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Kao LS, Diller ML. Embedding Mindfulness-Based Resiliency Curricula Into Surgical Training to Combat Resident Burnout and Improve Wellbeing. Am Surg 2024; 90:954-958. [PMID: 37129239 DOI: 10.1177/00031348221117046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Surgery residents are at a higher-than-average risk of burnout syndrome, which is characterized by emotional exhaustion, depersonalization, and a sense of ineffectiveness. This risk of burnout can translate to increased stress and distress in trainees, poor performance, as well as worse patient outcomes. Therefore, developing and implementing burnout reduction strategies that are feasible, acceptable, and effective among surgical residents is paramount. Studies demonstrate that inherent mindfulness is associated with improved resiliency, reduced stress and burnout, as well as improved cognitive and motor skill performance. Fortunately, mindfulness is a skill that can be developed and maintained through targeted mindfulness-based interventions embedded within surgical education curriculum. Here, we present the data supporting the use of mindfulness as an integral part of burnout reduction efforts in surgical trainees as well as highlight evidence-based strategies for implementation in diverse surgical training environments.
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Scrimgeour G, Turner K. Hospital and departmental level strategies for managing the impact of adverse events on surgeons. Urol Oncol 2024:S1078-1439(24)00347-8. [PMID: 38514276 DOI: 10.1016/j.urolonc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
Adverse events have a profound impact on surgeons. This impact extends to physical and mental health, psychological wellbeing, and professional performance. Surgeons are ill prepared for these consequences of adverse events and are under-supported when they inevitably occur. Here we review the data on how adverse events affect surgeons. We explore the efforts made to date to both prepare surgeons before and support them after such events and we make recommendations regarding how this should and could be done better.
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Affiliation(s)
- Gemma Scrimgeour
- Department of Urology, Royal Bournemouth Hospital, University Hospitals Dorset, Castle Lane East, Bournemouth, UK
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Coopersmith AS, Berler MH, Johnston B, Knutilla L, Edwards AL, Lebares CC. Investigating influential factors and mechanisms of surgical resident well-being using social network analysis. Am J Surg 2024; 228:45-51. [PMID: 37722938 DOI: 10.1016/j.amjsurg.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/09/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Burnout and depression in General Surgery residents affect patient care and drive attrition. Few impactful interventions exist, in part because little is known about influential drivers and mechanistic relationships. METHODS Residents from 16 general surgery programs completed published well-being scales in January 2021. Social network analysis demonstrated influential relationships between factors, and path analysis revealed drivers of burnout and depression. RESULTS 300 residents completed the survey (34% response rate). Workplace demand and mindfulness influenced depressive symptoms and emotional exhaustion, mediated by perceived stress. Mindfulness increased personal accomplishment, mediated by psychological well-being (p < 0.05 for all results). All mediated effects were greater than direct effects. CONCLUSIONS This study yielded a quantitative conceptual model of mechanistic relationships affecting well-being in surgical residency, identifying stress and psychological well-being (measuring sense of purpose) as central mediators, and triangulating workplace demand and mindfulness as potentially high-yield interventional targets for reducing burnout and depression in surgical residency.
