Competence by Design Strains Surgical Residency Training Programs

To evaluate the impact of Competence by Design (CBD) on surgical training at the University of Calgary, with a focus on burnout and well-being among residents and surgeons.

Cross-sectional survey-based study.

Surgical residency training programs at a Canadian academic university.

Surgical residents and surgeons at the University of Calgary across multiple specialties.

A single-phase survey was distributed via email (July-September 2024) to Surgery and Obstetrics/Gynecology departments. The Maslach Burnout Inventory (MBI) measured burnout, additional Likert-scale items assessed emotional/physical, occupational, and intellectual/educational wellness. Responses were dichotomized ("agree" vs. "disagree"). Quantitative data were analyzed using Chi Square and Fisher's exact tests (GraphPad Prism v10.0.0, p < 0.05). Open-text responses assessed perceived impact on the same domains of wellness and resultant qualitative data was analyzed using Braun and Clarke's thematic approach with NVivo 15 software.

Subjective self-reported burnout was higher among residents than surgeons (67% vs. 38%; p < 0.001). The MBI confirmed burnout in 29.6% of residents vs. 9.3% of surgeons (p < 0.05). Most residents (75%) self-attributed their burnout to CBD. Emotional wellness was more negatively affected in residents (p < 0.05), who reported greater stress (p < 0.0001), sleep disruption (p = 0.0021), and interference with physical wellness from EPA tasks. Surgeons were more likely to believe CBD motivates residents (68% vs. 26%; p < 0.001) and strengthens relationships (33% vs. 6%, p = 0.0026). Few participants felt that CBD improved surgical skills (38% of staff, 23% residents), autonomy (38% staff, 17% residents), or readiness for practice (23% of staff, 18% of residents). The most common themes identified in the open-text responses included: operational burden, psychological impact, perceived ineffectiveness and structural issues. These themes were present in all domains of wellness. Overall, residents reported more burnout and a greater perceived negative impact of CBD/EPAs across wellness domains compared to staff surgeons.

CBD aims to enhance autonomy and preparedness for practice; however, its implementation at the University of Calgary introduced challenges that have impacted resident and staff surgeon wellness. Our findings highlight the need for programmatic adjustments that better support surgical trainees.