Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness

Abstract

Importance: Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. Objectives: To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. Design, Setting, and Participants: A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Exposure: Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Main Outcomes and Measures: Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. Results: A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. Conclusions and Relevance: One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents..