In this episode, Tom Varghese, MD, MS, MBA, FACS, is joined by Lauren M Janczewski, MD, MS, from Northwestern University, and Yue-Yung Hu, MD, MPH, FACS, from the Ann & Robert H. Lurie Children’s Hospital and Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES). They discuss their recent article, “Contemporary Evaluation of Work-Life Integration and Well-being in US Surgical Residents: A National Mixed-Methods Study,” in which the authors found that parents and female residents were more likely to report work-life conflicts, which were associated with career dissatisfaction, burnout, thoughts of attrition, and suicidality. Qualitative data revealed work-life integration interventions: protecting health-maintenance time, supporting life outside of work, and allowing meaningful autonomy in scheduling.
Disclosure Information: Drs Varghese, Janczewski, and Hu have nothing to disclose.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr Tom Varghese,and throughout the series, Dr Lillian
Erdahl and I will speak with recently
published authors about the motivationbehind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants,
(00:26):
and not necessarilythat of the American College of Surgeons.
Welcome loyal listenersto another episode of The Operative
Word, the podcast from the Journalof the American College of Surgeons.
This is the podcast where we deep diveinto fascinating articles
that have been recently published in JACS.
And I'm honored to be joined todayby two superstars in the House of Surgery.
(00:52):
First is, Dr Lauren Janczewski,
who is a fourth yeargeneral surgery resident at Northwestern
University, havingjust finished a two year, t32, sponsored,
research postdoctoral fellowshipthere at Northwestern.
And also, by the seniorauthor of this article that we're going to
(01:13):
discussing, Dr Yue-Yung Hu.
Dr Hu is a pediatric surgeon at the Annand Robert H.
Lurie Children's Hospital of Chicagoand a health services researcher
at Northwestern's, Surgical OutcomesResearch Center.
Dr Hu and Dr Janczewski,welcome to the podcast.
Thanks for having us.
(01:35):
The first questionto ask both of you, any disclosures,
that we need to talk about, for this,relevant study?
None for me.
None for me either.
I should say that Lauren is interviewingfor a surgical oncology fellowship,
and she's a superstar.
So that's athat's a shout out. That's funny.
and of course, the other disclosureI have to tell everybody is
(01:55):
I'm a proud alum of the NorthwesternSurgical training program.
So if you see a heads, you'rea little bit of a hint of favoritism,
sorry about that.
But, that's still going to be remainingthroughout the interview, so thanks.
Let's go ahead and take it away.
The article
where we're going to be talking todayabout is, “Contemporary evaluation
of work-life integrationand well-being in US surgical residents,
(02:18):
a national mixed-methods study.” Dr LaurenJanczewski is the first author
and Dr Yue-YungHu is the senior author of this article.
Let's start with you, Dr Hu.
Taking a 30,000-ft view, this
article was done under the frameworkor the auspices of the SECOND Trial.
Could you describe for uswhat that trial is or,
(02:41):
why you ended up embarking on this,amazing, innovative clinical trial?
Yeah.
SECOND stands for surgical education
and culture optimizationbased on national comparative data.
And I did I get all the acronym? Yeah.
That's correct.
And it's a trial of general surgeryresidency programs
looking at resident well-being.
(03:02):
And the reason it came aboutis because data
from the FIRST trial,which was run by Carl Bilimoria,
my co-PI on SECOND, showed
that resident well-being was declining,
in both arms of the trialabout duty hours.
And so there's clearly some issue there.
And we thought as quality improvementsort of researchers,
(03:23):
we could bring some dataand some technique to improve that issue.
That's amazing.
And, I want to get right into this articlebecause, I think that the article itself
is going to lend itselfto a lot of questions afterwards.
So, getting you starting with the article,you know,
you know,
your opening sentence was, you know,eye opening on the kind of reflecting back
(03:45):
what you just said.
Your opening sentence said that“Nearly 50%, half,
of US physicians report dissatisfactionwith the balance in their personal
and professional lives, frequentlyreferred to as work-life integration.”
I guess we're starting off right there.
probably a question to either of you.
The debate between work-life integrationand work-life balance.
(04:08):
I mean, you guys went right kneedeep into that.
Comments about that or,
you know, you just said, I'mgoing to jump right in and let's go to it?
Yeah, that's a great question.
I feel like ittruly is from a surgeons perspective,
work-life integrationcompared to work-life balance, because,
(04:29):
the demands of our job are so,
it's a it's unique in that it'sphysically demanding.
The scheduling is extremely challenging.
And so you're trying to fitin multiple facets of your life,
both personal and professional,into a very limited time frame.
And it requires,you know, when you're scrubbed
(04:50):
in, you have no access to what's going onoutside of the operating room.
And so you're constantly trying to fit in,
multiple facets of your lifein between cases.
And so it really is kind of integratedall into one.
I mean, obviously the vastmajority of the time spent at work
(05:12):
is dedicated to work, but often that workspills over into your home time, too.
And so I don't think that a true 50/50balance exists.
It really is most, a lot,
a lot of it truly is work-life integrationon a daily basis.
I don't knowif you have anything to add, Dr Hu.
No, I think that was really well said.
And so to some degree it'sjust a semantic difference between balance
(05:35):
and integration, but balance kind of makesyou feel like you are failing at it
when you are not perfectlybalanced. Right?
And it's the same...have you heardMichelle Obama talk about marriage?
And she talks about like relationshipsare rarely 50/50, right?
