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Gonzales PA, Coopersmith AS, Kaushik D, Lebares C, Malotte M, Taylor JM, Pierorazio PM. A mindful approach to complications: Brief review of the literature and practical guide for the surgeon. Urol Oncol 2024; 42:302-309. [PMID: 38845297 DOI: 10.1016/j.urolonc.2024.04.018] [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] [Received: 03/11/2024] [Accepted: 04/18/2024] [Indexed: 07/27/2024]
Abstract
Patient complications and adverse outcomes are inherent to surgical practice and training. In addition to the impact on patients, there are profound and well-documented impacts of complications on surgeons, surgical trainees, and surgical teams. This manuscript reviews the literature regarding mindfulness-based practices and the associated mitigation of the adverse impact of complications. These mindfulness-based practices prepare surgeons for complications by improving mental and cognitive resilience facilitating more effective management of complications that avoids undue psychological and emotional stress. Practical recommendations are provided for the practicing surgeon from providers experienced in mindfulness-based training and preparation.
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Affiliation(s)
- Paul Adam Gonzales
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Ari S Coopersmith
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Dharam Kaushik
- Department of Urology, Houston Methodist, 6560 Fannin St # 2100, Houston, TX 77030
| | - Carter Lebares
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Michael Malotte
- UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Jennifer M Taylor
- Department of Urology, Baylor College of Medicine, 7200 Cambridge St Ste 10B, Houston TX 7703
| | - Phillip M Pierorazio
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine, 51 N. 39th Street, Suite 300 MOB, Philadelphia PA 19104.
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Rhines A, Medina J, Reed R, Stewart K, Raines A. Assessing the efficacy and feasibility of emotional intelligence and stress management training for medical students within their third-year surgery clerkship. Am J Surg 2024; 238:115817. [PMID: 39094427 DOI: 10.1016/j.amjsurg.2024.115817] [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: 04/18/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND This study aimed to evaluate the efficacy and feasibility of a cognitive fitness training (CFT) program on the development of emotional intelligence and stress management skills in medical students during their 3rd year surgery clerkship. METHODS MS3s (n = 80) were randomized into a training or control group. The training group received CFT during their clerkship, the control group received online access afterwards. A cognitive fitness (CF) assessment was administered before and after the clerkship. RESULTS The training group demonstrated a significant improvement in cumulative assessment scores (126.4-146.5, p < 0.0001) and most dimensions of CF assessment. Integration of the curriculum did not adversely impact performance on surgery NBME or surgery OSCE when compared to control (p > 0.05). CONCLUSIONS The CFT provided to MS3s resulted in significant improvements in CF, including most subcategories. The CFT also did not have an adverse impact on academic performance indicating its feasibility within medical education curricula.
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Affiliation(s)
- Austin Rhines
- AAT 9000 800 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA.
| | - Joey Medina
- College of Health Professions Oklahoma City University, 2501 N Blackwelder Ave, Oklahoma City, OK, 73106, USA.
| | - Rachelle Reed
- Reed Science & Health, LLC 1808 Maddison Avenue, Watkinsville, GA, 30677, USA.
| | - Kenneth Stewart
- AAT 9000 800 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA.
| | - Alexander Raines
- AAT 9000 800 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA.
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Kajee N, Montero-Marin J, Saunders KEA, Myall K, Harriss E, Kuyken W. Mindfulness training in healthcare professions: A scoping review of systematic reviews. MEDICAL EDUCATION 2024; 58:671-686. [PMID: 38234144 DOI: 10.1111/medu.15293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The effectiveness of mindfulness training (MT) on mental health and wellbeing in different groups and contexts is well-established. However, the effect of MT on different healthcare professionals' (HCPs) mental health and wellbeing needs to be synthesised, along with a focus on outcomes that are specifically relevant to healthcare settings. The aim of this study is to summarise the effect of MT interventions on HCPs' mental health and wellbeing, to explore its effect on communication skills and to identify potential gaps in the literature. METHODS A scoping review of systematic reviews (SRs) investigating MT interventions in HCPs was conducted. A comprehensive systematic search was conducted from database inception to 22 February 2023 on Ovid MEDLINE, Ovid Embase, Scopus, Cochrane (CENTRAL), EBSCHOhost CINAHL, Ovid PsycINFO, Web of Science (Core Collection), OpenGrey, TRIP Database and Google Scholar. Snowballing of reference lists and hand-searching were utilised. Risk of bias and quality of included SRs were assessed using the ROBIS and AMSTAR2 tools. RESULTS Sixteen SRs were included in this review. We found substantial evidence for MT interventions improving mental health and wellbeing across different HCPs, with the exception of burnout, where evidence is mixed. There is a paucity of SRs evaluating communication skills other than empathy. However, the available evidence is suggestive of improvements in self-reported empathy. Details of MT fidelity and dosage are largely absent in the SRs, as is study populations from representative EDI samples. CONCLUSIONS Synthesis of SRs suggests that MT improves mental health and wellbeing in HCPs. The exception is burnout, where results are inconclusive. Insufficient data exists to evaluate effects of MT on the full spectrum of communication skills. Other HCPs than medicine and nursing are inadequately represented. Further research is required that considers the specific target population of HCPs and MT curriculum, and reports on fidelity, dosage and the effects on communication skills.
