Competing institutional logics in surgical training: a qualitative study of coping strategies in China's dual-track system

The study examined challenges faced by surgical postgraduates in China, where medical education combines professional master's training with standardized residency training. The research involved 14 surgical postgraduates (12 males, 2 females) from a large teaching hospital in southern China through semi-structured interviews. Results revealed three main themes: institutional anxiety caused by competition between research and surgical skill development, institutional barriers including time constraints and emphasis on research achievements, and coping strategies developed by students such as informal learning communities and learning within system gaps. Findings suggest the need for system-level changes to align evaluation practices and protect opportunities for clinical skill development.