Physician residents and fellows perform better when they feel like they are working in an environment of trust, a December 2025 study published in JAMA Surgery found.
The study evaluated 6,136 surgical residents’ sense of belonging and their performance on the 2025 American Board of Surgery In-Service Training Examination, which was administered in January 2025.
Here are four takeaways from the study:
1. Researchers found that residents who felt the least sense of belonging—in the bottom 10% of respondents—did worse on the exam than those in the top 10% of the spectrum.
2. The average test scores of the bottom 10% were lower, at 476, compared with the top 10% at 532.
3. “It is not clear from this study whether belonging precedes or is influenced by performance, and the association may be bidirectional,” the study’s authors noted. “For example, belonging may foster engagement resulting in better performance, or high performance may reinforce belonging.”
4. The study’s authors noted that even seemingly modest efforts to improve connections may have meaningful results. This might look like creating opportunities for residents to socialize with faculty and building trust early on with residents.
