collected via a survey including a one-item Burnout scale, Stanford Professional Fulfillment Index, and Johns Hopkins Learning Environment Scale subscales. Qualitative data were gathered through open-ended responses and analyzed deductively using Seligman's PERMA framework (Positive Emotion, Engagement, Relationships, Meaning, Accomplishment). Two programs-referred to by pseudonyms Juniper and Birch-were compared based on contrasting quantitative results.
Results:
Residents at Juniper reported stronger learning environments and lower levels of empathy loss than those at Birch (mean difference (Juniper and Birch) of learning environment score = 0.50 with a 95% CI (0.09, 0.92) and adjusted P = 0.01; mean difference (Juniper and Birch) of empathy loss score = -0.66 with a 95% CI (-1.25, -0.08) and adjusted P = 0.02). Qualitative survey responses showed that 58.06% of Juniper residents described experiences consistent with flourishing, compared to 21.4% of Birch residents. Juniper residents often mentioned supportive relationships that helped them stay engaged and feel successful. In contrast, 78.5% of Birch residents described negative interactions that contributed to emotional fatigue and limited their sense of progress.
Conclusions:
Proactive and intentional efforts to create surgical CLE defined by trust, mentorship, and peer connection were associated with stronger learning, lower emotional fatigue, and a clearer path toward professional growth. When residents feel valued as learners and for who they are rather than just for their performance, improved well-being and a higher level of patient care is possible.
