The "M" Word: Defining Malignancy in Surgical Residencies

We sought to define the term "malignancy" in the setting of medical students applying to general surgery residencies.

This was a retrospective qualitative analysis of Reddit.com's yearly General Surgery Match Application spreadsheets. Programs were marked as malignant (Y), nonmalignant (N), and Mixed (Y/N). A code book was developed and responses coded. Thematic and pattern analysis was performed.

We found malignancy could be broken into program and people factors. Program factors included: duty hours and violations, resident workload, resident training and education, resident autonomy, program hierarchy, and benefits. People factors included people from all levels in a program and included: instances of a toxic work culture, attending teaching, and resident cohesion. The label of malignancy caries significant impacts for both programs and residents like decreased amount of applicants, residents leaving programs early, or legal/administrative troubles.

Despite implementation of duty hour restrictions and abuse reporting systems, general surgery residencies are still noted to have issues with breaking hours and emotional, mental, and physical abuse. These characteristics have been complied under the umbrella term, "malignancy." Malignant residencies have program wide factors, as well as individual people factors that contribute to malignancy.