Experiences of Identity-Related Vigilance in Surgical Trainees: A Qualitative Study

Experiences with identity-related mistreatment are a critical concern in surgical residency training. Prior research demonstrates those who experience identity-related mistreatment or scrutiny can experience subsequent vigilance for additional encounters with associated stress. It is unknown whether surgical trainees who experience identity-related mistreatment or scrutiny also experience identity-related vigilance.

To determine whether identity-related vigilance impacts surgical trainees in the learning environment.

This qualitative study of general surgery trainees from multiple institutions used semistructured interviews conducted from May to October 2025. The interview explored how vigilance may be experienced in the surgical learning environment, including the extent to which trainees felt scrutinized by others, how they perceived their identities factoring into this, and how this affected their experience of the learning environment.

Thematic analysis of experiences of vigilance in the surgical learning environment.

A total of 20 trainees participated (mean [SD] age, 30.4 [2.1] years; 9 [45%] cisgender men, 9 [45%] cisgender women, 2 [10%] not disclosed); 13 (65%) identified as belonging to a racial and/or ethnic minoritized background. We identified 4 themes describing experiences and impacts of vigilance during training: (1) perceiving threats of increased identity-related scrutiny (ongoing uncertainty about whether identity-related mistreatment exists or will recur); (2) recalibration of self-presentation to prevent future negative judgment (continuous adjustment of speech, demeanor, and other modifiable identifiers to prevent future negative judgment); (3) checking the environment for safety or risk (persistent hyper-monitoring of the environment generates emotional exhaustion, stress, and diminished professional self-efficacy); and (4) interrupting the cycle (vigilance can lead to burnout and/or attrition; however, validation from peers and mentors affirmed trainees' experiences and mitigated negative consequences).

In this qualitative study, surgical residents described experiencing vigilance as the perception of identity-related threats, the adjustment of self-presentation accordingly, and the monitoring of the environment for risk. Participants expressed that this process imposed significant emotional and cognitive demands, contributing to fatigue, burnout, and, in some cases, thoughts of leaving surgery; however, they identified opportunities on the programmatic level to mitigate the negative consequences of vigilance.