Like someone always is doing more or less.And it sort of goes back over time.
I think integration speaks to thatbetter than that.
No, I think those are, eloquentstatements.
(05:56):
Absolutely.
Well, let's, go further into the study.
So, the methodology, it was very unique.
You did a convergent mixed-method studywhere you combined
national quantitative survey dataas a result of getting it from
the ABSITE, the in-training exam, thegeneral surgery residents take every year.
And then you follow that up with in-depth
(06:18):
semi-structured interviewsand focus groups.
Dr Janczewski,how difficult was this to do?
Because I think that, you know, first off,I'm just trying to wrap my mind around
getting everybody to agreeto take a survey
at the end of taking an exam,and then you're following up with,
you know, this is not an easy topicfor many surgeons to talk about.
(06:38):
Can you comment on on the ease or thetechnical difficulties of doing the study?
Yeah, I think we're,
well, me inparticular is extremely fortunate
to have the opportunityto work on SECOND trial research
at northwestern because,
you know,
the setting is truly unique because that'sone of the extreme challenges
(07:01):
in performing a survey-based studyis especially with modern,
administration
techniques, with social media.
One, we have a calculable response rate,and the response rate is extremely high.
And so, I think, I mean, I don't know
what your perspective is, Dr Hu,from what, what,
(07:23):
what you were expecting in terms
of a response rate after the first timeyou administered one of these studies.
But routinely every yearthe response rate is extremely high,
despite it being administered after,the ABSITE exam
when people have just taken a five-hourtest, people still,
fill out the survey.
And I think it just it is a tributeto how important the topic of resident
(07:46):
wellness is right now,because even after taking a five-hour
exam, people still feel passionatelyabout filling out the survey.
To provide us with the data to both,
so that we can study this and
then design interventions to help,
you know, improve upon this topicmoving forward.
And so,
(08:07):
each year there's different questionsthat get worked into the survey.
And so from this particular year,we had several questions
that were dedicated towardswork-life integration.
And it started outprimarily as a quantitative study.
But then we realized after, you know,we have so many transcripts available
from the qualitative portionof the SECOND Trial study as well, that,
(08:29):
even though it was primarily designedaround resident wellness time
and time again,there are so many transcripts
where the topic of work-lifeintegration came up.
And so we were able to, expand
it to become, mixed-methods, study.
Yeah,the study mechanism predated me, actually.
That's something Carlset up for our FIRST Trial.
(08:50):
I like what I hope the reasonpeople take the test is, I mean,
everyone has take the test.
There's.
I hope that the reason people takethe survey is for a second.
We basically aggregate all the responsesat the level of the program, benchmark
against other programs,and then feed it back to the program
so that they canthen do something about their response.
So, the survey is meant to be
a mechanism for residents to communicateanonymously with their program
(09:12):
about issues that they may feeluncomfortable talking about.
Right?
You can imagine,
I think we were just talking beforewe started this conversation about how,
like, these are issues nobody talks about,so nobody wants to go back and be like,
I need more work-life integration.
Like I don't have enough home life.
Like everyone has some shame around sayingthat.
And so, this is a way for the programto get data to say, like, our residents
(09:35):
feel worse about this
than other residents in the countryand then, use that as a tool.
So hopefully that's the motivationbehind survey completion.
Yeah. No, but I mean, that's a survey.I, I agree with that.
But I thought that the unique thingwas the qualitative
I mean the you went and did two-day tours
at 15 general surgery programs,
(09:56):
you know, interviewing residentsof all levels as well as faculty members.
I mean, you know,just trying to wrap my mind around
how labor intensive that is.
But you pulled it off.
I mean, I mean, I mean, kudos to you.
I mean, it's one thing to get everybodyto answer a survey at the end of an exam.
I mean, that in itself is the logisticsbeyond that.
But, you know, you've been doing thatfor a few years now.
(10:18):
But the qualitative aspect,I mean, I guess the question was,
was there any barriers that you encounter,I mean, was or buy in
or were people like suspiciouswhen you were coming to ask them about,
you know, perceived,you know, touchy feely issues?
I mean, was there a lot of resistance
where you guys went and visitedthese programs?
You know, I have to, first of all,give flowers to Julie Johnson.
(10:39):
She's the qualitativePhD that works with us.
She's now at UNC and she was amazing andhelping us plan and strategize about this.
You know, we worried about that.
But then when we got there,people were like coming
out of the woodwork to tell us things,and it's almost like you were an outlet.
And so
even years after people that I interviewwill come back and be like,
that was like a therapy session,and I'll be like, that's what I am like,
(11:03):
but,
you know, I don't really feel likewe had to like, draw it out of people.
And it just was right at the forefront.
And we conducted the interviewssort of broadly
such that we were asking about well-being.
And people would tell us, you know,maybe there are a couple of prompts,
but we weren't specifically like,how do you feel about work-life balance?
I don't know, it was amazing
learning experience that helped us developfuture questions in the ABSITE survey.
(11:25):
I don't think we could have donewhat we did
without all those peoplewho were willing to participate.
That's amazing.
Well, let's get right into thethe results.
So, you had, out of,
8460 people who took the ABSITE,
you had, 7233 respondents.
So about an 86% response rate.
(11:46):
I mean, kudos to you, right?
That there I mean, that's a tremendousresponse rate for a survey.
And then,
Dr Janczewski, let's just talk about it.
