Do you see what I see?: exploring trends in organizational culture perceptions across residency programs

Program culture is a highly emphasized attribute across surgery residency programs and throughout trainee recruitment. A positive program culture has been linked to increased resident satisfaction, perceptions of improved program support, and reduced resident burnout and attrition. The aim of this study was to evaluate trends in program culture across residency programs and to identify differences in culture perceptions between residents and faculty members. This was a multi-institutional study involving seven general surgery residency programs. Faculty and residents completed a 29-item program culture inventory which was divided into four distinct dimensions: Authoritative, Self-directed, Empowering, and Relational. Dimensions were rated on a scale of 1–5, with 1 being “Not at all accurate” and 5 being “Very accurate.” Statistical analyses were assessed via independent t-tests and analysis of variance (ANOVA). A total of 124 subject matter experts (SME, 95 faculty and 29 senior residents) across seven general surgery residency programs completed the program culture inventory. Each program had an average of 18 SMEs (range 8–38). Average ratings across the four dimensions ranged from 2.53 to 4.03. Collectively, programs were rated lowest in the Empowering dimension, which evaluated whether trainees felt encouraged to identify opportunities for leading and taking initiative. Programs were rated highest under the Relational dimension, which assessed interpersonal support and relationship with peers. Programs shared similar perceptions of Self-directed, Empowering, and Relational culture. However, there was a significant difference in the degree of perceived Authoritative culture across programs (p < 0.05, CI 0.03–1.26). Faculty members tended to rate their program as less Authoritative (2.71 versus 3.14, p < 0.05; CI − 1.14 to − 0.25) compared to residents. Surgery residency programs differ significantly in the perception of Authoritative attributes among residents and faculty. Further evaluation of leadership styles can offer opportunities to create a more cohesive and favorable culture in residency programs.