Flourishing as a Measure of Global Well-being in First Year Residents: A Pilot Longitudinal Cohort Study

Mindfulness-based Interventions for Surgeons: A Scoping Review

OBJECTIVE

To review the evidence on mindfulness-based interventions (MBIs) for surgeons.

BACKGROUND

Health care professionals have alarmingly high rates of burnout, yet little is known about psychological factors that support resilience. MBIs, which involve codified training in specific skills such as self-awareness, emotional regulation, and perspective-taking, have shown benefit to professionals in high-stress environments but have had limited implementation in the health care workplace and in surgery. To our knowledge, there has not been a scoping review of MBIs in surgery to date.

METHODS

We conducted a scoping review of the evidence for the feasibility and effectiveness of MBIs for surgeons, including evidence on interventions that explicitly train mindfulness, which spans multiple cohorts and settings, utilizing different methodologies and outcome measures.

RESULTS

This scoping review yielded 24 studies, including 2 mixed method/qualitative studies, 9 randomized control trials, 3 nonrandomized interventional studies, and 8 single-arm interventional studies.

CONCLUSIONS

We find that MBIs in surgery (1) are feasible in surgical contexts, with implementation science providing insights on sustainability; (2) increase mindfulness, (3) improve well-being in terms of burnout and both psychological and neurophysiological measures of stress, and (4) enhance performance as measured in executive function, surgical skills, and communication skills. These conclusions are supported by psychometric measures, observations of technical skills, and neurophysiological evidence. Future directions include studying MBIs in larger and more diverse populations and iteratively tailoring mindfulness-based interventions to other health care contexts.

The Moderating Effects of Moral Injury and Discrimination Trauma on Women Physician Trainees' Well-Being

BACKGROUND

Graduate medical trainees are positioned to experience high rates of negative well-being due to the demanding and hierarchical nature of this time in their careers. Focusing on the well-being of physician trainees is required to ensure a better future of medicine. A novel avenue of examining physician trainee well-being is through understanding the effects of moral injury and discrimination trauma in overall well-being.

OBJECTIVE

This secondary data analysis examines the moderating role of discrimination trauma and moral injury on six well-being metrics cross-sectionally at baseline and 4 months postcoaching intervention, respectively.

DESIGN

This is a secondary, cross-sectional analysis using survey data collected at two time points.

PARTICIPANTS

The participants in this study (n = 1017) are women physician trainees in the USA.

MAIN MEASURES

The predictor measures are as follows: Moral Injury Symptom Scale- Healthcare Providers and Trauma Symptoms of Discrimination Scale. The outcome measures are as follows: Maslach's Burnout Inventory, Young Impostor Scale, Self-Compassion Scale, and Secure Flourishing Index.

KEY RESULTS

At baseline, discrimination trauma moderates the relationship among moral injury with impostor syndrome and self-compassion. After the coaching intervention, moral injury moderates the effect of the intervention on impostor syndrome.

CONCLUSIONS

The results of this secondary analysis emphasize the role moral injury and discrimination play in overall well-being, specifically through the experiences of self-compassion and impostor syndrome. This study calls for early measurement and mitigation efforts of both moral injury and discrimination trauma, which may effect well-being for graduate medical trainees and lessen the impact of our coaching intervention.

Flourishing levels among health and non-health profession students in Saudi Arabian colleges

Objectives

This study aimed to evaluate the levels of flourishing among university students, compare these levels between students in health-related and non-health-related colleges, and identify factors that predict flourishing.

Methods

A cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Saudi Arabia, involving 1,148 students from the first to fourth year across both academic sectors. Data were collected utilizing the self-reported Global Flourishing Study Questionnaire (GFS) during the period from September 2023 to June 2024. Multistage sampling techniques were employed to ensure a representative sample, with data collection facilitated through a self-administered electronic link on QuestionPro resulting in a response rate of 51.7%. Data analysis was performed using SPSS version 22, incorporating descriptive statistics, t-tests, ANOVA, and regression analysis to identify predictors of flourishing. The reliability and validity of the questionnaire were assessed using Cronbach's alpha and Pearson's correlation analysis.

