Research Letter
Pacific Coast Surgical Association
Faculty and Resident Perceptions of Learning Activities During Surgery Residency
David M. Rosenberg, Cooper Nagaki, Christian de Virgilio, et al
JAMA Surg 2026;161;(10):1093-1095. doi:10.1001/jamasurg.2026.3208
Nonclinical resident educational activities in general surgery residency, such as morbidity and mortality conference (M&M), are vital to the maturation of trainees into independent surgeons. Previous studies1-4 have examined resident and faculty evaluations of the perceived effectiveness of these activities; however, many are limited in scope to a few select activities or small number of institutions. Thus, a framework to systematically measure their quality is needed. Gap analysis is a model of organizational improvement by which the discrepancy between a process’s current performance and a desired future state is measured by eliciting stakeholder input.5 We performed a gap analysis with a multi-institutional survey of 19 nonclinical resident educational activities, assessing the importance and perceived effectiveness of each.
Methods
Core faculty and residents from 15 general surgery residency programs were recruited via direct email communication. Survey respondents were asked to assess the importance and effectiveness of 19 different nonclinical education activities on a 5-point Likert Scale, ranging from “not important/effective” to “extremely important/effective.” Respondents were also given optional responses of “have not yet participated” and “not available at my institution.” The meanings of important and effective were left to the interpretation of individual survey respondents. Survey responses were collected anonymously via Microsoft Forms.
Responses were obtained anonymously and aggregate comparisons were tested for statistical significance using the nonparametric Mann-Whitney U test with an α level of .05. To compare across junior vs senior resident vs faculty responses, the Kruskal-Wallis test was performed followed by the Dunn post hoc test to identify which subgroups significantly differed from one another (with the Holm method used to correct for multiple comparisons). All data analysis was performed on Python version 3.8.8 (Python Software Foundation). The results and methods described were reported using the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).6 Institutional review board exemption was obtained from the Lundquist Institute.
Results
There were 538 survey responses of 1229 possible respondents (43.7%), of which 283 were faculty (53%) and 255 (47%) were residents. The demographic data are shown in the Table.
Table. Demographic and Professional Traits of Respondents
| Responses to questions | No. (%) |
|---|---|
| Gender | |
| Male | 290 (53.9) |
| Female | 240 (44.6) |
| Something elsea | 5 (0.9) |
| Nonbinary | 3 (0.6) |
| Self-reported race (select all that apply), No. (% of total respondents) | |
| Asian | 119 (22.1) |
| Black/African American | 31 (5.8) |
| Latino/a/x | 36 (6.7) |
| Native American | 4 (7.4) |
| Pacific Islander | 6 (1.3) |
| White | 353 (65.6) |
| Something elsea | 41 (7.6) |
| Self-reported Hispanic ethnicity | |
| No | 496 (92.2) |
| Yes | 42 (7.8) |
| Role | |
| Junior resident (R1-R3) | 148 (27.5) |
| Senior resident (R4-R5) | 107 (19.9) |
| Faculty | 283 (52.6) |
| Faculty role | |
| Program director/assistant program director | 39 (13.8) |
| Division chief | 36 (12.7) |
| Vice chair | 12 (4.2) |
| Department chair | 6 (2.1) |
| No additional designation | 187 (66.1) |
| Faculty experience, y | |
| 0-5 | 93 (32.8) |
| 6-10 | 50 (17.7) |
| >10 | 140 (49.5) |
The activities, in order of perceived importance, are listed in the Figure. Only 8 of the activities (42%) were offered at all programs. Both residents and faculty rated M&M as the most important activity, though faculty rated it higher (mean [SD], 4.8 [0.4] vs 4.5 [0.7] for residents; P < .001). There was a statistically significant difference between perceived importance and effectiveness for all activities except the diversity and inclusion curriculum (Figure). For effectiveness, faculty rated 14 activities higher than residents, whereas for importance faculty only rated 5 activities higher. For the 8 activities offered at all institutions, the largest gap between importance and effectiveness was attending rounds (mean [SD], importance, 4.4 [0.7] vs effectiveness, 3.6 [1.0]; P < .001). The activities with the greatest difference of rated effectiveness were clinical simulation (mean [SD], resident vs faculty, 3.2 [1.2] vs 3.8 [0.9]; P < .001) and career planning (mean [SD], resident vs faculty, 2.8 [1.3] vs 3.4 [1.2]; P = .001).
Figure. Likert Scales Showing Perceived Importance vs Effectiveness of Nonclinical Educational Activities
A, The perceived importance and effectiveness of noneducational educational activities, plotted by their mean values with their standard error margins. B, The perceived importance and effectiveness ratings plotted by mean faculty vs resident ratings with their standard error margins. Light blue circles represent residents, dark blue squares represent faculty both for importance columns; light orange circles represent residents and orange squares represent faculty both for effectiveness columns. ABSITE indicates American Board of Surgery In-Training Examination; FES, fundamentals of endoscopic surgery; FLS, fundamentals of laparoscopic surgery.
aActivity available at all surveyed programs.
bP < .05; Mann-Whitney U test.
For the subgroup analysis, the largest statistically significant differences in ratings provided by junior vs senior residents vs faculty were for the importance of fundamentals of laparoscopic surgery (FLS) and fundamentals of endoscopic surgery (FES) curricula. These differences were driven primarily by junior vs senior residents, with junior residents providing higher ratings in each case (mean [SD] for FLS, 3.8 [1.2] vs 3.2 [1.2]; P = .004; for FES, 3.7 [1.2] vs 3.0 [1.3]; P < .001). For effectiveness ratings, FLS and FES once again exhibited the largest differences, with these differences being driven by senior residents vs faculty (mean [SD] for FLS, 2.9 [1.2] vs 3.4 [1.0]; P = .001; for FES, 2.6 [1.2] vs 3.3 [1.0]; P < .001). The junior resident vs faculty ratings did not differ significantly.
Discussion
M&M was deemed the most important nonclinical educational activity by both residents and faculty. This likely reflects surgical programs placing emphasis on M&M and its importance to resident learners while also likely being the longest standing educational activity at most residencies. M&M also often provides a forum in which faculty and residents interact directly. There were significant gaps between resident and faculty perceptions of the importance and effectiveness of many other educational activities that comprise nonclinical residency training. Some activities, such as attending rounds and technique/operative simulation, had a high level of perceived importance yet exhibited the largest gaps in effectiveness. Residents and faculty were largely aligned on the importance of activities, yet residents often rated the effectiveness of many activities lower than did faculty. Future directions for this work should include qualitative approaches, such as interviewing respondents, to determine why these gaps exist and how they would envision an effective activity. Ongoing research is needed to identify why these gaps in educational effectiveness exist in order to meaningfully improve nonclinical activities for future trainees.
