Transitioning to a General Surgery Residency: An Ethnographic Study

Abstract

Aims and objectives: To explore and describe struggles encountered by surgical interns during the first month of residency and how they overcome those difficulties. Background: A performance gap has been widely noted between undergraduate and graduate medical education. Previous studies have identified areas of focus to prepare graduating students for residency. Concerning surgical education, bootcamps are a current means of addressing this gap. However, curricula lack an emphasis on non-technical skills. Moreover, the specific process by which interns overcome barriers is absent from the literature. Design: Ethnographic. Method: Access to an ACGME accredited 5-year general surgery residency was obtained and total purposive sampling was used in the recruitment of 9 participants. Two series of semi structured interviews were conducted before and after the first month of residency. During, approximately 300 hours of participant observation took place and field notes were collected. Additional ethnographic interviews were conducted in the field. Data from all sources was transcribed and underwent thematic analysis. Results and Discussion: Interns encounter two overarching types of barriers – general barriers and novel barriers. General barriers describe obstacles related to use of skills acquired in medical school and are often overcome in an individual manner. Novel barriers relate to struggles that are unique to residency. Interns take an approach to novel barriers that often involves asking for help. Quasi-novel barriers are a subset of novel barriers that hold a general component. Skills related to quasi-novel barriers may have been introduced in medical school but occurred too infrequently or to a degree that did not yield development of competence. Similar to novel barriers, interns often overcame quasi-novel barriers by asking for assistance. Conclusions: General barriers, novel barriers, and quasi-novel barriers differed in how residents overcame obstacles. However, each type of barrier did not present as a lasting challenge to the intern. Relevance to Surgical Education: Incoming surgical interns reported a nearly unanimous concern over quasi-novel barriers. However, these obstacles were surmounted relatively quickly. Strengthening competencies to fortify against general barriers, particularly medical knowledge, may be a more productive use of resources concerning non-technical skills in residency preparation.