From Benchmarking to Intervention: Using SECOND Trial Data to Improve Residency Culture

Burnout and mistreatment remain persistent challenges in surgical residency, with wide-ranging consequences for both resident well-being and patient care. Much of the existing literature describes the prevalence and causes of resident burnout, but fewer studies provide practical insight into how programs can effectively address it. In 2019, our program enrolled in the Surgical Education Culture Optimization through Targeted Interventions based on National Comparative Data (SECOND) Trial, a national benchmarking initiative that measures resident wellness, work environment, and mistreatment relative to institutions nationwide. Initial SECOND Trial benchmarking demonstrated lowest-quartile (Q4) performance in burnout, emotional exhaustion, suicidal thoughts, and work-life integration, with outlier-level mistreatment across multiple domains relative to national peers. These findings prompted targeted organizational interventions led by residents with sustained faculty partnership. Interventions were centered around three domains: (1) structural and culture-focused initiatives through an inclusive excellence committee that promoted belonging, education on healthcare disparities, and anonymous reporting of mistreatment; (2) wellness initiatives including retreats, family-inclusive social events, protected wellness days, and peer mentorship; and (3) mentorship and professional development through faculty workshops, invited speakers, and resident and faculty recognition programs. By 2024, SECOND Trial benchmarking demonstrated improvement to mid-quartile (Q2) performance in burnout-related domains, including burnout, emotional exhaustion, work-life integration, and suicidal thoughts. Mistreatment measures no longer met outlier criteria, although gender disparities persisted. Our experience provides real-world evidence that structured, organizational interventions can produce measurable improvement in resident well-being and residency culture, while highlighting the continued need to address persistent disparities in surgical training.