I mean, what were the thingsthat really struck out to you about,
you know, some of the findings?
So, I mean, we could go through all this,but I want you from your perspective,
what were the things that really stuck outas, you know,
things that you expected,but things that were surprising?
(12:09):
Yeah, I think we were expecting
we were definitely expecting that,
Overall, the,
that work-life integration amongstsurgical residents would be poor.
But it was it was pretty interestingto see how it differed
amongst the different work-lifeintegration domains that we were serving,
surveying, particularly with,
(12:32):
dissatisfactionwith the time for personal life,
because that was actually the lowestin terms of dissatisfaction,
which I think while we were approachingthat survey, we anticipated
that that would be like the highestamong those amongst the list.
And I think moving forward beyond that.
Thus we found such a strong associationwith the presence of work-life conflicts
(12:55):
with all four well-being measuresthat we were studying being,
career dissatisfaction, burnout,thoughts of attrition, and
and even suicidality, which I think justgoes to show how important this topic is
in addressing moving forward sothat we can improve well-being as a whole.
But the fact that
the frequency of residentsreporting dissatisfaction with their time
(13:17):
for personal lifebeing lower than we expected,
I think you know, your timeoutside of the hospital as a resident
is so limited that you only have timeto prioritize a few things,
and so perhaps people aren't pri...I mean,this is all speculation,
but perhaps people are not prioritizingtheir personal relationships over,
(13:38):
over their, like, physical health.
But again, it's you have such little time.
You're trying to fit everythinginto one thing until into one time frame.
And so,
it's it's a really hard problem to solve.
But we're hoping that,
you know, this data will help shed somelight into moving the needle a little bit.
Moving and moving forward.
Yeah. Okay. Oh, go ahead, Dr Hu.
(14:00):
And then I was just gonna saythe way the question is framed,
it's like,are you dissatisfied with your ability to.
And so it could be
that you never go to the doctor,but that doesn't dissatisfy you, per se.
Yeah, I know,
I mean, yeah, because I mean,I was going to comment on the numbers.
I mean, you know, just looking at it,you know, 37.6% of residents
report dissatisfaction with how much timethey have for their personal life.
(14:23):
But then the beauty of this study isyou went and teased all that out.
I love the way that you frame thatDr Janczewski about, well-being measures.
You know, 52% were dissatisfiedwith a time
that they needed to maintaina healthy habit.
It’s 48% were dissatisfied with timeto perform routine health maintenance.
and then additionally,this was a surprising,
(14:45):
well,I guess of which shouldn't be surprising
because many of us facultyare at fault for this,
that 44% of residents were doing noneducational tasks
after they got home,and we know from national data
faculty are the biggest,you know violators of that.
Like when they get homethey're always charting on
electronic medical recordsand things like that.
(15:07):
And so that part didn't surpriseme as much, but it was just I like the way
you frame that Dr Hu, is like, even,you know, what is the dissatisfier here?
It's because the question is framed
is, “are you dissatisfied with the timeyou have?” But I guess
nobody who cares about their homelife wouldn't be dissatisfied.
But but we're not asking.
But we're not saying like you shouldn'tcare about your health or you shouldn't,
(15:28):
you know, care about spending timewith your family.
But we weren't trying to make those valuejudgments for people like that.
That's why the questions framed that way.
But yeah, yeah, getting to next steps.
I mean, I think I encourageall the listeners of this podcast,
I mean, this is a phenomenal article.
There's so much rich data.
I really hope that people spend,especially program directors out there,
(15:51):
and residents spend time
with this article teasing thatthat the only thing I loved about it
is you guys actually gave highlightsabout programs that are doing it well
and some pragmatic stepsthat programs could do.
Dr Janczewski, can you talk to us aboutwhat are the things that you found that so
the programs that were doing thingswell, yeah, I'm definitely biased
(16:11):
because I think that as someonewho was involved with the study.
But I think that's what makes it special.
It's incorporatingsome of the qualitative data and,
being able to provide like
the programs who are reportingwhat information and data
with regards to programs,who are reporting that
they're doing itwell and finding success and
(16:33):
improving work-life integrationamongst their residents. And,
some of the key
like qualitativefindings amongst those programs
were, for example, giving some more
autonomy to the residentsin terms of their scheduling,
and a common theme that we found amongstthat was residents or programs
(16:56):
incorporating a flex weekwhere they could use those days however,
you know, of course,
with communication and advanced planning,but use those days throughout the year
so that they could have a day offto schedule appointments or,
you know, go to a weddingthat they would need to travel for,
as well as other factorsthat I think were kind of expected.
(17:19):
But, important to, talk about as well.
Like, you know, a lot of this is dependentupon the program culture as well.
And it comes from the leadershipand faculty down to the residency program.
It it prioritized in role modelingand prioritizing work life integration
so that residents, you know,I think it starts with the culture, too.
(17:40):
Yeah.
And, it actually brings to mind,you know, one of my favorite
books that I've ever read is,
you know, Daniel Pink's,
book on drive and where he, he talks about
there'sthree essential components to have,
you know, really fulfillment in life,which is you pick something which where
(18:01):
there's a purpose, mastery, and autonomy
and the first twowe clearly have in the world of surgery.
Right?
We're doing things on behalfor for patients,
you know, something beyond ourselves.
Mastery.
Of course, surgeryis the ultimate example of mastery.
The more you do it, you get masterful.
But I love the factthat, you've landed on autonomy.
(18:23):
Like, that's the piecethat we need to figure out to hopefully
help solve these issues. Correct?
Yeah, I one of my favorite well-beingarticles is like a perspectives
piece in the New England Journal.
It's by Groopman and Hartzband and it'sabout like what is faculty motivation?
And they have three pillarsand they are: competence which,
that makes sense for a clinician. Right.
(18:44):
You have to feel like you're competentat your job and you're growing your job.
The other is
they call it like affiliation.
I would say it'sbasically a sense of community, right?
Like you have to feel connected to peopleyou work with.
And then the third is autonomy.
Like, you have to have some controlthat says autonomy, sense of control.
We have long thought that residency is atime where you just lose autonomy, right?
(19:05):
You just submit to the process.
I had this super interesting conversationwith,
there's an anthropologist who was hired bythe American Board of Internal Medicine,
and he pointed me to this, like,seminal article in anthropology
about how there are transitions,like rituals of transitioning
in every culturewhere you move from one phase to the next.
And in the middle,you're in this liminal phase
(19:25):
where you're just expected to submit.
There's no questioning about what theprocess is. You just do it. Right? And it
may or may not make sense.
And so that's kind of what residency is.
But it's a really long time. Right? So.
It's like, my, residencytraining was like ten years for us.
Right?
Yeah a long time to not have any controlover you know, do you see your family?
(19:46):
Yeah. Do you go to the doctor?
No, I hear you.
Well, we could go all daywith this conversation.
There's so many different ways,but I just have a few moments left.
But, so,I wanted to give you the last word.
Dr Hu.
Yeah, I just wanted to...sorry...can
Our toolkit can be foundat Toolkit.theSECONDtrial.org.
(20:06):
You need to spell out
“second,” so it’s S-E-C-O-N-D,and so, people can go there and look up
how to do a bunch of the interventions
we talked about,like the flexible vacation week. Perfect!
Perfect.
But, yeah.
So, yeah, kind of final thoughts. I mean,
Dr Janczewski, you could, you could,chime in as well.
Dr Hu, do we need to do somethingsimilar for faculty,
(20:28):
you know,or is that, like, too big a Pandora's box?
So we should -Oh, it probably is too big a Pandora's box.
You know, for all of a SECONDI was, like, out of scope.
I don’t want to deal with that problem.yeah.
Part of what we were hearing fromall these interviews
were faculty being like,what about my well-being?
What about my well being.
And I think that's now we're like,okay, maybe we can take this on.
So the THIRD trial is going to dealwith inclusion and departments
(20:51):
and surgery and faculty and residentwell-being, like all the things.
So I think that’sthe next layer of the onion.
But I mean, what do you think?
So, like as faculty,senior faculty, what’s your...
Translation, loyal listeners,
that they’re calling me old right now,but that’s all, you know.
[Laughter]
I admire all of youfor doing two things. I think
(21:13):
that we are changing it.
The culture is changing in the Houseof Surgery.
And the reason I say that iswe are finally talking about these things.
You know, Ithe old sayings that people used to say,
you know, “The problemwith every other day call was you missed
half the cases.” You know,these are like antiquated,
outdated things that need to be retired.
(21:35):
Go by the go like the dinosaurs.
They just need to go extinct.
I mean, I think that what we need to dois talk about, this is a hard profession.
What we do is hard work. It’s.
But we have amazing, talented,
dedicated human beingswho want to do this hard work.
But we shouldn’t be doing this hard work
(21:55):
by destroying our personal livesand everything around us.
You know?
And I think that the fact
that we're talking about this,I think, is a major first step.
I still think that we do have some uphillbattles,
to tackle.
You know, one of this is talking aboutthese
type of things is not a sign of weakness.
Actually, it’s a sign of strengthto say that these are the things
(22:19):
that we need to address to make surewe have long, productive careers.
Now, let's be honest with it.
The better or more productivea career a surgeon has,
patients and communitiesbenefit from that.
So, yeah.
So, you you've got me as a card-carrying,you know, member of, “Absolutely.
We need to do more of this.”
And I really, really am excitedabout your future work.
(22:43):
Dr Janczewski, I’m assuming that, eventhough you’re going to surgical oncology,
this is going to be part of your careergoing forward, correct?
Yeah, I think so.
I, I mean, I look forward to as someone I,as someone who,
has like, pursued family
planning in and growing my familyduring residency.
I’ve realized how challenging it is,
(23:04):
And that.
I look forwardto mentoring people in the future
who, are looking to go down thatroad as well, because I think, like Dr
because I think,
like Dr. Hu said is such a long time, and the vast,huge portion of your adult life
that you are dedicatingtowards your career.
(23:27):
And it’snot to say that no one’s dedicated.
I mean, you would never do this jobif you didn’t truly love it,
but you can’tput your life on hold for 7 to 10 years.
And so, I’m looking forwardto continuing this work with Leap Forward.
Dr Hu, final words for our listeners.
Yes, for peopleinterested in enrolling in THIRD Trial,
(23:47):
which again, is free
for both faculty
and residents, it’s SENTteam@IU.edu.
So email us at SENTteam@iu.edu.
Dr Janczewski, Dr Hu,thank you from the bottom of our hearts.
On behalf of our listenersfor The Operative Word, the podcast
for The Operative Word, the podcast
for the Journal of the American College of Surgeons.
(24:08):
Thank you for joining us.