Results

The study included nearly equal proportions of students from health (51.0%) and nonhealth (49.0%) colleges. The average flourishing score was 85.6 (SD=18.6), with a slight increase in health colleges (85.7) compared with non-health colleges (85.4). Factors that significantly affected flourishing included gender, employment status, exercise frequency, experiences of abuse, and income. In the multiple regression analysis, well-being emerged as the strongest predictor, followed by external factors, disposition, and behavior. Gender exhibited a positive association with flourishing, whereas religion had a negative influence. Furthermore, employment and higher income levels were found to positively contribute to flourishing.

Conclusion

This study revealed elevated levels of flourishing among university students in Saudi Arabia, with a notable average score of 85.6. Although the differences between students enrolled in health-related and non-health-related colleges were minimal, significant predictors of flourishing were identified, including well-being, external factors, disposition and behavior, gender, religious affiliation, employment status, income, frequency of exercise, and experience of abuse. These findings underscore the complexity of flourishing and highlight the necessity of considering a range of sociodemographic and lifestyle factors to promote student well-being.

Exploring the Influence of Demographic Factors and Flourishing on Workplace Distractions: A Cross-Country Analysis

Objective: To explore the influence of demographic factors and flourishing on workplace distractions in a cross-country analysis of Saudi Arabia and Jordan. Methods: This cross-sectional comparative study was conducted in two government hospitals: one in eastern Saudi Arabia and the other in northern Jordan. Data were collected from the nurses using convenience sampling. The required sample size was determined using the G∗Power software, with a target of 242 nurses per country, resulting in 484 participants. Ultimately, the final sample consisted of 437 nurses: 222 from Saudi Arabia and 215 from Jordan. Two online instruments were used to collect data on the distractions and flourishing. Results: The study found that "using the Internet" and "using the phone" were the most time-consuming distractions among nurses, while "watching TV" was the least time-consuming. There were significant associations between demographics and distractions, with participants from Saudi Arabia having lower distraction scores than participants from Jordan. Younger participants were more distracted than older participants, whereas male participants were more distracted than female participants were. Smokers and individuals with less expertise exhibit higher levels of distraction. Furthermore, degree of education was associated with higher levels of distraction. Nurses in Saudi Arabia experience a much greater loss of productivity due to distractions than their Jordanian counterparts. Regression analysis revealed that experience, "Mental and Physical Health" domain scores, smoking status, and educational level all highly predicted distraction levels among Saudi Arabian and Jordanian nurses, accounting for approximately 9.6% of the differences in distraction. Conclusion: In this cross-country study on workplace distractions among Saudi and Jordanian nurses, "using the Internet" and "using the phone" emerged as the most time-consuming distractions. Younger age, male sex, smoking, and less experience are associated with higher distraction levels. Additionally, higher education levels were linked to increased distraction. Implementing employee flourishing activities can help reduce distractions and enhance productivity. This study offers valuable insights into improving nurses' performance and well-being.

Oncologists' psychological flourishing: A driving force for positive attitudes at work

OBJECTIVE

Oncologists' psychological health is a major challenge due to the consequential concerning the quality of the care they provide. However, only critical states of their health have been really examined by scientists. This study sought to plug this gap by investigating the mediating role of psychological flourishing in the relationship between the perception of the professional social context (i.e., perceived workplace isolation and organizational support) and positive attitudes at work among oncologists (i.e., work engagement, task adjustment and empathy).

METHODS

The study was a cross-sectional, including 541 French oncologists. Participants completed a self-report questionnaire. Structural Equation Modeling was employed to test the hypotheses.

RESULTS

The analysis revealed that workplace isolation and organizational support perceptions were related to oncologists' work engagement, task adjustment and empathy. Additionally, psychological flourishing acted as a partial mediator between these perceptions of professional social context and oncologists' work-related attitudes.

CONCLUSIONS

This research underlined the potential of enhancing the psychological flourishing of oncologists by improving organizational support and mitigating their sense of isolation, and in turn, to enhance some dimensions of their positive attitudes at work.

Embedding Mindfulness-Based Resiliency Curricula Into Surgical Training to Combat Resident Burnout and Improve Wellbeing

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.

Investigating Workplace Support and the Importance of Psychological Safety in General Surgery Residency Training

OBJECTIVE

Workplace interventions that increase support can mitigate burnout, improve workplace satisfaction, and increase well-being. Our aim is to provide evidence-based targets to inform future work for operationalizing support in general surgery residency.

