Second Trial - Program Tours

As part of the SECOND Trial, we conduct Program Tours at surgical residency programs around the country to learn about various strategies they employ to enhance and improve their learning environments and residents’ well-being. Program Tours are an opportunity for programs to showcase their wellness initiatives. The lessons we learn are used to build our Wellness Toolkit of adaptable and ready-to-implement interventions. Institutions and intervention experts are credited in the Toolkit for their innovative approaches. Experts are invited to host webinars sharing their experience and challenges implementing these interventions, and many volunteer to support programs in advisory roles.

To protect the confidentiality of participating residents, faculty, and staff, all information collected during the Program Tours is kept confidential. There is no feedback to participating programs. No identifiable information (e.g., name, etc.) is collected from individuals participating in the Program Tours.

Summarized Program Tour Information

Duration: Each Program Tour lasts approximately two days. Coordination is performed by SECOND Trial staff in conjunction with each program’s residency coordinator(s). We want to learn from what you do every day, so there is no need to alter your daily routine.

To adapt to our present circumstances with COVID-19, we may conduct future Program Tours virtually.


You can anticipate in-person Program Tours to include:

  • Resident social event
  • Observations of educational conferences
  • Tour of resident workspaces
  • Individual interviews with residents, faculty, staff, and program and institutional leadership
  • Resident focus groups
  • Review of standing policies impacting resident experience (e.g., maternity/paternity leave, vacation scheduling protocols, etc.)

You can anticipate Virtual Tours to include:

  • Observations of educational conferences conducted virtually
  • Individual interviews with residents, faculty, staff, and program and institutional leadership
  • Resident focus groups
  • Review of standing policies impacting resident experience (e.g., maternity/paternity leave, vacation scheduling protocols. etc.)

Program Tour FAQs

What is a Program Tour?

A team of SECOND Trial researchers visit a variety of programs to learn about their learning environments and different approaches to resident wellness. Over the course of two days, our team observes educational conferences and resident work processes as well as performs interviews and focus groups within the organization.

Because Virtual Program Tours do not require travel, they are not restricted to the two day schedule; they may be scheduled over 1-2 weeks.

How does my program benefit from a Program Tour?

The Program Tour is a way for us to highlight the work you have done to improve the learning environment and wellness of residents. Program Tours should therefore be a source of pride among your residents and faculty; we hope programs view the Tour as a showcase and a celebration. Upon completion of the in-person two day Program Tour, the SECOND Trial team will host a social event for your residents.

Resident wellness initiatives and resources identified during Program Tours may be included as content in the SECOND Trial’s Wellness Toolkit. All content included in the Toolkit will be credited to the source program. By including your work in the Wellness Toolkit, we all will be able to influence the experience of surgical residents throughout the country.

How many programs are being toured?

Program Tours have temporarily been paused because of COVID-19.

We will tour programs until we reach the thematic saturation (i.e., when we begin to encounter redundant ideas or interventions). Currently, we have completed 15 Program Tours but plan to resume them, either in person or virtually, in 2022-2023.

How are programs being chosen for Tours?

We are utilizing a variety of sampling techniques:

  1. We aggregate data from the ABSITE survey at the program-level and use it to identify programs that represent a range of performance on various metrics of the learning environment and well-being of residents. The data from the ABSITE survey are de-identified at the individual resident and the program level.
  2. We have asked several national experts in physician wellness to identify exemplary programs (i.e., snowball sampling).
  3. We surveyed Program Directors to identify programs with innovative or unusually comprehensive wellness initiatives.

Members of the Program Tour team do not know why any particular program has been chosen for a tour.

Who is on the Program Tour team?

Each team has 4-6 members. Co-PI Dr. Hu attends all Tours. The remainder of the team consists of a rotating complement of surgical research residents, Julie Johnson (a PhD-level qualitative researcher with expertise in conducting hospital visits to assess implementation of quality improvement initiatives), Gaurava Agarwal (a psychiatrist who studies healthcare professional wellness), and Daniela Amortegui (SECOND Trial study coordinator, Masters-level health services researcher).

What will the Program Tour team look for?

All Program Tour personnel are blinded to the programs’ data, and all Tours are conducted similarly. We observe educational conferences such as Morbidity & Mortality. On in-person Tours, we observe residents working in their typical environments (e.g., clinical workspaces, resident lounge). We interview a sample of residents and faculty, as well as departmental and institutional education leadership (e.g., Program Director, Chair, DIO). Our interviews consist of questions regarding the learning environment and resident wellness. For example, “How has your residency experience been thus far? Tell us about how your program promotes wellness. What initiatives has your program implemented? Did you take part? What were the barriers? What do you think works or doesn’t work and why?”

What is the time commitment for each program?

We try to conduct the Tours in a minimally disruptive way. We want to understand your program in its natural state. We will plan our visit around your existing conferences and workflow. We do not intend to interview all residents, faculty, and/or leadership - only those who are available and open to the process.

Won’t programs know they are bad if they are being visited and change their behaviors?

Our goal is to learn about resident wellness. This requires us to visit a range of programs, especially those that are exemplary. This is not a Joint Commission or an ACGME visit; we are not trying to uncover bad behavior. We seek to understand how we can all do better together and identify lessons that may be shared across the surgical education community.

How do observations help you build a Toolkit of interventions?

Broadly, we are interested in how policies, procedures, and initiatives translate into culture, and how this culture manifests in wellness. Observations are key to helping understand complex environments. Our experience with quality improvement tells us that the mere existence of initiatives is not enough to effect change. There are nuances to implementation that may make all the difference in outcomes; this is what we seek to understand through observations and interviews. For example, we may find that the same initiative was implemented at two different programs, but that one was more successful based upon local context.

Additionally, observations are a way to triangulate the data that we collect from surveys and/or interviews. As in other qualitative research, we learn a lot by observing how people interact with one another. These interactions may be shaped by policies, training, or infrastructure that is exportable to other programs. Aspects of local culture and environment may not be readily apparent to those who are embedded in it; hence, these important factors may be missed if we only conduct interviews, focus groups, and surveys. For example, we may find that there is something about the learning environment that is a major contributor to wellness and that goes largely unrecognized (i.e., aspects of a program may not appear unique to those at the program but are recognized as unique by outsiders).

Will our program get feedback after our Program Tour?

To protect the confidentiality of the people who participate in the focus groups and interviews, we will not be providing feedback to programs after the Tours. However, if a resident reports physical abuse, sexual harassment, or suicidal thoughts, we will work with the resident to report these issues to an appropriate institutional representative. Residents will be made aware of this potential breach in confidentiality in the verbal consent process. This protocol is based upon feedback from our Bioethics Panel.