title: Effect of program type on the training experiences of 248 university, community, and US military-based general surgery residencies.
abstract: BACKGROUND
  There is a paucity of research comparing resident training experiences of university, community, and military-affiliated surgical programs.
  
  
  METHODS
  We reviewed a cross-sectional national survey (NEARS) involving all US categorical general surgery residents (248 programs). Demographics and level of agreement regarding training experiences were collected. Statistical analysis included chi-square, ANOVA, and hierarchical logistic regression modeling (HLRM).
  
  
  RESULTS
  There were 4,282 residents included (82.4% response rate). The majority (69%) trained in university programs. Types of programs differed by sex mix (p < 0.001), racial makeup (p = 0.005), marital status profile (p = 0.002), and parental status profile (p < 0.001). Community residents were most satisfied with their operative experience (community 84.5%, university 73.4%, military 62.4%; p < 0.001), most likely to feel their opinions are important (76.0% vs 69.4% vs 67.9%, respectively; p < 0.001), and least likely to believe attendings will think worse of them if residents asked for help with patient management (12.6% vs 15.9% vs 14.7%, respectively; p = 0.025). Military residents were least likely to report that surgical training is too long (military 7.4%, community 14.0%, university 23.8%; p < 0.001). On HLRM, community programs were independently associated with residents feeling their opinions are important (odds ratio [OR] 1.91; p < 0.001), and reporting satisfactory operative experience (OR 4.73; p < 0.001). Residents training at military programs (OR 0.23; p = 0.002) or community programs (OR 0.31; p < 0.001) were less likely to feel that surgical training is too long, or that attendings will think worse of them if asked for help with patient care (community OR 0.19; p < 0.001; military OR 0.27; p = 0.004).
  
  
  CONCLUSIONS
  Residents at university, community, and military programs report distinct training experiences. These findings may inform programs of potential targeted strategies for enhanced support.
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Sullivan
authors.forename: Gloria
authors.initials: G
authors.lastname: Sue
authors.forename: Emily
authors.initials: E
authors.lastname: Bucholz
authors.forename: Heather
authors.initials: H
authors.lastname: Yeo
authors.forename: Richard H
authors.initials: RH
authors.lastname: Bell
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000328:Adult; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D058749:Military Facilities; D015999:Multivariate Analysis; D012577:Schools, Medical; D011795:Surveys and Questionnaires; D014481:United States