Podium IID - DEI / Wellness
BEHIND A MASK OF SHAME: A PHENOMENOLOGICAL INVESTIGATION INTO SHAME IN SURGICAL TRAINING
Steven Thornton, MD1, Sophie Korenek, BS2, Luna Dolezal, PhD3, Jacob Greenberg, MD, EdM1, William Bynum, MD, PhD4; 1Duke University Hospital Department of Surgery, 2University of North Carolina at Chapel Hill School of Medicine, 3University of Exeter, 4Duke University School of Medicine
Background: Shame is a powerful emotion that shapes well-being and professional identity. It results from negative self-evaluations that cause feelings of global unworthiness. Surgical trainees may be particularly prone to shame due to the unique norms and roles they encounter in an emotionally and physically challenging learning environment. Although shame in surgical education has recently been examined quantitatively, the lived experience of shame in surgical residents remains unknown. This study employs hermeneutic phenomenology, a qualitative methodology well-suited to address this gap, to ask: “How do surgical residents experience shame in training?”
Methods: From July - November 2025, 12 general surgery residents from the Collaboration of Surgical Education Fellows committee of the Association for Surgical Education were recruited. In a single session, participants completed a written reflection on their experiences of shame during training and a one-hour semi-structured interview exploring these experiences. Data were analyzed using Ajjawi and Higgs's 6 steps of hermeneutic analysis to produce a rich description of surgical residents’ shame experiences.
Results: Triggered by technical errors, violated cultural norms, and interpersonal interactions (particularly with senior residents and faculty), shame was a highly distressing emotion ranging from acute and fleeting to chronic and pervasive. Central to participants’ shame experiences was a destabilized professional identity, which often grew from a sense of ego insecurity, questions of belonging, the need to protect one’s reputation, and learning environments characterized by gossip, harsh teaching tactics, and poorly communicated feedback. Morbidity and Mortality conference was a recurrent structural feature across participants’ stories of shame. Shame recovery was aided by both giving and receiving support within trusting relationships, along with cognitive reframing to address the skewed frame of reference caused by shame.
Conclusion: Shame is deeply intertwined with the experience of surgical training. Its development reflects powerful norms, standards, and ideals – both implicit and explicit – that govern who a surgical resident should and should not be. Shame in this context can have a profoundly negative impact on learning, patient care, professional relationships, and residents’ self-concept. Despite this, participant narratives highlight opportunities for constructive shame engagement and offer ways to build resilience into the culture of surgical training programs.
A NATIONAL SURVEY OF PRELIMINARY VERSUS CATEGORICAL GENERAL SURGERY RESIDENTS’ PERSONAL AND PROFESSIONAL EXPERIENCES
S Lund1, R Moreci2, K Sadiq3, X Luo4, J Broecker5; 1University of Michigan, 2Lousiana State University, 3Georgia Washington University, 4Tulane University, 5University of California San Francisco
Introduction:
There is single institutional data demonstrating differences between preliminary and categorical surgery residents’ demographics, professional success and personal experience of burnout; however, multi-institutional data is lacking and preliminary surgery residents are relatively under-studied. We aimed to investigate differences nationwide in the personal and professional experiences of preliminary versus categorical surgery residents.
Methods: An anonymous, voluntary survey was emailed twice May-June 2024 and 2025 nationally to individual programs’ PGY1 and PGY2 preliminary and categorical general surgery residents. Preliminary residents were classified as designated or non-designated (NDP) and separate analyses comparing preliminary to categorical residents were performed for each group. Descriptive stats, chi-square and Fisher’s exact tests were performed using Python.
