A Systematic Review of Wellness in Plastic Surgery Training

Strategies to Improve Resident Wellness in Plastic Surgery Training

Residency is known to be a challenging time in a surgeon's career. Surgical residents must learn the breadth of their field and develop technical skills while maintaining relationships and well-being outside their training. High burnout rates are well documented among all medical specialties, particularly during residency. Proven strategies in medical education that help decrease burnout and improve resident well-being, while maintaining quality patient care, have been reported in the medical education literature. However, little has been published specific to plastic surgery training programs. We discuss strategies that can be implemented into the curricula and workflow at plastic surgery residency programs to maximize resident well-being. We advocate for a multifaceted approach that includes a night float system, day call, integrating advanced practice providers to offload noneducational resident tasks, and establishing a wellness program. It is our hope that these strategies may serve as a guide for plastic surgery residency programs to promote general wellness and prevent burnout among trainees.

The Current State of Plastic Surgery Residency Wellness Programs: Benefits and Barriers

Background

Wellness programs are especially important in residency. However, the resources available to plastic surgery residents through residency wellness programs have not been described. This study reports current plastic surgery residency wellness programs' organization, leadership, and resources.

Methods

An anonymous and voluntary e-mail survey was sent to 106 plastic surgery residency program directors through May and June 2022. Features of residency wellness programs were detailed, and program directors' sentiments towards residency wellness programs were evaluated.

Results

A 30.2% (32 of 106) complete response rate was achieved. Nearly 90% (87.5%, 28 of 32) of program directors indicated the presence of a wellness program. More than 75% (21 of 28) of programs are supported by the Office of Graduate Medical Education. Wellness events were offered by 92.9% (26 of 28) of programs. More than half of programs offered resources for mental health, physical health, mentorship, and protected time. Several resources were associated with the presence of wellness leadership roles, suggesting residents can positively shape wellness program offerings. Program directors strongly indicated that wellness programs are important, relevant, and effective. Additionally, 75% (24 of 32) report a desire to learn about wellness programs at other plastic surgery residency programs.

Conclusions

Resources offered through plastic surgery residency wellness programs are comparable to those in other specialties. However, plastic surgery programs vary in the resources offered to residents and barriers to access exist. Greater involvement of residents in plastic surgery wellness programs may better support physician wellness.

Resident Burnout and Well-being in Otolaryngology and Other Surgical Specialties: Strategies for Change

OBJECTIVE

To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.

DATA SOURCES

Ovid Medline, Embase, and article reference lists.

REVIEW METHODS

A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.

CONCLUSIONS

Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.

IMPLICATIONS FOR PRACTICE

Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.

A Social Media Analysis of Wellness Culture in Plastic Surgery Residency

BACKGROUND

Burnout, "a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment", afflicts approximately one third of plastic surgery attending surgeons and residents. Burnout can be detrimental to resident training and patient outcomes. Therefore, cultivating wellness during residency is essential. In fact, the Accreditation Council for Graduate Medical Education requires residency programs to create learning and working environments that optimize faculty and resident wellness. With increasing social media use by plastic surgery residency programs, this study aimed to analyze their posts for wellness-related content.

METHODS

Integrated plastic surgery residency programs were obtained from the American Council of Academic Plastic Surgeons Web site, and their associated social media accounts were identified. The authors reviewed all post images, captions, and comments made by the program's account, until July 3, 2021. Any hashtags relating to wellness were also recorded.

RESULTS

Of 82 programs, 76 (92.7%) had active Instagram accounts, 31 (37.8%) had active Facebook accounts, and 30 (36.6%) had active Twitter accounts. Instagram had higher rates of engagement than Facebook and Twitter (P < 0.001). Across all platforms, the mean percent of total posts related to wellness was 18.87%. The most common wellness content showcased resident work-life balance (48.73%), followed by educational events incorporating wellness activities (27.61%), attention to physical health (17.71%), healthy work environments (5.29%), wellness-specific activities (3.25%), team building activities (2.40%), and images implying but not directly showing resident wellness (1.46%). Programs did not vary significantly in percentages of total posts related to wellness by geographic region, ranking, or accreditation length. In total, 1893 wellness-related hashtags were used on Instagram, 253 on Facebook, and 72 on Twitter. The most used wellness-related hashtag was #residentlife. Only 40.8% to 50.8% of posts using wellness hashtags met at least 1 wellness criterion.

CONCLUSION

Despite the importance of burnout prevention during plastic surgery residency, less than a quarter of residency program social media content promote wellness. Social media can demonstrate how residency programs are incorporating wellness into their curricula, but whether residencies lack sufficient wellness initiatives or are not advertising such programming on their social media accounts remains to be studied.

What Attributes Make United States Plastic Surgery Programs Desirable? Perspectives from Medical Students and Residents

BACKGROUND

Plastic surgery is a competitive specialty that attracts many qualified applicants. This study provides results of a survey conducted to identify the attributes that make integrated and independent plastic surgery residency programs in the United States most desirable. Medical students' preferences for virtual events during the 2020 to 2021 Match cycle were also investigated.

METHODS

An anonymous 7-question survey was deployed to plastic surgery residency program directors to forward to medical students and current residents during the 2021 to 2022 National Resident Matching Program cycle. Demographics and ranking of program attributes were collected in the survey, and data analysis consisted of both qualitative and quantitative results.

RESULTS

A total of 50 survey respondents from 28% of plastic surgery residency programs was received. The happiness and well-being of residents and training at their preferred geographical location were identified as the most desirable qualities of a program (P < 0.05). However, 82% of respondents opposed mandatory research (P = 0.002). There was a statistically significant larger proportion of students that highly valued faculty responsiveness to feedback over perceived program ranking (P < 0.05). In the context of COVID-19, virtual meet and greets, as well as resident happy hours, were rated most desirable (n = 35, 70%), followed by social media outreach (n = 23, 46%).

CONCLUSIONS

Resident happiness and well-being, followed by preferred geographical location, were the most favorable program attributes. Plastic surgery residency programs may seek to better integrate these preferences within their curricula, as well as showcase them on social media, to attract high-quality applicants and optimize the training experience for matched residents.