An enriching learning environment is integral to resident wellness. Integrated vascular (VS) and general surgery (GS) residents share 18 months of core GS rotations in postgraduate year (PGY)1-3; differences in their experiences may help identify practical levers for change. We used a convergent mixed-methods design. Cross-sectional surveys were administered after the 2020 ABSITE and VSITE, assessing eight domains of the learning environment and resident wellness. Multivariable logistic regression models compared thoughts of attrition between categorical PGY1-3 residents in GS and VS at 57 institutions with both types of programs. Resident focus groups were conducted during the 2022 Vascular Annual Meeting to elicit personal experience of the learning environment. Transcripts were analyzed using inductive and deductive logics until thematic saturation was achieved. Surveys were completed by 205 VS and 1198 GS PGY1-3 residents (response rates of 76.8% VS, 82.5% GS). After adjusting for resident demographics, PGY level, and program type, GS residents were more likely than their VS peers to consider leaving their programs (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.37-4.99). This finding did not persist after adjusting for differences in perceptions of the learning environment, specifically mistreatment (OR, 1.99; 95% CI, 1.36-2.90), work-life integration (OR, 2.88; 95% CI, 1.41-5.87), resident camaraderie (OR, 3.51; 95% CI, 2.26-5.45), and meaning in work (OR, 2.94; 95% CI, 1.80-4.83). Qualitative data (Table) provided insight into how the shared learning environment was perceived differently: (1) vascular trainees expressed that early specialization and a smaller, more invested faculty allows for an apprenticeship model with early operative exposure, hands-on guidance, frequent feedback, and thus early skill acquisition (meaning in work); (2) a smaller program is conducive to closer relationships with co-residents and faculty, increasing familiarity (camaraderie, work-life integration); (3) owing to increased familiarity with program leadership, vascular trainees feel comfortable reporting mistreatment allowing for prompt response (mistreatment). Despite sharing a learning environment, VS and GS residents experience training differently, contributing to differential thoughts of attrition. These differences may be attributable to intrinsic features of the integrated training paradigm that are not easily replicated by GS programs, such as smaller program size and higher faculty investment owing to early specialization. Alternative strategies to compensate for these inherent differences should be considered (eg, structured operative entrustment programs, faculty incentivization).TableRepresentative quotes reflecting differing perceptions about the same learning environmentThemesRepresentative quotesEarly specialization and smaller, invested faculty leads to meaning in work“There's so many general surgeons at our site and they're spread across so many different hospitals and there's some really big personalities that aren't necessarily the same as in our small group. I get the sense they never get to know the staff as well as we do, because they're constantly moving around and they're seeing maybe a little bit more as a commodity or workers versus necessarily having staff that are invested in their success and improvement.” -PGY-2“Where I come from for general surgery, it's pretty malignant. Up until a couple years ago as a resident, the staff would call us secretaries. When I first met our vascular staff, it was night and day difference…My general surgery program is really big. There's residents I never even met. I always wondered if it had to do with that versus the vascular program is very tight knit. It's a lot smaller.” – Vascular Fellow“The things that truly probably affect my wellness…knowing that the attendings care about you and that they value what you do. Because I don't think any of us went into this for it to be a strict 80 hour work week or to have a certain amount of time off. But the things that make you sort of burnout are feeling like, “This stuff doesn't matter. Why do I have to do all of this?” And when an attending is like, “Hey, how are you doing? What's going on with you?” I would do pretty much anything for those people. I'll stay there all night, I'll do whatever. But just knowing that what you do is valued and contributing to your patient care and that they care about how you do and if you're learning and if you're getting better.” – PGY-1Familiarity leads to resident camaraderie and work-life integration“I have a group of female surgical residents across different specialties and we'll discuss it then with my co-residents. Find support amongst each other.”- PGY-2“Yeah, that's the biggest part of residency is that you don't feel in control for a long time. So when you do have a schedule that's made two months in advance and you can plan your weekends, that does add to wellness because you feel like you're in charge of your life and in charge of the events that you can go to. So I think that's really important...We struggled in my general surgery residency because the schedule would come out a week before the new month and people are just like, “Oh my God, when are you going to be off?” You're like, “I don't know.” But [in vascular] we do make sure that the schedule is made in advance.” – Vascular FellowFamiliarity leads to improved reporting of mistreatment and/or likelihood of leadership response“I can say from my perspective, when I was a general surgeon, a lot of us were scared to report things. Like I said, I was even scared to report…one thing [in vascular fellowship]. Obviously I should have, because [my program director] was amazing about it. But if I had a problem now, I would call up the program director and just be like, "Hey, this is going on.” No hesitation now. But I mean, even talking to some of my friends that are still in the [general] surgery program, it's a constant struggle.” – Vascular Fellow“I just told them [about an instance of mistreatment]. I think the benefit of our staff is that we're able to have fairly open conversations. We regularly meet with our program director. We're a very small program. We just have five residents and six surgeons across two sites. So we're able to interact with them really frequently. Obviously in the vascular you bond over these horrible cases that go wrong. I think over the course of our residency, we bond, we're quite open with our staff and able to have some of these more difficult conversations.”- PGY-2 Open table in a new tab