Podium IID - DEI / Wellness
(S067) 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.
(S068) TEACHING INCLUSION: DESIGNING BELONGING IN EARLY SURGICAL EDUCATION
Tasha Posid, MA, PhD, Lisa Cunningham, MD, Megan Leitnaker, Vivian Wong, MD, Emily Huang, MD; The Ohio State University Wexner Medical Center
Introduction:
Persistent underrepresentation of URiM trainees in surgical specialties is rooted in structural barriers that limit early exposure, mentorship, and access to surgical learning spaces. The Surgical Education Research Fellowship (SERF JR.) was piloted at a single academic institution as an 8-week immersive program designed to cultivate surgical identity formation, mentorship, and career interest among undergraduate medical students from diverse backgrounds. This study qualitatively explores how an early exposure program designed for URiM medical students functioned to dismantle these barriers and foster inclusion, representation, and emerging surgical identity.
Methods:
Eight of twelve inaugural participants completed semi-structured 1:1 interviews approximately one month post-program. Transcripts were analyzed thematically using inductive coding to identify overarching themes, sub-themes, and representative quotations were extracted to illustrate key concepts.
Results:
Four overarching themes emerged: (See Figure 1).
(1) Structural barriers to surgical pathways (pre-program; 100% reported by participants): students described limited access to surgical opportunities, difficulty finding mentors, and a perception that surgery was “off-limits” or inaccessible—“I didn’t know how people even got involved in surgical research.”
(2) Inclusion as educational design (86% reported by participants): program elements intentionally centered URiM learners through visible representation, psychologically safe spaces, and explicit validation of belonging—“It was the first time I didn’t feel out of place in a surgical setting.”
(3) Mentorship and representation as mechanisms (100% reported by participants): longitudinal mentor relationships, informal conversations, and modeled navigation of barriers provided tangible pathways into surgery.
(4) Surgical identity and belonging (outcome; 86% reported by participants): participants reported new confidence and self-recognition as future surgeons—“This program helped me finally see myself as someone who could do surgery.”
Conclusions:
This SERF JR. pilot program fostered mentorship, confidence, and early surgical identity formation among URiM medical students, addressing structural barriers to surgical career entry. Programs such as this that intentionally foster inclusion can actively counter structural inequities limiting entry into surgical fields. Embedding representation, psychological safety, and mentorship continuity within educational design enables early identity formation and promotes equity in the surgical workforce pipeline. These findings highlight design principles for scalable approaches to surgical education.
(S069) ALL SURGICAL INTERN SALARIES ARE NOT CREATED EQUAL: GEOGRAPHIC AND PROGRAM-LEVEL VARIATION IN SURGICAL INTERN COMPENSATION
Nicholas J Iglesias, MD, Akshat Sanan, MD, Talia R Arcieri, MD, Ana M Reyes, MD, Megan V Laurendeau, BS, Nikita Shah, Vanessa W Hui, MD, FACS, FASCRS, Laurence R Sands, MD, MBA, Chad M Thorson, MD, MSPH; University of Miami, DeWitt Daughtry Family Department of Surgery
Introduction:
Surgical resident pay varies widely across the United States. With medical school debt now exceeding $250,000 and inflation rising, understanding regional salary differences is essential for program leaders. This study analyzed geographic and institutional factors associated with surgical intern compensation, adjusting for taxes and the cost of living.
Methodology:
The Residency Explorer (RE) 2025 database was queried for all university-based and community-based, university-affiliated general surgery programs. Extracted variables included university affiliation, geographic region, and PGY-1 salary. Federal and state income taxes were applied to determine post-tax salary. County-level cost-of-living data was obtained from the Economic Policy Institute, and program reputation was determined by Doximity ranking. The Salary-to-Cost-of-Living Ratio (StCOLR) was calculated as post-tax salary divided by cost of living.
