LAUSR

BACKGROUND Value congruence is the degree of alignment between worker and workplace values and is strongly associated with reduced job strain and retention. Within general surgery residency, the impact of value congruence and how to operationalize it to improve workplace wellbeing remain unclear. STUDY DESIGN This two-part mixed-methods study comprised two surveys of US general surgery residents and qualitative interviews with program directors. In Part 1, January 2021, mixed-level surgical residents from 16 ACGME-accredited general surgery residency programs participated in Survey #1. This survey was used to identify shared or conflicting perspectives on value congruence concerning wellbeing initiatives and resources. In April 2021, interviews from eight institutions were conducted with nine program directors or their proxies. In Part 2, May-June 2022, a similar cohort of surgical residents participated in Survey #2. Unadjusted logistic and linear regression models were used in this survey to assess the association between value congruence and individual-level global wellbeing (i.e., flourishing), respectively. RESULTS In Survey #1 (N=300, 34% response rate), lack of value congruence was an emergent theme with sub-themes of inaccessibility, inconsiderateness, inauthenticity, and insufficiency regarding wellbeing resources. Program directors expressed variable awareness of and alignment with these perceptions. In Survey #2 (N=251, 31% response rate), higher value congruence was significantly associated with flourishing (OR 1.91, 95% CI 1.44-2.52, p<0.001). CONCLUSIONS Exploring the perceived lack of value congruence within general surgery residency reveals an important cultural variable for optimizing wellbeing, and suggests open dialogue as a first step toward positive change. Future work to identify where and how institutional actions diminish perceived value congruence is warranted.