Results: A total of 152 responses were obtained from 81 categorical (53%), 44 non-designated (29%), and 25 designated preliminary (16%) residents. Respondents were from the Midwest (30.9%), Southeast (27.6%), Northeast (21.1%), Southwest (12.5%) Northwest (3.9%) and other (2.6%). NDP surgery residents were less likely compared to categorical residents to be satisfied with: their quality of life during intern year (preliminary=47%, categorical=68%, p=0.002), their professional trajectory (preliminary=55%, categorical=79%, p=0.001), and mentorship (preliminary=28%, categorical=57%, p<0.001). Among all respondents, 68% believed preliminary vs categorical status impacted assigned rotations and 54% believed preliminary vs categorical status impacted access to research opportunities. More NDP residents experienced burnout than categorical residents (preliminary=54%, categorical=32%, p=0.009). NDP residents were more likely to experience unfriendly co-workers (preliminary=50%, categorical=4%; p<0.001), perceive their opinion to be overlooked (preliminary=41%, categorical=5%; p<0.001), feel ignored at work (preliminary=43%, categorical=3%; p<0.001), feel coworkers assumed that their work was inferior (preliminary=61%, categorical=7%; p<0.001), and feel they were treated differently due to their preliminary status (preliminary=63%, categorical=22%; p<0.001).
Conclusion:
These results suggest that disparities exist between the personal and professional experiences of non-designated preliminary surgery residents and categorical surgery residents. More investigation is needed to validate these results nationally as well as within individual programs, to better understand the mechanisms behind why these disparities may exist and to evaluate interventions that may promote equity between preliminary and categorical surgery residents.
ASSESSING INCLUSIVITY FROM BEHIND THE SCREEN: LGBTQ+ SURGERY RESIDENTS’ EXPERIENCES DURING VIRTUAL INTERVIEWS
Aryana J Jones, MD1, Cody Dalton, MD2, Ryan Shabahang3, Mohsen Shabahang, MD, PhD4, Alessandra Landmann, MD2, Christie Buonpane, MD5; 1University of Louisville School of Medicine, Department of Surgery, 2University of Oklahoma, College of Medicine, Department of Surgery, 3Vanderbilt University, 4Department of Surgery, WellSpan Health, 5Norton Children's Hospital/University of Louisville, Division of Pediatric Surgery
Background:
While the National Resident Matching Program (NRMP) is designed match the best residents for programs, applicants must equally evaluate which programs will best support their career path and personal values. While in-person interviews previously offered insight into program culture and comradery, virtual interviews limit these assessments to brief online interactions. For lesbian, gay, bisexual, transgender, and queer (LGBTQ+) applicants–who report higher rates of mistreatment in surgical training–evaluating inclusivity may be particularly challenging. We aimed to evaluate LGBTQ+ surgery residents’ experiences and challenges in assessing program inclusivity during virtual interviews.
Methods:
From August to November 2024, 14 general surgery residents participated in 2-on-1 semistructured interviews with members of the research team via Microsoft Teams. Interviews were recorded and transcribed, then analyzed using the Delve Qualitative Analysis Software. Using an inductive theoretical framework, themes and subthemes were identified.
Results:
Fourteen general surgery residents participated, median age 30 [IQR, 29–31] years. Participants identified as male (n = 5), female (6), nonbinary (2), and reported sexual orientation as gay (5), lesbian (3), bisexual (2), and queer (3). Analysis of interview transcripts revealed five themes describing the unique concerns of LGBTQ+ applicants in the general surgery NRMP process. Themes encompassed (1) location and community, (2) disclosure of gender or sexual minority status, (3) perceptions of belonging and representation, as well as reflections of the (4) limitations of virtual interviews in assessing inclusivity and (5) program responsibility for the promotion of diversity, equity, and inclusion. Subthemes aligned with the distinct stages of the NRMP process–application, interviews, ranking, and program integration–illustrating how these factors influence applicants’ perceptions and decision-making at each step.
Conclusion:
General Surgery applicants must evaluate multiple factors when evaluating residency programs. For LGBTQ+ applicants, this process is further complicated by the need to consider how their gender or sexual identity may impact their training experience. Our findings suggest that applicants face notable challenges when evaluating program inclusivity, particularly in the setting of virtual interviews, emphasizing the need for programs to more clearly demonstrate their culture and commitment to diversity.