And, we are really excitedand looking forward to the work ahead.
Thanks so much.
Thank you for listeningto the journal of the American College
of Surgeons Operative Word Podcast.
If you enjoyed today’s episode,
Spread the Word on social mediaby using the hashtag #JACSOperativeWord.
(24:28):
Subscribe to The Operative Wordwherever podcasts are available,
or listen on the American Collegeof Surgeons website at FACS.org/podcast.
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr Tom Varghese,and throughout the series, Dr Lillian
Erdahl and I will speak with recently
published authors about the motivationbehind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants,
(00:26):
and not necessarilythat of the American College of Surgeons.
Welcome loyal listenersto another episode of The Operative
Word, the podcast from the Journalof the American College of Surgeons.
This is the podcast where we deep diveinto fascinating articles
that have been recently published in JACS.
And I'm honored to be joined todayby two superstars in the House of Surgery.
(00:52):
First is, Dr Lauren Janczewski,
who is a fourth yeargeneral surgery resident at Northwestern
University, havingjust finished a two year, t32, sponsored,
research postdoctoral fellowshipthere at Northwestern.
And also, by the seniorauthor of this article that we're going to
(01:13):
discussing, Dr Yue-Yung Hu.
Dr Hu is a pediatric surgeon at the Annand Robert H.
Lurie Children's Hospital of Chicagoand a health services researcher
at Northwestern's, Surgical OutcomesResearch Center.
Dr Hu and Dr Janczewski,welcome to the podcast.
Thanks for having us.
(01:35):
The first questionto ask both of you, any disclosures,
that we need to talk about, for this,relevant study?
None for me.
None for me either.
I should say that Lauren is interviewingfor a surgical oncology fellowship,
and she's a superstar.
So that's athat's a shout out. That's funny.
and of course, the other disclosureI have to tell everybody is
(01:55):
I'm a proud alum of the NorthwesternSurgical training program.
So if you see a heads, you'rea little bit of a hint of favoritism,
sorry about that.
But, that's still going to be remainingthroughout the interview, so thanks.
Let's go ahead and take it away.
The article
where we're going to be talking todayabout is, “Contemporary evaluation
of work-life integrationand well-being in US surgical residents,
(02:18):
a national mixed-methods study.” Dr LaurenJanczewski is the first author
and Dr Yue-YungHu is the senior author of this article.
Let's start with you, Dr Hu.
Taking a 30,000-ft view, this
article was done under the frameworkor the auspices of the SECOND Trial.
Could you describe for uswhat that trial is or,
(02:41):
why you ended up embarking on this,amazing, innovative clinical trial?
Yeah.
SECOND stands for surgical education
and culture optimizationbased on national comparative data.
And I did I get all the acronym? Yeah.
That's correct.
And it's a trial of general surgeryresidency programs
looking at resident well-being.
(03:02):
And the reason it came aboutis because data
from the FIRST trial,which was run by Carl Bilimoria,
my co-PI on SECOND, showed
that resident well-being was declining,
in both arms of the trialabout duty hours.
And so there's clearly some issue there.
And we thought as quality improvementsort of researchers,
(03:23):
we could bring some dataand some technique to improve that issue.
That's amazing.
And, I want to get right into this articlebecause, I think that the article itself
is going to lend itselfto a lot of questions afterwards.
So, getting you starting with the article,you know,
you know,
your opening sentence was, you know,eye opening on the kind of reflecting back
(03:45):
what you just said.
Your opening sentence said that“Nearly 50%, half,
of US physicians report dissatisfactionwith the balance in their personal
and professional lives, frequentlyreferred to as work-life integration.”
I guess we're starting off right there.
probably a question to either of you.
The debate between work-life integrationand work-life balance.
(04:08):
I mean, you guys went right kneedeep into that.
Comments about that or,
you know, you just said, I'mgoing to jump right in and let's go to it?
Yeah, that's a great question.
I feel like ittruly is from a surgeons perspective,
work-life integrationcompared to work-life balance, because,
(04:29):
the demands of our job are so,
it's a it's unique in that it'sphysically demanding.
The scheduling is extremely challenging.
And so you're trying to fitin multiple facets of your life,
both personal and professional,into a very limited time frame.
And it requires,you know, when you're scrubbed
(04:50):
in, you have no access to what's going onoutside of the operating room.
And so you're constantly trying to fit in,
multiple facets of your lifein between cases.
And so it really is kind of integratedall into one.
I mean, obviously the vastmajority of the time spent at work
(05:12):
is dedicated to work, but often that workspills over into your home time, too.
And so I don't think that a true 50/50balance exists.
It really is most, a lot,
a lot of it truly is work-life integrationon a daily basis.
I don't knowif you have anything to add, Dr Hu.
No, I think that was really well said.
And so to some degree it'sjust a semantic difference between balance
(05:35):
and integration, but balance kind of makesyou feel like you are failing at it
when you are not perfectlybalanced. Right?
And it's the same...have you heardMichelle Obama talk about marriage?
And she talks about like relationshipsare rarely 50/50, right?
Like someone always is doing more or less.And it sort of goes back over time.
I think integration speaks to thatbetter than that.
No, I think those are, eloquentstatements.
(05:56):
Absolutely.
Well, let's, go further into the study.
So, the methodology, it was very unique.
You did a convergent mixed-method studywhere you combined
national quantitative survey dataas a result of getting it from
the ABSITE, the in-training exam, thegeneral surgery residents take every year.
