Second Trial - Overview

Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial

Through numerous interviews and focus groups with residents, program directors, surgical faculty, wellness experts, and many others, we identified two main issues. First, programs had no data about their performance on these issues compared to others in the country; thus, programs are uncertain where to focus their efforts to improve well-being. Second, programs lacked access to readily available strategies to make improvements. This study was designed to address these two main issues.

The SECOND Trial is a national prospective, pragmatic cluster-randomized trial that seeks to improve the learning environment, and resident well-being.

In fall of 2019, programs were randomized to control vs. intervention. Programs randomized to control are given an annual program-specific report on their residents’ burnout, thoughts of attrition, suicidal ideation, benchmarked against other programs in the country, as well as access to protocols for addressing suicide. Programs randomized to intervention receive a Learning Environment and Resident Well-Being Report detailing their performance in eight domains, described by our Surgical Resident Well-Being Conceptual Model.

Intervention programs also receive access to our interactive Wellness Toolkit along with implementation support to facilitate their efforts on improving the learning environment and well-being of their residents. Our Wellness Toolkit incorporates data from the literature, best practice guidelines, advice from wellness experts, and lessons learned from visiting surgical residency programs across the country. To date, 212 general surgery programs are enrolled.

If you are interested in learning more about the SECOND Trial, please reach out to our team at

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NEJM Paper
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SECOND Trial Fact Sheet