ImportanceMany 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.ObjectivesTo 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 ParticipantsA 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.ExposureResidents were asked, “Do you have a mentor who genuinely cares about you and your career?”Main Outcomes and MeasuresResident 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.ResultsA 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 RelevanceOne-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.

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指导方面的差异及其对美国外科住院医师教育和健康的影响

重要性许多外科医生将指导视为培训的重要组成部分。然而，关于与指导相关的因素以及指导对受训者教育或健康的影响的证据很少。 目标评估与外科受训者对有意义的指导的看法相关的因素，评估指导与住院医师教育和健康的关联，并评估指导中的程序变化设计、设置和参与者在 2019 年美国外科委员会在职培训考试之后，对所有经认可的美国普通外科住院医师计划中的临床活跃住院医师进行了一项自愿、匿名调查。对 2019 年 7 月至 2022 年 7 月的数据进行了分析。Exposure 居民被问到，“你有一位真正关心你和你的职业生涯的导师吗？”主要结果和措施通过多变量逻辑回归评估与有意义的指导报告相关的居民特征。使用控制住院医师和项目因素的聚类调整多变量逻辑回归来检查指导与教育（临床和操作自主性）和健康（职业满意度、倦怠、消耗想法、自杀）的关联。居民的种族和族裔是使用美国人口普查类别（美洲印第安人或阿拉斯加原住民、亚洲人、黑人或非裔美国人、夏威夷原住民或其他太平洋岛民以及白人）进行自我识别的，这些类别被组合并分为非西班牙裔白人和非西班牙裔白人-白人或西班牙裔。结果共有来自 301 个项目的 6956 名居民完成了调查（回复率为 85.6%）； 6373 人回答了所有相关问题（2572 人 [40.3%] 为女性；2539 人 [39.8%] 非白人或西班牙裔）。其中，4256 人（66.8%）表示受到了有意义的指导。与非西班牙裔白人居民相比，非白人或西班牙裔居民报告有意义的指导的可能性较小（比值比 [OR]，0.81，95% CI，0.71-0.91）。高级住院医师（研究生 4/5 年）比实习生更有可能报告有意义的指导（OR，3.06；95% CI，2.59-3.62）。受到有意义指导的住院医师更有可能认可操作自主权（OR，3.87；95% CI，3.35-4.46），并且不太可能报告倦怠（OR，0.52；95% CI，0.46-0.58）、减员想法（OR，与没有有意义指导的居民相比，自杀率（OR，0.42；95% CI，0.36-0.50）和自杀倾向（OR，0.47；95% CI，0.37-0.60）。结论和相关性三分之一的受训者报告缺乏有意义的指导，尤其是非白人或西班牙裔实习生。尽管教育和健康是多因素问题，但指导与改善相关。因此，需要努力促进指导，特别是针对少数群体居民。