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Affiliation(s)
- Ari S Coopersmith
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael H Berler
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brianna Johnston
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Lillian Knutilla
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anya L Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carter C Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
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Catapano P, Cipolla S, Sampogna G, Perris F, Luciano M, Catapano F, Fiorillo A. Organizational and Individual Interventions for Managing Work-Related Stress in Healthcare Professionals: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1866. [PMID: 37893584 PMCID: PMC10608642 DOI: 10.3390/medicina59101866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
The workplace represents a relevant source of stress for workers, being a risk factor for many mental disorders and psychological difficulties, including burn-out syndrome. Healthcare workers and other help-professions are particularly susceptible to work-related stress. The present systematic review aims to (1) identify available interventions for managing workplace-related stress symptoms; (2) assess their efficacy; and (3) discuss the current limitations of available interventions. A systematic review has been conducted, searching on PubMed, APA PsycInfo, and Scopus databases. Eighteen papers have been identified, which included different interventions for the management of work-related stress in healthcare professionals. These approaches can be grouped as follows: (1) interventions focusing on the individual level using cognitive-behavioral therapy (CBT) approaches; (2) interventions focusing on the individual level using relaxation techniques; and (3) interventions focusing on the organizational level. As regards interventions targeting the individual level using CBT approaches, mindfulness-based interventions were effective in reducing levels of burn-out, stress, and anxiety and in improving quality of life. As regards intervention using relaxation techniques, including art therapy, Emotional Freedom Techniques (ECT) and brief resilience retreats had a positive effect on the levels of anxiety, stress, and burnout. As regards interventions at the organizational level, we found no evidence for supporting its effectiveness in reducing the levels of burnout. Furthermore, available studies are heterogeneous in terms of assessment tools, target populations, and type of interventions, which limits the generalizability of findings.
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Affiliation(s)
| | | | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Luton OW, James OP, Mellor K, Eley C, Hopkins L, Robinson DBT, Barlow E, Lebares CC, Lewis WG, Egan RJ. Enhanced Stress Resilience Training for UK Surgical Trainees; Effect and Evolution Evaluated. JOURNAL OF SURGICAL EDUCATION 2023; 80:1395-1402. [PMID: 37567800 DOI: 10.1016/j.jsurg.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/22/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body. METHOD CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories. RESULTS Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, ηp2=0.167], less stress [PSS-10; 19.22 (±5.91) vs. 15.79 (±5.47), F 8.740, p < 0.001, ηp2=0.200], but more mindfulness [CAMS-R; 19.22 (±5.91) vs. 20.57 (±2.93), F 3.201, p = 0.047, ηp2=0.084]. On multivariable analysis, Improving Surgical Training (run-through CST) program (OR 5.2 (95% CI 1.42-28.41, p = 0.022), MRCS pass (OR 17.128 (95% CI 1.48-197.11, p = 0.023) and ESRT engagement (OR 13.249, 95% CI 2.08-84.58, p = 0.006) were independently associated with NTN success. DISCUSSION ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression.
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Affiliation(s)
- Oliver W Luton
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom
| | - Osian P James
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom; Department of General Surgery, Cardiff University School of Medicine, Heath Park, Cardiff, United Kingdom.
| | - Katie Mellor
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom
| | - Catherine Eley
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom
| | - Luke Hopkins
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom
| | - David B T Robinson
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom
| | - Emma Barlow
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom
| | - Carter C Lebares
- Department of General Surgery, University of California, San Francisco, California
| | - Wyn G Lewis
- Department of General Surgery, NHS Wales Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, United Kingdom; Department of General Surgery, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Richard J Egan
- Department of General Surgery, Morriston Hospital, Swansea Bay University Health Board, Swansea, United Kingdom; Department of General Surgery, Swansea University, Singleton Park, Swansea, United Kingdom
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Bisgaard EK, Moore MK, Stadeli KM, Champan CY, Sanapoori SH, Lobova VA, Tate K, Maine RG. Defining the Culture of Surgery. J Am Coll Surg 2023; 237:280-290. [PMID: 37326319 DOI: 10.1097/xcs.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Surgical culture is often referenced but not well defined. Recent research and changing policies in graduate medical education have influenced the training paradigm and expectations of surgical trainees. It is unclear how these changes impact surgeons' understanding of surgical culture today and how those views impact surgical training. We sought to understand surgical culture and its impact on training from the perspective of a diverse group of surgeons with varied amounts of experience. STUDY DESIGN A series of semi-structured, qualitative interviews were conducted with 21 surgeons and trainees in a single academic institution. Interviews were transcribed, coded, and analyzed using directed content analysis. RESULTS We identified 7 major themes that impact surgical culture. Cohorts were separated by those who had been promoted to at least associate professor (late-career surgeons) and assistant professors, fellows, residents, and students (early-career surgeons). Both cohorts similarly emphasized patient-centered care, hierarchy, high standards, and meaningful work. Late- and early-career surgeons highlighted themes differently: late-career surgeons' perceptions were informed by experience and focused on challenges, complications, humility, and work ethic, while perceptions of early-career surgeons were more individually focused and referenced being goal-oriented and self-sacrificing, and focus on education and work-life balance. CONCLUSIONS Late- and early-career surgeons both emphasize that patient-centered care is core to surgical culture. Early-career surgeons expressed more themes related to personal well-being, while late-career surgeons emphasized themes related to professional accomplishment. Differences in the perceived culture can lead to strained interactions between generations of surgeons and trainees, and a better understanding of these differences would lead to improved communication and interactions between these groups, as well as better management of expectations for surgeons in their training and career.
