An Exploration of Culture in General Surgery Training Programs: A Scoping Review

Katrina Monton; Olivia Monton; Ann-Margret Ervin; Alexandria L Frank; Stella M Seal; Caryn J Block; Fabian M Johnston

doi:10.1097/SLA.0000000000006932

An Exploration of Culture in General Surgery Training Programs: A Scoping Review

Ann Surg. 2025 Sep 10. doi: 10.1097/SLA.0000000000006932. Online ahead of print.

Authors

Katrina Monton¹, Olivia Monton², Ann-Margret Ervin³, Alexandria L Frank¹, Stella M Seal⁴, Caryn J Block¹, Fabian M Johnston⁵

Affiliations

¹ Department of Organization and Leadership, Teachers College, Columbia University, New York, NY.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, McMaster University, Hamilton, ON.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁴ Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.

PMID: 40928079
DOI: 10.1097/SLA.0000000000006932

Abstract

Objective: The objective of this study was to systematically explore how culture has been conceptualized, investigated, and measured within general surgery residency training programs.

Summary background data: Research on the culture of general surgery residency training programs has primarily focused on examining individual parameters, such as mistreatment and burnout, rather than comprehensively analyzing the overall culture, climate, or learning environment.

Methods: Five databases (PubMed, Embase, Cochrane, CINAHL, APA PsycInfo) were searched. The searches included a combination of controlled vocabulary and keyword terms related to culture, environment, climate, and general surgery training. Two reviewers performed title and abstract screening and full text review. A narrative synthesis was performed.

Results: Seven studies met the eligibility criteria and were included. Most studies (n=6, 85.7%) were conducted in the United States. Four studies (57.1%) were single-center and three (42.9%) were multi-center studies. Only two studies defined and three measured culture, climate, or the learning environment using validated instruments. The included studies explored various components and outcomes of culture, including teaching, training, and learning opportunities; workload, resources, and support; well-being, stress, and suicidal ideation; duty hour violations and burnout; mistreatment, harassment, discrimination, and abuse; and job satisfaction and attrition.

Conclusions: This scoping review revealed significant heterogeneity in the ways in which culture has been evaluated and characterized within the general surgery training literature. A more unified approach to exploring organizational culture in general surgery training programs would allow for advancement of the field.

Keywords: climate; culture; environment; general surgery residency; general surgery training; resident wellbeing.