Title : The sustainability literacy gap: A multi-centre analysis of resident doctor perceptions and barriers to green surgery
Abstract:
Introduction: Despite initiatives such as the Green Theatre Checklist and Green Surgery Report, adoption of sustainable practices in surgery is limited, due to low stakeholder engagement. Existing literature has focused primarily on consultant perspectives. As future key stakeholders, this study aimed to evaluate resident doctors’ perceptions of sustainability in surgery.
Methods: A validated questionnaire was distributed to resident doctors across general surgery, ENT, trauma and orthopaedics, and plastic surgery in four NHS hospitals within the Kent, Surrey, and Sussex Deanery. Data included 5-point Likert scale responses and categorical questions assessing awareness, attitudes and priorities.
Results: Of the 69 responses received, 68.1% were junior residents (foundation, core trainees and SHO grade) and 31.9% were senior residents. General surgery was most represented (50.7%), followed by ENT (21.7%). 84% of participants reported strong concern about climate change and 92% acknowledged the environmental impact of surgery.
However, an attitude–behaviour gap was seen, with more respondents reporting sustainable changes in their personal life than at work (66.7% vs 42.0%). Additionally, 84.1% were unaware of NHS sustainability targets and 81.2% did not receive any formal sustainability training. Seniority did not significantly improve target awareness (p=0.83), indicating a deficit across training grades.
When weighed against sustainability, 76.8% viewed sustainability as equal to, or more important than financial cost and 63.8% were willing to accept a longer operative time to achieve a more sustainable procedure. The top perceived barriers to sustainable practice were the time and effort required (79.7%), financial cost (76.8%), and organisational factors (69.6%).
Conclusions: Resident doctors are highly motivated to engage with sustainable surgery but are hindered by a significant literacy gap. Sustainability must be formally integrated into the resident doctor surgical curriculum to overcome the primary organisational and awareness-based barriers identified.
