THIRD Trial - FAQs

What data will THIRD collect (and how)?

Residents will continue to be surveyed annually. This fall, we will launch a new survey mechanism in partnership with the ACGME to solicit perspectives from faculty and residents. Departments will be required to ensure 70% response rates. None of these data will be accessible to the ABS or the ACGME; these data cannot be used for individual or program evaluation, certification, or accreditation. This is clearly stated in our contract with each department and with the ACGME. We may additionally request data from national organizations (e.g., AAMC) or from individual departments (e.g., resident evaluations) who opt into pilot tests of novel data metrics. We will also conduct an annual survey of department leaders to assess what interventions have implemented in both arms of the study. At the conclusion of the Trial, metrics of the working environment (e.g., inclusion) and faculty well-being (e.g., burnout) will be compared between the intervention and control groups.

Why randomize? Isn’t it unethical to withhold resources from the control group?

There are currently very little data about the effectiveness of any inclusion and/or well-being interventions in surgery. The existing evidence based in organizational psychology indicates that implicit bias training, one of the most common (and often the only) inclusion effort in surgical departments and/or hospitals, is not only ineffective but counterproductive; backlash turns people against the cause. Similarly, over the past 5 years, we’ve observed many institutions implement well-being interventions that do not resonate with faculty and paradoxically worsen trust in leadership. Thus, there is a need for data-driven interventions to address both inclusion and well-being. Randomization will allow us to address the secular trend of increasing emphasis on diversity, equity, and inclusion and physician well-being. Additionally, we will closely track the interventions implemented at all departments in both study arms annually.

Who is conducting the THIRD Trial?

Like the FIRST and SECOND Trials, the THIRD Trial is a joint effort between the Surgical Education Numbers Trials group, the Accreditation Council for Graduate Medical Education, the American College of Surgeons, the Association of Program Directors in Surgery, and the American Board of Surgery. The Surgical Outcomes and Quality Improvement Center (SOQIC) at Indiana University will serve as the Coordinating Center for the Trial. The Surgical Education Numbered Trials (SENT) group relocated to Indiana from Northwestern in 2022.

How will the confidentiality of individual residents and faculty be protected?

All observations, interviews, and focus groups will be conducted confidentially. All individual resident and faculty identifiers are removed from survey data prior to transfer to the data center; identification of individuals is not possible. Department-specific reports will provide data comparatively (i.e., for racial/ethnic diversity, your department ranks in the best quartile of programs in the country). We will not provide programs with the responses of individuals or even the proportion of individuals that reported any particular metric, thus precluding attempts to identify reporters of any particular issue.

How will the confidentiality of programs be protected?

Survey data will be sent to the data center, and departments will be immediately de-identified. Data remain de-identified throughout all analyses. Department-specific reports will be generated using securely maintained department-level linkages. Much like clinical quality improvement programs, we will mandate that departments cannot disseminate or publicize/advertise the data in their reports outside of their institutions. We encourage sharing within each institution (i.e., with residents and faculty), to help drive departmental change.

When will the THIRD Trial start and end?

Recruitment for the Trial will occur in spring 2024, with randomization occurring in fall 2024. The first data reports will be released in late fall 2024. Access to an initial iteration of the THIRD Trial Toolkit will be released in winder 2025; it will be updated in waves as the Trial progresses. Resident and faculty surveys will be annually over the course of the study. All departments will be given access to the THIRD Trial intervention at the end of the study in Spring 2028.