Results:
Among 270 programs, the median pre-tax salary was $67,763 [IQR $63,724–$72,700], with a post-tax median wage of $57,802 [IQR $54,652–$61,653]. Median cost of living was $49,178 [IQR $44,558–$58,753], producing a median StCOLR of 1.15 [IQR 1.02–1.26]. Programs in the West North Central (1.32 [IQR 1.24–1.36]) and East North Central (1.26 [IQR 1.20–1.38]) regions demonstrated more favorable StCOLR compared to South Atlantic (1.03 [IQR 0.95–1.17]), Pacific (1.07 [IQR 1.00–1.16]), New England (1.01 [IQR 0.90–1.26]), and Middle Atlantic regions (1.11 [IQR 0.94–1.27]) (all p ≤ 0.001 except Pacific vs. West North Central p = 0.002; New England vs. West North Central p = 0.004). West South Central programs also outperformed South Atlantic programs (p < 0.001). Programs in the 20 largest U.S. cities had lower StCOLR than less populous areas (1.12 vs. 1.16, p = 0.037). No differences were found based on program ranking or university affiliation.
Conclusions:
Surgical intern compensation remains highly variable across the United States, even after adjusting for taxes and cost of living. Programs in major metropolitan areas provide comparatively lower cost-adjusted compensation. These findings highlight the need for transparent, data-driven benchmarking of resident salaries that accounts for regional economic conditions and trainee debt burden. Aligning compensation with local living costs is essential to promote equity, financial well-being, and sustainability in surgical education.
(S070) 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.
(S071) 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.
(S072) "THERE IS NO GOOD TIME TO HAVE A BABY” - FAMILY PLANNING AND PREGNANCY AS A SURGEON
Jillian Schneidman, MD, MPhil1, Madison Dusick2, Jacob Davidon, MSc3, Claire Wilson, MSc, PHD3, Anthony DeLuca3, Jennifer Shaw4, Fiona Webster, MA, PHD5, M. Elise Graham, MD6, Natashia Seemann, MD, MSc7; 1Department of Surgery, McGill University, 2Schulich School of Medicine and Dentistry, 3Division of Pediatric Surgery, Children's Hospital at London Health Sciences Centre, 4Women's Studies, Western University, 5Department of Sociology, McGill University, 6Department of Pediatric ENT, Dalhousie University, 7Division of Pediatric Surgery, Western University
Purpose: Surgical training and early career practice often coincide with the optimal time for starting a family. While prior research documents logistical, financial, and fertility-related challenges faced by women in surgery, less is known about how these are experienced and managed in daily life. This qualitative study explores how women surgeons navigate family planning, fertility, and pregnancy within the structures and culture of surgical education and practice.
Methods: Women surgeons and trainees participated in semi-structured interviews about their experiences with pregnancy and family planning. Interviews were transcribed, de-identified, and analyzed using constructivist grounded theory. The research team conducted open coding to build familiarity with the data, followed by focused coding and iterative discussions to refine themes and achieve consensus.
Results: Sixteen women surgeons from a range of specialties were interviewed, including three residents and one fellow. Half had their first pregnancy during residency and half in early career. Participants described investing significant thought and effort timing family planning around surgical training and career progression. For many, however, the rigid structure of surgical programs and culture of surgical practice constrained or disrupted these plans and, occasionally, impacted fertility. Fertility challenges and pregnancy complications were common and often accompanied by feelings of frustration, anger, or regret toward their careers and/or the culture of surgery. The physical demands of pregnancy, particularly during call and operative work, were considerable, while formal accommodations for fertility treatment or pregnancy complications were uncommon. Although residents and staff encountered different challenges depending on their career stage, both relied heavily on informal mentorship and peer support. Many emphasized the need for earlier and more open discussions about fertility and pregnancy in training and sought to “pay it forward” by supporting others navigating similar experiences.
Conclusion: This study illustrates how structural and cultural aspects of surgical training and profession shape opportunities for building a family. Parenthood remains constrained by surgical workload demands, limited flexibility, and enduring norms around productivity and dedication. Addressing these barriers requires a combination of mentorship, targeted education, and, most importantly, institutional policies and cultural changes to create a fully supportive environment for family building in surgery.