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Background Efforts are underway to enhance learner input into the accreditation of educational programs, including residencies and fellowships. Objectives To aggregate the perspectives of residents and fellows from a cross-section of specialties to highlight common dimensions in learners' perceptions of strengths and opportunities for improvement (OFIs) in their program and to assess whether the ACGME Resident Survey captures areas important to residents' perceptions of their learning environment. Results The data set included 206 core and 193 subspecialty programs representing a wide range of specialties and subspecialties. Comments on strengths and OFIs addressed most of the items in the Resident Survey, with items not addressed in the survey also not represented in the ACGME requirements. The findings suggest that some program attributes are mentioned only in their absence (hygiene factors), whereas other dimensions (satisfiers), particularly quality and quantity of residents' interactions with faculty, procedural volume, and variety and didactic offerings, are critical to learners' perceptions of the quality of their learning environment. For some strengths, residents indicated their programs exceeded the ACGME standards, and for areas identified as OFIs, comments suggested programs were in compliance, but the residents desired more. Mentioned in this context were opportunities to perform research, access to board preparation courses and career counseling, and availability of new technology, including new patient care modalities. Conclusions The findings allow insight into program attributes important to residents' perceptions of their learning environment. Programs may find the results helpful in suggesting areas for improvement in their learning environment.

Satisfiers and Hygiene Factors: Residents' Perceptions of Strengths and Limitations of Their Learning Environment