And then you follow that up with in-depth
(06:18):
semi-structured interviewsand focus groups.
Dr Janczewski,how difficult was this to do?
Because I think that, you know, first off,I'm just trying to wrap my mind around
getting everybody to agreeto take a survey
at the end of taking an exam,and then you're following up with,
you know, this is not an easy topicfor many surgeons to talk about.
(06:38):
Can you comment on on the ease or thetechnical difficulties of doing the study?
Yeah, I think we're,
well, me inparticular is extremely fortunate
to have the opportunityto work on SECOND trial research
at northwestern because,
you know,
the setting is truly unique because that'sone of the extreme challenges
(07:01):
in performing a survey-based studyis especially with modern,
administration
techniques, with social media.
One, we have a calculable response rate,and the response rate is extremely high.
And so, I think, I mean, I don't know
what your perspective is, Dr Hu,from what, what,
(07:23):
what you were expecting in terms
of a response rate after the first timeyou administered one of these studies.
But routinely every yearthe response rate is extremely high,
despite it being administered after,the ABSITE exam
when people have just taken a five-hourtest, people still,
fill out the survey.
And I think it just it is a tributeto how important the topic of resident
(07:46):
wellness is right now,because even after taking a five-hour
exam, people still feel passionatelyabout filling out the survey.
To provide us with the data to both,
so that we can study this and
then design interventions to help,
you know, improve upon this topicmoving forward.
And so,
(08:07):
each year there's different questionsthat get worked into the survey.
And so from this particular year,we had several questions
that were dedicated towardswork-life integration.
And it started outprimarily as a quantitative study.
But then we realized after, you know,we have so many transcripts available
from the qualitative portionof the SECOND Trial study as well, that,
(08:29):
even though it was primarily designedaround resident wellness time
and time again,there are so many transcripts
where the topic of work-lifeintegration came up.
And so we were able to, expand
it to become, mixed-methods, study.
Yeah,the study mechanism predated me, actually.
That's something Carlset up for our FIRST Trial.
(08:50):
I like what I hope the reasonpeople take the test is, I mean,
everyone has take the test.
There's.
I hope that the reason people takethe survey is for a second.
We basically aggregate all the responsesat the level of the program, benchmark
against other programs,and then feed it back to the program
so that they canthen do something about their response.
So, the survey is meant to be
a mechanism for residents to communicateanonymously with their program
(09:12):
about issues that they may feeluncomfortable talking about.
Right?
You can imagine,
I think we were just talking beforewe started this conversation about how,
like, these are issues nobody talks about,so nobody wants to go back and be like,
I need more work-life integration.
Like I don't have enough home life.
Like everyone has some shame around sayingthat.
And so, this is a way for the programto get data to say, like, our residents
(09:35):
feel worse about this
than other residents in the countryand then, use that as a tool.
So hopefully that's the motivationbehind survey completion.
Yeah. No, but I mean, that's a survey.I, I agree with that.
But I thought that the unique thingwas the qualitative
I mean the you went and did two-day tours
at 15 general surgery programs,
(09:56):
you know, interviewing residentsof all levels as well as faculty members.
I mean, you know,just trying to wrap my mind around
how labor intensive that is.
But you pulled it off.
I mean, I mean, I mean, kudos to you.
I mean, it's one thing to get everybodyto answer a survey at the end of an exam.
I mean, that in itself is the logisticsbeyond that.
But, you know, you've been doing thatfor a few years now.
(10:18):
But the qualitative aspect,I mean, I guess the question was,
was there any barriers that you encounter,I mean, was or buy in
or were people like suspiciouswhen you were coming to ask them about,
you know, perceived,you know, touchy feely issues?
I mean, was there a lot of resistance
where you guys went and visitedthese programs?
You know, I have to, first of all,give flowers to Julie Johnson.
(10:39):
She's the qualitativePhD that works with us.
She's now at UNC and she was amazing andhelping us plan and strategize about this.
You know, we worried about that.
But then when we got there,people were like coming
out of the woodwork to tell us things,and it's almost like you were an outlet.
And so
even years after people that I interviewwill come back and be like,
that was like a therapy session,and I'll be like, that's what I am like,
(11:03):
but,
you know, I don't really feel likewe had to like, draw it out of people.
And it just was right at the forefront.
And we conducted the interviewssort of broadly
such that we were asking about well-being.
And people would tell us, you know,maybe there are a couple of prompts,
but we weren't specifically like,how do you feel about work-life balance?
I don't know, it was amazing
learning experience that helped us developfuture questions in the ABSITE survey.
(11:25):
I don't think we could have donewhat we did
without all those peoplewho were willing to participate.
That's amazing.
Well, let's get right into thethe results.
So, you had, out of,
8460 people who took the ABSITE,
you had, 7233 respondents.
So about an 86% response rate.
(11:46):
I mean, kudos to you, right?
That there I mean, that's a tremendousresponse rate for a survey.
And then,
Dr Janczewski, let's just talk about it.
I mean, what were the thingsthat really struck out to you about,
you know, some of the findings?
So, I mean, we could go through all this,but I want you from your perspective,
what were the things that really stuck outas, you know,
things that you expected,but things that were surprising?
(12:09):
Yeah, I think we were expecting
we were definitely expecting that,
Overall, the,
that work-life integration amongstsurgical residents would be poor.
