Surgical Resident Training and Ergonomics

Why Early Habits Shape Long-Term Outcomes

A surgeon who trains for five to seven years without ergonomic awareness builds compensatory postural patterns across tens of thousands of operative hours. Those patterns become the baseline for attending practice. The research on this is striking: a study published in the Journal of Surgical Education, “Incorporating Surgical Ergonomics Education into Surgical Residency Curriculum,” found that ninety-one percent of general surgery residents reported musculoskeletal symptoms attributed to their training. A survey study published in PeerJ (2025), examining orthopedic surgery residents, found that 75.9% of 158 residents reported musculoskeletal pain, predominantly affecting the lower back, feet, and neck. These findings suggest that the occupational health burden begins during training, not after it. Contact NekSpine to discuss how the device applies to residency program ergonomics, or review the clinical evidence on our clinical evidence page.

Why Residency Creates Particular Ergonomic Risk

Several factors converge during surgical residency to create a higher postural risk profile than attending practice alone:

• High case volumes across long operative days produce cumulative cervical and lumbar load distributed differently from the more selective case mix of established attending practice
• Unfamiliar operative environments mean residents may not optimize their position relative to the operative field in the way experienced attendings do instinctively
• Stress-driven muscle guarding — sustained muscle tension accompanying cognitive and procedural stress — adds a postural load component independent of the operative position itself
• Limited autonomy to adjust table height, monitor position, or operative approach means residents adapt their posture to the environment rather than the environment to their posture
• The culture of residency has historically discouraged residents from raising ergonomic concerns that might be perceived as weakness

Epstein et al., JAMA Surgery, 2018 found neck and back among the most prevalent sites of work-related musculoskeletal disorders across surgical practice, with prevalence increasing over career length — a pattern that raises the question of cumulative exposure beginning during training. Hansraj KK, Surg Technol Int, 2014 documented the cervical spine load produced by forward head flexion, a biomechanical reality that applies to residents in every operative case they perform.

Formal Ergonomics Education Is Rare in Residency Programs

Despite the prevalence of musculoskeletal symptoms in resident populations, formal ergonomics education is uncommon in surgical training programs. The ScienceDirect study, Incorporating Surgical Ergonomics Education into Surgical Residency Curriculum, noted that while all residents who received an ergonomics curriculum reported increased awareness of their habits while operating and improved understanding of injury prevention, most programs lacked formal ergonomics content before the intervention. The ScienceDirect Interprofessional Approach to Assessing Musculoskeletal Pain in Surgery Residents (2024) found that, in a survey of general surgery residents, everyone reported some degree of pain related to surgery—most commonly neck pain at 75%, shoulder pain at 61%, and foot pain at 53%. The PMC article “Musculoskeletal pain and surgical ergonomics among orthopedic residents” (2025) found that musculoskeletal pain influenced fellowship decisions, mobility, and frustration tolerance among orthopedic residents. These findings suggest that the absence of ergonomic education during residency has measurable downstream consequences.

The Institutional Argument for Residency Program Ergonomics

Resident wellness has become an increasingly prominent priority in surgical training programs, driven by recognition that the conditions of residency affect career outcomes, patient safety, and program quality. Ergonomic support fits naturally within this framework. Program directors and academic medical centers that invest in ergonomic awareness and support during residency are addressing a career-length outcome rather than only a training-period concern. The institutional case may include supporting postural awareness during residency, which could help surgeons carry ergonomic habits into their attending careers. Supporting postural health among attending surgeons may also help them maintain their ability to participate in operative work throughout their careers.

 According to PMC Musculoskeletal pain and surgical ergonomics among orthopedic residents, 2025, musculoskeletal pain among residents influenced their fellowship selection decisions — suggesting that unaddressed ergonomic burden during training affects program pipeline as well as individual career outcomes.

The Case for Introducing NekSpine During Residency

Whether introducing NekSpine during residency produces better long-term postural outcomes than introducing it later in a career is a question the current peer-reviewed evidence does not address—the Mayo Clinic and Alberta studies evaluated biomechanical and surgical-use outcomes, not timing of adoption or career-length habit formation. A residency pilot can address whether the device is practical and acceptable within the training environment, and what outcomes look like in a resident population. An independent trial across attending surgeons reported a 56% increase in static posture endurance and a 91.7% device acceptance rate. Individual results will vary.

The NekSpine Mayo Clinic study, Annals of Surgery, 2025, evaluated NekSpine across twelve surgeons in six specialties and reported a 41.7% reduction in neck and shoulder discomfort at 45 degrees of flexion. The University of Alberta / EWI Works, Sensors, 2026 reported up to a thirty-one percent reduction in neck muscle activity across multiple flexion angles. Contact NekSpine to discuss what a structured pilot looks like for a training program context.

What Program Directors Can Do

• Include a session on surgical ergonomics — covering the biomechanics of intraoperative posture, the peer-reviewed evidence on cumulative strain, and practical OR positioning principles — in the program’s didactic curriculum
• Evaluate the structural ergonomic factors in the department’s ORs that affect resident positioning, including table height adjustability, monitor placement, and floor matting
• Survey residents about occupational neck and back discomfort at baseline, creating a documented starting point for any subsequent ergonomic intervention
• Consider a NekSpine pilot evaluation that includes resident participants alongside attending surgeons, using the hospital pilot execution kit as the evaluation framework

Contact NekSpine to discuss what a residency program pilot looks like.

The Habits That Form in Residency Follow Surgeons Into Careers That May Span Three Decades or More

Research has documented musculoskeletal symptoms among surgical residents, while formal ergonomics education may be less common. Ergonomic habits developed during training may also carry into later stages of a surgical career.

Program directors and academic medical centers that address ergonomics during training are investing in the occupational health of every surgeon their program produces. Contact NekSpine to discuss how the device and evidence base apply to your residency program, or review the full clinical evidence on our clinical evidence page.