Barriers to Wellness Among General Surgery Residents During the COVID-19 Pandemic: Qualitative Analysis of Survey Responses.

Background: Health care provider burnout worsened during the COVID-19 pandemic. Objective: This qualitative study described general surgery residents' perceptions of burnout and the impact of the COVID-19 pandemic and their attitudes toward wellness initiatives. Methods: General surgery residents at a large training program in Canada completed a 21-item survey focused on self-reported burnout, mental health, perceptions of wellness resources, and the effects of the COVID-19 pandemic. Free-text responses were extracted for qualitative thematic content analysis. A coding framework was established, and emergent themes were identified. Results: A total of 62% (51/82) of the residents completed the survey. Most respondents were senior residents (21/51, 41%) and identified as male (32/51, 63%). In total, 65% (33/51) of the residents met the criteria for burnout. Three themes were identified: (1) the culture of general surgery does not promote wellness, (2) the COVID-19 pandemic worsened existing access to vacation days and rest, and (3) wellness education in general surgery is ineffective and onerous to complete. General surgery residents emphasized the rigid lifestyle and culture of the specialty. Residents said that the idea of wellness was poorly executed. COVID-19 protocols increased the acceptance of taking sick days, but this was offset by staff shortages during the pandemic. Finally, residents emphasized the inefficacy of wellness education. They felt that they did not lack knowledge on reaching wellness but simply lacked the adequate time and resources to improve their well-being. Conclusions: There are persistent concerns within the culture of general surgery that were further impacted by workload and stress during the pandemic. These results may inform future programmatic efforts to decrease resident burnout.