But it was it was pretty interestingto see how it differed
amongst the different work-lifeintegration domains that we were serving,
surveying, particularly with,
(12:32):
dissatisfactionwith the time for personal life,
because that was actually the lowestin terms of dissatisfaction,
which I think while we were approachingthat survey, we anticipated
that that would be like the highestamong those amongst the list.
And I think moving forward beyond that.
Thus we found such a strong associationwith the presence of work-life conflicts
(12:55):
with all four well-being measuresthat we were studying being,
career dissatisfaction, burnout,thoughts of attrition, and
and even suicidality, which I think justgoes to show how important this topic is
in addressing moving forward sothat we can improve well-being as a whole.
But the fact that
the frequency of residentsreporting dissatisfaction with their time
(13:17):
for personal lifebeing lower than we expected,
I think you know, your timeoutside of the hospital as a resident
is so limited that you only have timeto prioritize a few things,
and so perhaps people aren't pri...I mean,this is all speculation,
but perhaps people are not prioritizingtheir personal relationships over,
(13:38):
over their, like, physical health.
But again, it's you have such little time.
You're trying to fit everythinginto one thing until into one time frame.
And so,
it's it's a really hard problem to solve.
But we're hoping that,
you know, this data will help shed somelight into moving the needle a little bit.
Moving and moving forward.
Yeah. Okay. Oh, go ahead, Dr Hu.
(14:00):
And then I was just gonna saythe way the question is framed,
it's like,are you dissatisfied with your ability to.
And so it could be
that you never go to the doctor,but that doesn't dissatisfy you, per se.
Yeah, I know,
I mean, yeah, because I mean,I was going to comment on the numbers.
I mean, you know, just looking at it,you know, 37.6% of residents
report dissatisfaction with how much timethey have for their personal life.
(14:23):
But then the beauty of this study isyou went and teased all that out.
I love the way that you frame thatDr Janczewski about, well-being measures.
You know, 52% were dissatisfiedwith a time
that they needed to maintaina healthy habit.
It’s 48% were dissatisfied with timeto perform routine health maintenance.
and then additionally,this was a surprising,
(14:45):
well,I guess of which shouldn't be surprising
because many of us facultyare at fault for this,
that 44% of residents were doing noneducational tasks
after they got home,and we know from national data
faculty are the biggest,you know violators of that.
Like when they get homethey're always charting on
electronic medical recordsand things like that.
(15:07):
And so that part didn't surpriseme as much, but it was just I like the way
you frame that Dr Hu, is like, even,you know, what is the dissatisfier here?
It's because the question is framed
is, “are you dissatisfied with the timeyou have?” But I guess
nobody who cares about their homelife wouldn't be dissatisfied.
But but we're not asking.
But we're not saying like you shouldn'tcare about your health or you shouldn't,
(15:28):
you know, care about spending timewith your family.
But we weren't trying to make those valuejudgments for people like that.
That's why the questions framed that way.
But yeah, yeah, getting to next steps.
I mean, I think I encourageall the listeners of this podcast,
I mean, this is a phenomenal article.
There's so much rich data.
I really hope that people spend,especially program directors out there,
(15:51):
and residents spend time
with this article teasing thatthat the only thing I loved about it
is you guys actually gave highlightsabout programs that are doing it well
and some pragmatic stepsthat programs could do.
Dr Janczewski, can you talk to us aboutwhat are the things that you found that so
the programs that were doing thingswell, yeah, I'm definitely biased
(16:11):
because I think that as someonewho was involved with the study.
But I think that's what makes it special.
It's incorporatingsome of the qualitative data and,
being able to provide like
the programs who are reportingwhat information and data
with regards to programs,who are reporting that
they're doing itwell and finding success and
(16:33):
improving work-life integrationamongst their residents. And,
some of the key
like qualitativefindings amongst those programs
were, for example, giving some more
autonomy to the residentsin terms of their scheduling,
and a common theme that we found amongstthat was residents or programs
(16:56):
incorporating a flex weekwhere they could use those days however,
you know, of course,
with communication and advanced planning,but use those days throughout the year
so that they could have a day offto schedule appointments or,
you know, go to a weddingthat they would need to travel for,
as well as other factorsthat I think were kind of expected.
(17:19):
But, important to, talk about as well.
Like, you know, a lot of this is dependentupon the program culture as well.
And it comes from the leadershipand faculty down to the residency program.
It it prioritized in role modelingand prioritizing work life integration
so that residents, you know,I think it starts with the culture, too.
(17:40):
Yeah.
And, it actually brings to mind,you know, one of my favorite
books that I've ever read is,
you know, Daniel Pink's,
book on drive and where he, he talks about
there'sthree essential components to have,
you know, really fulfillment in life,which is you pick something which where
(18:01):
there's a purpose, mastery, and autonomy
and the first twowe clearly have in the world of surgery.
Right?
We're doing things on behalfor for patients,
you know, something beyond ourselves.
Mastery.
Of course, surgeryis the ultimate example of mastery.
The more you do it, you get masterful.
But I love the factthat, you've landed on autonomy.
(18:23):
Like, that's the piecethat we need to figure out to hopefully
help solve these issues. Correct?
Yeah, I one of my favorite well-beingarticles is like a perspectives
piece in the New England Journal.
It's by Groopman and Hartzband and it'sabout like what is faculty motivation?
And they have three pillarsand they are: competence which,
that makes sense for a clinician. Right.
(18:44):
You have to feel like you're competentat your job and you're growing your job.
