Belonging in Surgical Residency: A Nationwide Cohort Study.

Introduction: Belonging is the human need to form meaningful relationships with those in one's community. Belonging is associated with improved academic performance and mental health. The factors that contribute to belonging in surgical residency are unknown. We aimed to examine belonging in surgical residency. Methods: A nationwide survey of general surgery residents was administered after the 2025 American Board of Surgery In-Service Training Exam. Using a previously validated 11-item instrument, belonging in surgery was measured (scale 11-55). Resident hometown, demographics, stress levels, and program location and size were collected. Univariate analyses were performed using χ2 and Kruskal-Wallis tests. A multivariable linear regression was used to identify the covariates that were associated with belonging while clustering at the level of the residency program state. Results: A total of 6166 of 10,747 residents responded to the survey (58.9%) with a median belonging score of 47 (range: 15-55). Belonging was positively associated with training in the same region as one's hometown (β = +0.6, P < 0.001), postgraduate year-5 level (β = +1.2, P < 0.001), and lower stress levels (P < 0.001). Belonging was negatively associated with non-White race. The characteristics examined explained 16% of the variation in belonging scores. Conclusions: A wide variation in surgical resident belonging exists nationally. Much of the variation in belonging across residents was unexplained by the individual, program, and geographic features examined. The first step to developing a sustainable culture of inclusivity may be to measure belonging within programs and offer voluntary support to those who experience a weak sense of belonging.