A creative residency culture is many things—adaptive, fluid, innovative—but at its core, it is focused on developing a cohesive group of cognitively diverse individuals. Rather than using traditional metrics (e.g., test scores, case logs, or academic publications), creative residency programs measure success by a resident’s impact on clinical care, scientific advancement, and society. These programs foster diverse skill acquisition and encourage residents to define their personal success in the context of their individual strengths, values, and goals. In doing so, residents develop the requisite leadership, academic, clinical, and personal skills
to progress into roles with increasing responsibility. Creative programs empower residents to utilize their unique perspectives as they engage in solving the complex problems facing health care today. This chapter will discuss the rationale for developing a creative culture in surgical residency, the elements necessary to maintain this culture, potential threats to sustainability, and examples of what can be achieved.

A creative culture is one that values, recruits, and intentionally develops cognitive diversity (Figure 16.1). As discussed in Chapter 1, cognitively diverse teams offer a competitive advantage. Corporations with the highest levels of ethnic and cultural diversity outperform those with the lowest and consistently generate greater profitability and long-term value.^1,2,3 This competitive advantage arises in part from an increase in creativity—input from multiple perspectives fosters new and innovative ideas, and diverse skill sets allow those ideas to become reality.⁴ However, increasing cognitive diversity alone may not yield benefits unless the environment promotes inclusion and values each individual’s contributions.⁵ This environment is the creative culture that is essential to success. In surgical residency, a creative culture promotes clinical, professional, and academic success.

To achieve a creative culture in surgical residency, one must recognize three key facts. First, the surgeon’s primary responsibility is to the patient. Because residents care for a diverse population of patients with varying social and cultural needs, today’s surgical residents must function beyond clinical and technical expertise to provide optimal care. They must also recognize the human experience of being a patient. While each resident brings their own limited personal experiences to the patient care environment, a cognitively diverse group that shares their experience offers a greater breadth of understanding of human needs. For example, residents may learn from other residents who themselves live with chronic medical conditions or who have had an operation. A creative residency fosters an appreciation for these different perspectives and provides the psychological safety and open-minded platforms through which residents can share their experiences.

Surgeons no longer occupy a narrow clinical domain—instead, they are expected to rise to influential roles in healthcare systems, address deficits in health policy, and work toward advancements in science. To do so, surgeons need to learn how modern economic and political forces intersect with the delivery of health care as well as with the broader strategic goals of health systems. Surgeons must be cognizant of the healthcare needs of the communities they serve and recognize opportunities to drive local and national change. These powerful lessons become only more challenging to learn as surgeons move further into their careers. Therefore, creative programs are needed to encourage resident participation early on to facilitate their commitment to the greater healthcare community after completion of training.

Clinical subspecialization has flourished to care for patients with complex problems, and integrated training programs have emerged to promote early subspecialization. These programs create microcosms of multidisciplinary clinical teams within a single department. Similarly, promoting expertise in the basic sciences, health services, social sciences, business, education, innovation, and other diverse fields fosters cognitive diversity within a department. Residents in a creative culture are encouraged to pursue training in nonclinical areas of interest and develop diverse skill sets to more effectively contribute to their department, institution, and national societies. They will begin to think about their accomplishments in terms of impact, rather than checkboxes for advancement, and they will carry this mental model forward throughout their surgical career.