The other is
they call it like affiliation.
I would say it'sbasically a sense of community, right?
Like you have to feel connected to peopleyou work with.
And then the third is autonomy.
Like, you have to have some controlthat says autonomy, sense of control.
We have long thought that residency is atime where you just lose autonomy, right?
(19:05):
You just submit to the process.
I had this super interesting conversationwith,
there's an anthropologist who was hired bythe American Board of Internal Medicine,
and he pointed me to this, like,seminal article in anthropology
about how there are transitions,like rituals of transitioning
in every culturewhere you move from one phase to the next.
And in the middle,you're in this liminal phase
(19:25):
where you're just expected to submit.
There's no questioning about what theprocess is. You just do it. Right? And it
may or may not make sense.
And so that's kind of what residency is.
But it's a really long time. Right? So.
It's like, my, residencytraining was like ten years for us.
Right?
Yeah a long time to not have any controlover you know, do you see your family?
(19:46):
Yeah. Do you go to the doctor?
No, I hear you.
Well, we could go all daywith this conversation.
There's so many different ways,but I just have a few moments left.
But, so,I wanted to give you the last word.
Dr Hu.
Yeah, I just wanted to...sorry...can
Our toolkit can be foundat Toolkit.theSECONDtrial.org.
(20:06):
You need to spell out
“second,” so it’s S-E-C-O-N-D,and so, people can go there and look up
how to do a bunch of the interventions
we talked about,like the flexible vacation week. Perfect!
Perfect.
But, yeah.
So, yeah, kind of final thoughts. I mean,
Dr Janczewski, you could, you could,chime in as well.
Dr Hu, do we need to do somethingsimilar for faculty,
(20:28):
you know,or is that, like, too big a Pandora's box?
So we should -Oh, it probably is too big a Pandora's box.
You know, for all of a SECONDI was, like, out of scope.
I don’t want to deal with that problem.yeah.
Part of what we were hearing fromall these interviews
were faculty being like,what about my well-being?
What about my well being.
And I think that's now we're like,okay, maybe we can take this on.
So the THIRD trial is going to dealwith inclusion and departments
(20:51):
and surgery and faculty and residentwell-being, like all the things.
So I think that’sthe next layer of the onion.
But I mean, what do you think?
So, like as faculty,senior faculty, what’s your...
Translation, loyal listeners,
that they’re calling me old right now,but that’s all, you know.
[Laughter]
I admire all of youfor doing two things. I think
(21:13):
that we are changing it.
The culture is changing in the Houseof Surgery.
And the reason I say that iswe are finally talking about these things.
You know, Ithe old sayings that people used to say,
you know, “The problemwith every other day call was you missed
half the cases.” You know,these are like antiquated,
outdated things that need to be retired.
(21:35):
Go by the go like the dinosaurs.
They just need to go extinct.
I mean, I think that what we need to dois talk about, this is a hard profession.
What we do is hard work. It’s.
But we have amazing, talented,
dedicated human beingswho want to do this hard work.
But we shouldn’t be doing this hard work
(21:55):
by destroying our personal livesand everything around us.
You know?
And I think that the fact
that we're talking about this,I think, is a major first step.
I still think that we do have some uphillbattles,
to tackle.
You know, one of this is talking aboutthese
type of things is not a sign of weakness.
Actually, it’s a sign of strengthto say that these are the things
(22:19):
that we need to address to make surewe have long, productive careers.
Now, let's be honest with it.
The better or more productivea career a surgeon has,
patients and communitiesbenefit from that.
So, yeah.
So, you you've got me as a card-carrying,you know, member of, “Absolutely.
We need to do more of this.”
And I really, really am excitedabout your future work.
(22:43):
Dr Janczewski, I’m assuming that, eventhough you’re going to surgical oncology,
this is going to be part of your careergoing forward, correct?
Yeah, I think so.
I, I mean, I look forward to as someone I,as someone who,
has like, pursued family
planning in and growing my familyduring residency.
I’ve realized how challenging it is,
(23:04):
And that.
I look forwardto mentoring people in the future
who, are looking to go down thatroad as well, because I think, like Dr
because I think,
like Dr. Hu said is such a long time, and the vast,huge portion of your adult life
that you are dedicatingtowards your career.
(23:27):
And it’snot to say that no one’s dedicated.
I mean, you would never do this jobif you didn’t truly love it,
but you can’tput your life on hold for 7 to 10 years.
And so, I’m looking forwardto continuing this work with Leap Forward.
Dr Hu, final words for our listeners.
Yes, for peopleinterested in enrolling in THIRD Trial,
(23:47):
which again, is free
for both faculty
and residents, it’s SENTteam@IU.edu.
So email us at SENTteam@iu.edu.
Dr Janczewski, Dr Hu,thank you from the bottom of our hearts.
On behalf of our listenersfor The Operative Word, the podcast
for The Operative Word, the podcast
for the Journal of the American College of Surgeons.
(24:08):
Thank you for joining us.
And, we are really excitedand looking forward to the work ahead.
Thanks so much.
Thank you for listeningto the journal of the American College
of Surgeons Operative Word Podcast.
If you enjoyed today’s episode,
Spread the Word on social mediaby using the hashtag #JACSOperativeWord.
(24:28):
Subscribe to The Operative Wordwherever podcasts are available,
or listen on the American Collegeof Surgeons website at FACS.org/podcast.
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