How constant self-monitoring fuels burnout in surgery training

Clinical takeaway: Surgical trainee well-being may be shaped by more than workload alone. Some participants described constant self-monitoring as an added source of strain, while belonging, mentorship, and peer support helped ease that burden.

Burnout in surgical training is often attributed to workload, long hours, and the pressures of caring for patients in a high-stakes environment. But interviews with surgical trainees suggest another source of strain: the constant effort to monitor how they are perceived after identity-related negative experiences.

Researchers interviewed 20 surgical trainees from seven training sites and found that some participants described a recurring cycle of self-monitoring that extended well beyond individual encounters. Trainees said they spent significant mental energy assessing how colleagues, supervisors, and patients viewed them, adjusting their behavior and presentation, and watching for signs of bias or differential treatment.

Many trainees described a distinction between routine surgical feedback and the added scrutiny they perceived after identity-related negative experiences. While evaluation and feedback are expected parts of residency, some participants said they spent considerable time replaying interactions, questioning whether criticism reflected their performance or bias, and adjusting how they spoke, behaved, or presented themselves to avoid future negative judgments.

The cumulative effect, according to participants, was emotional and cognitive fatigue. Several trainees described feeling as though they were always on guard, even outside the clinical setting. Some linked that burden to burnout, anxiety, impostor syndrome, and thoughts of leaving surgery altogether. As one participant put it, surgery was “an exhausting job made even more exhausting by feeling like I can't completely be myself.”

The study also identified factors that appeared to provide relief. Participants reported that peer relationships, mentorship, community, and a sense of belonging helped reduce the need for constant monitoring and offered reassurance that their experiences were shared by others. The authors point to community building, psychological safety, and fostering belonging as potential ways training programs could help interrupt the cycle of self-monitoring and emotional strain described by trainees.

The findings suggest that the effects of identity-related negative experiences may extend well beyond individual encounters. Rather than describing isolated incidents, trainees portrayed self-monitoring as an ongoing process that could shape how they interacted with colleagues, interpreted feedback, and moved through their training environment.

The study broadens the conversation about trainee well-being. Participants described self-monitoring not simply as an emotional response to difficult experiences, but as an ongoing demand on attention and mental energy. The findings suggest that efforts to improve trainee well-being may need to account not only for workload and schedules, but also for the day-to-day experiences that shape how trainees engage with feedback, learning, and professional growth.

Source: Picart JK, et al. (2026 Aug 12) JAMA Netw Open. Experiences of Identity-Related Vigilance in Surgical Trainees: A Qualitative Study