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Perceptions of Attending Approachability Among Vascular Surgery Trainees
Margaret A. Reilly, MD, MS1, Christina L. Cui, MD, MAS2, Eric B. Pillado, MD, MBA, MS1, Ruojia D. Li, MD, MS3, Joshua S. Eng, PhD4, Leanne E. Grafmuller, MD5, Katheryn L. DiLosa, MD, MPH6, Allan M. Conway, MD7, Guillermo A. Escobar, MD8, Palma M. Shaw, MD9, Yue-Yung Hu, MD, MPH1, Karl Y. Bilimoria, MD, MS4, Malachi G. Sheahan, III, MD10, Dawn M. Coleman, MD2.
1Northwestern University, Chicago, IL, USA, 2Duke University, Durham, NC, USA, 3Loyola University, Maywood, IL, USA, 4Indiana University, Indianapolis, IN, USA, 5University of Rochester, Rochester, NY, USA, 6University of California Davis Health, Sacramento, CA, USA, 7University of California San Francisco, San Francisco, CA, USA, 8Emory University, Atlanta, GA, USA, 9Upstate Medical University, Syracuse, NY, USA, 10Louisiana State University, New Orleans, LA, USA.

OBJECTIVES: Psychological safety in surgery has been shown to increase trainee engagement while improving patient outcomes. The purpose of this study is to investigate the predictors and outcomes of psychological safety using vascular surgery trainee perceptions of attendings.
METHODS: A survey of trainees following the 2023 Vascular Surgery In-Training Exam (VSITE) was administered and de-identified data was collected. Trainees were queried about perceptions of attending approachability, demographics (e.g. year in training), and learning environment factors (e.g. protected educational time). Multivariable logistic regression modeling was used to compare predictors of and effects of attending approachability.
RESULTS: Of 521 eligible trainees (78.2% response rate) who completed the survey, 474 (71.2%) had complete data on our variables of interest. 415 (87.5%) agreed that their faculty were approachable. Participants were more likely to report approachable attendings if trainees endorsed protected educational time (OR 5.58, p<0.005), education as a priority of their attendings (OR 7.47, p<0.005), and attending appreciation of their work (OR 70.4, p<0.005). Trainees who felt attendings were approachable were more likely to report satisfaction with time for their personal life (OR 15.3, p<0.005), their decision to be a surgeon (OR 6.88, p<0.005), and a feeling of belonging in their program (OR 24.4, p<0.005). These trainees were less likely to report thoughts of attrition (OR 0.1, p<0.005), less reluctant to report mistreatment (OR 10.8, p<0.005), and less likely to endorse pressure to underreport duty hours (OR 0.2, p<0.005). There were no significant differences based on gender, post graduate year (PGY), race, ethnicity, or sexual orientation.
CONCLUSIONS: Trainees are more likely to report approachable attendings if they endorse protected educational time and attending appreciation of their work. Trainees who perceive attendings as approachable were more likely to report satisfaction with their career choice. The perception of approachable attendings is a protective factor against thoughts of attrition and reluctance to report mistreatment. More investigation is merited to further evaluate how attendings promote wellness and psychological safety among vascular surgery trainees.

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