DESIGN

This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1) in May 2022 to assess the association between perceived psychological safety (PS) and flourishing, as well as PS and languishing.

SETTING

National multi-center study including 16 ACGME-accredited academic programs.

PARTICIPANTS

General surgery residents at various training levels, in both clinical and research.

RESULTS

A total of 28 residents participated in the focus groups which revealed both enhancers and inhibitors of support pertaining to PS in the workplace. Enhancers of support included those currently implemented (i.e., allyship of mentors) and those proposed by residents (i.e., nonpunitive analysis of mistakes). Inhibitors of support included both systems (i.e., wellness initiatives as a 'band-aid' for systems issues) and culture (i.e., indefatigability, stoicism). About 251 residents (31%) responded to the survey which revealed higher perception of PS was significantly associated with flourishing at the level of residency program and departmental leadership. Lower perception of PS was significantly associated with languishing at the level of residency program leadership only.

CONCLUSION

Our findings highlight the promotion of PS, such as expansion of mentorship to include advocacy (advocating on a resident's behalf, recognition when mistreated) and affirmation (i.e., soliciting opinions on controversial social matters/events, recognizing different life experiences), cultural acceptance of asking for help (without being perceived as weak), formal help navigating interpersonal dynamics (i.e., guidance from senior residents), and leadership presentations and modeling to destigmatize asking for help, as a means of operationalizing workplace support to increase flourishing and decrease languishing.

Flourishing among undergraduate nursing students: Insights from a cross-sectional study in Saudi Arabia

AIM

This study aimed to examine the factors that influence the level of flourishing among nursing students.

DESIGN

Cross-sectional study.

METHODS

A multistage sampling technique was used to recruit 328 undergraduate nursing students from a nursing college. Data were collected from February to June 2023 using the Global Flourishing Study (GFS) questionnaire, which assesses six domains of flourishing and their determinants. To ensure reliability and validity, a pilot study was conducted and a thorough validation process was employed.

RESULTS

The Flourishing Index ranged from 24.0 to 100.0, with an average score of 74.2 (SD = 14.8). Well-being, disposition and behaviour, as well as external factors, correlated strongly positively with the Flourishing Index (r = 0.741, r = 0.565, r = 0.596, all p < 0.001). The Flourishing level was significantly negatively correlated with religion (r = -0.381, p < 0.001). Married participants had a significantly negative association with flourishing (p = 0.009). Disposition and behaviour were significantly and positively associated with flourishing (p = 0.017). The regression model had goodness of fit (R2  = 0.628) and was significant overall (F = 108.703, p = 0.001). The Flourishing model was established based on well-being, external factors, religion, disposition and behaviour, and marital status.

CONCLUSION

Positive correlations between flourishing and well-being, disposition and external factors suggest areas of improvement. Conversely, the negative association with religion emphasizes the necessity of culturally sensitive approaches. Future studies with larger and more diverse samples, as well as additional variables, are crucial to obtain a deeper understanding of the factors that influence flourishing among nursing students in Saudi Arabia.

Flourishing and the Prioritization of Workplace Elements in General Surgery Residents

INTRODUCTION

To explore and begin to operationalize workplace elements that influence general surgery (GS) resident wellbeing. Tailoring workplace wellbeing interventions is critical to their success. Occupational science has revealed that a person-centered approach to identifying positive and negative workplace influences can inform tailoring while accounting for individual differences. To our knowledge, this approach has not been applied to the surgical training environment.

METHODS

A national sample of GS residents from 16 Accreditation Council for Graduate Medical Education training programs ranked the importance of workplace elements via an anonymous survey. Latent profile analysis was performed to identify shared patterns of workplace element prioritization and their relation to levels of flourishing, a measure of global wellbeing.

RESULTS

GS trainee respondents (n = 300, 34% response rate - average for studies with this sample population) expressed a hierarchy of workplace element importance which differed by gender and race. "Skills to manage stress" and "a team you feel a part of" were prioritized higher by non-males than males. Residents of color and residents underrepresented in medicine, respectively, prioritized "recognition of work/effort" and "skills to manage stress" more than White and overrepresented in medicine residents. Flourishing prevalence varied by 40% with small differences in the specific profile of workplace element prioritization.

CONCLUSIONS

Differences in prioritization of workplace elements reveal subtle but important differences that may guide the design of wellbeing interventions for different populations within surgery.