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Affiliation(s)
- Erika K Bisgaard
- From the Departments of Surgery (Bisgaard, Champan, Sanapoori, Maine), University of Washington, Seattle, WA
| | - Megan K Moore
- Social Work (Moore), University of Washington, Seattle, WA
| | - Kathryn M Stadeli
- Department of Surgery, University of California Davis, Sacramento, CA (Stadeli)
| | - Cara Y Champan
- From the Departments of Surgery (Bisgaard, Champan, Sanapoori, Maine), University of Washington, Seattle, WA
| | - Shwetha H Sanapoori
- From the Departments of Surgery (Bisgaard, Champan, Sanapoori, Maine), University of Washington, Seattle, WA
| | | | - Katrina Tate
- Virginia Mason Medical Center, Seattle, WA (Tate)
| | - Rebecca G Maine
- From the Departments of Surgery (Bisgaard, Champan, Sanapoori, Maine), University of Washington, Seattle, WA
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Systematic Review of Mind–Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era. Healthcare (Basel) 2022; 10:healthcare10061027. [PMID: 35742076 PMCID: PMC9222815 DOI: 10.3390/healthcare10061027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022] Open
Abstract
Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, −0.37; 95% confidence intervals, −0.53 to −0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.
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Greenberg AL, Boscardin C, Lebares CC. Flourishing as a guide to intervention: a national multicenter study of general surgery residents. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:12. [PMID: 38624947 PMCID: PMC8968303 DOI: 10.1007/s44186-022-00014-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 04/17/2024]
Abstract
Purpose Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have been limited. Here we provide early data on modifiable targets, potential interventions, and comparative impact. Methods In this cross-sectional survey-based study of mixed-level residents at 16 academic General Surgery training programs, gender-identity, race, post-graduate year, and gap years were self-reported. Correlation between our primary outcome variable, flourishing, and measures of resilience (mindfulness, personal accomplishment [PA], workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, perceived stress, anxiety, workplace demand) were assessed. Results Of 891 recipients, 300 responded (60% non-male, 41% non-white). Flourishing was significantly positively correlated with all measured resilience factors and negatively correlated with all measured risk factors. In multivariable modelling, mindfulness, PA, and workplace support were positively and significantly associated with flourishing, with PA having the strongest resilience effect. Depression and anxiety were negatively and significantly associated with flourishing, with depression having the strongest risk effect. Conclusions Our results suggest that interventions that increase mindfulness, workplace support, and PA, as well as those that decrease depression and anxiety may particularly impact flourishing (i.e., global wellbeing) in surgical trainees. These findings provide preliminary guidance on allocation of resources toward wellbeing interventions. In particular, cognitive (i.e., mindfulness) training is a feasible intervention with modest but significant association with flourishing, and potential indirect effects through influence on PA, anxiety and depression. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00014-3.
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Affiliation(s)
- Anya L. Greenberg
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Christy Boscardin
- Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Carter C. Lebares
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
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Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership. J Surg Res 2022; 277:A25-A35. [DOI: 10.1016/j.jss.2022.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/05/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
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OUP accepted manuscript. Br J Surg 2022; 109:308-310. [DOI: 10.1093/bjs/znab447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/14/2022]
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