Operationalizing the Culture of Burnout and Well-Being: Multicenter Study of Value Congruence and Flourishing in General Surgery Residency

BACKGROUND

Value congruence (VC) is the degree of alignment between worker and workplace values and is strongly associated with reduced job strain and retention. Within general surgery residency, the impact of VC and how to operationalize it to improve workplace well-being remain unclear.

STUDY DESIGN

This 2-part mixed-methods study comprised 2 surveys of US general surgery residents and qualitative interviews with program directors. In Part 1, January 2021, mixed-level surgical residents from 16 ACGME-accredited general surgery residency programs participated in survey #1. This survey was used to identify shared or conflicting perspectives on VC concerning well-being initiatives and resources. In April 2021, interviews from 8 institutions were conducted with 9 program directors or their proxies. In Part 2, May to June 2022, a similar cohort of surgical residents participated in survey #2. Unadjusted logistic and linear regression models were used in this survey to assess the association between VC and individual-level global well-being (ie flourishing), respectively.

RESULTS

In survey #1 (N = 300, 34% response rate), lack of VC was an emergent theme with subthemes of inaccessibility, inconsiderateness, inauthenticity, and insufficiency regarding well-being resources. Program directors expressed variable awareness of and alignment with these perceptions. In survey #2 (N = 251, 31% response rate), higher VC was significantly associated with flourishing (odds ratio 1.91, 95% CI 1.44 to 2.52, p < 0.001).

CONCLUSIONS

Exploring the perceived lack of VC within general surgery residency reveals an important cultural variable for optimizing well-being and suggests open dialogue as a first step toward positive change. Future work to identify where and how institutional actions diminish perceived VC is warranted.

The Trauma Fellow's Perspective on Grit and Resilience and Its Role in Wellness

Purpose of Review

To describe the unique stressors of surgical training and fellowship and how grit and resilience influence trainee wellness.

Recent Findings

Surgical training is an intense, high-stress experience. For fellows-in-training, unique stressors are associated with this chapter of training, from financial pressors to the stress of job acquisition. Wellness is essential for surgical fellows, not just for the critical need for quality mental health of providers, but also for the patients who are also affected by provider burnout. There are various wellness programs that can be instituted nationally and institutionally to optimize fellow wellness, but one of the most high-yield foci for fellow wellness is focused mentorship, the key to assuring wellness and harnessing grit.

Summary

Surgical residency and fellowship are prodigiously demanding experiences, which mandate grit and resilience. It is imperative that widespread cultural and institutional changes take place to best support surgical trainees.

Measuring Positive Mental Health and Depression in Africa: A Variable-Based and Person-Centred Analysis of the Dual-Continua Model

The dual-continua model of mental health provides a contemporary framework for conceptualising and operationalising mental health. According to this model, mental health is distinct from but related to mental illness, and not the opposite or merely the absence of psychopathology symptoms. To examine the validity of the dual-continua model, previous studies have either applied variable-based analysis such as confirmatory factor analysis (CFA), or used predetermined cut-off points for subgroup division. The present study extends this contribution by subjecting data from an African sample to both CFA and latent class analysis (LCA) to test the dual-continua model in Africa. We applied CFA separately for the Mental Health Continuum—Short Form (MHC-SF) and Patient Health Questionnaire—9 (PHQ-9); and LCA on combined item responses. College students (N = 892; average age = 22.74, SD = 4.92; female = 58%) from Ghana (n = 309), Kenya (n = 262), Mozambique (n = 232), and South Africa (n = 89) completed the MHC-SF and PHQ-9. With minor modifications to the measurement models, the CFA results of this study confirm the three-factor structure of the MHC-SF, and a unidimensional solution for the PHQ-9. LCA results show the presence of three distinct latent classes: languishing with moderate endorsement of depressive symptoms (25.9%), flourishing with low endorsement of depressive symptoms (63.7%), and moderate mental health with high endorsement of depressive symptoms (10.4%). These findings further contribute to affirming the evidence for the dual-continua model of mental health, with implications for the assessment of mental health, to inform policy, practise, and future research in community and clinical settings in Africa.

Flourishing in Healthcare Trainees: Psychological Well-Being and the Conserved Transcriptional Response to Adversity

While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the "conserved transcriptional response to adversity" (CTRA) characterized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.