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Affiliation(s)
- Nabeela Kajee
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health, CIBERESP), Madrid, Spain, 28029
| | - Kate E A Saunders
- Associate Professor, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
| | - Kearnan Myall
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
| | - Elinor Harriss
- Outreach and Enquiry Services Manager, Bodleian Health Care Libraries, University of Oxford, UK, OX3 7JX
| | - Willem Kuyken
- Professor, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
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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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Ojute F, Gonzales PA, Ghadimi TR, Edwards A, van der Schaaf M, Lebares C. Investigating First Year Surgery Residents' Expectations of Demand, Control, and Support During Training. JOURNAL OF SURGICAL EDUCATION 2024; 81:474-485. [PMID: 38388312 DOI: 10.1016/j.jsurg.2023.12.015] [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: 09/22/2023] [Revised: 12/09/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training. SUMMARY/BACKGROUND DATA General surgery (GS) interns are at highest risk for burnout and attrition. Maslach frames burnout as resulting from a mismatch between workplace expectations and reality. Occupational science demonstrates workplace demand, control, and support (DCS) as strong influencers of job strain. GS interns' realistic expectations of demands are associated with decreased likelihood of attrition, but their expectations regarding this factor are poorly understood. METHODS Semi-structured interviews were conducted with 14 incoming surgical residents at UCSF: University of California, San Francisco (57% women, 71% non-White), exploring expectations regarding workplace DCS. Transcripts were uploaded to analytic software and coded in dyads using an iterative approach to consensus. Transcripts were thematically analyzed using inductive and deductive reasoning, applying job-demand-resource theory frameworks, and following a published 6-step approach. RESULTS Four main themes emerged: past experiences, expected rewards, anticipated challenges, and the desire to belong. Past experiences describes the expectation to successfully cope with future stressors via self-reliance. Rewards such as professional mastery, personal growth, and sense of meaning were expected outcomes seen as balancing anticipated challenges. Anticipated challenges included low control, toxic cultural elements, and discrimination. Desire to belong (i.e., earned recognition as a peer, inclusion in an elite culture) emerged as a powerful motivator, with survival connotations for women and non-Whites. CONCLUSION Our results suggest incoming interns overestimate the efficacy of self-reliance for coping; count on specific rewards; express realistic expectations regarding challenges; and see inclusion among surgeons as an aspiration that off-sets prolonged effort. Further study is warranted to understand expectation-reality mismatch and potential interventions to target dissonance. MINI-ABSTRACT In this institutional study of general surgery interns, we provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training, and how we might target "expectations-reality" mismatch and the "desire to belong" as a means of mitigating burnout and minimizing attrition from training.
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Affiliation(s)
- Feyisayo Ojute
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Paul Adam Gonzales
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - T Roxana Ghadimi
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Anya Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Marieke van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, Department of Education, Utrecht University, Utrecht, Utrecht, Netherlands
| | - Carter Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California.
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Bhat SG, Nagaraj M, Balentine C, Hogan T, Meier J, Prince H, Abdelfattah K, Zeh H, Levi B. Assessing a Structured Mental Fitness Program for Academic Acute Care Surgeons: A Pilot Study. J Surg Res 2024; 295:9-18. [PMID: 37956507 DOI: 10.1016/j.jss.2023.09.052] [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] [Received: 02/22/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION There is a well-established positive correlation between improved physician wellness and patient care outcomes. Mental fitness is a component of wellness that is understudied in academic medicine. We piloted a structured mental fitness Positive Intelligence (PQ) training program for academic surgeons, hypothesizing this would be associated with improvements in PQ scores, wellness, sleep, and trainee evaluations. METHODS This is a single-institution, prospective, mixed-methods pilot study. All active Burn/Trauma/Acute & Critical Care Surgical faculty and fellows in our division were offered the PQ program and the option to participate in this research study. The 6-wk program consists of daily exercises on a smartphone application, weekly readings, and small-group meetings with a trained mindfulness coach. Study outcomes included changes in pretraining versus post-training PQ scores, sleep hygiene, wellness, and teaching scores. A Net Promoter Score was calculated to measure user overall experience (range -100 to 100; positive scores being supportive). For secondary analysis, participants were stratified into high versus low user groups by "muscle" scores, which were calculated by program use over time. A postintervention focus group was also held to evaluate perceptions of wellness and experience with the PQ program. RESULTS Data were analyzed for 15 participants who provided consent. The participants were primarily White (73.3%), Assistant Professors (66.7%) with Surgical Critical Care fellowship training (86.7%), and a slight female predominance (53.3%). Comparison of scores pretraining versus post-training demonstrated statistically significant increases in PQ (59 versus 65, P = 0.004), but no significant differences for sleep (24.0 versus 29.0, P = 0.33) or well-being (89.0 versus 94.0, P = 0.10). Additionally, there was no significant difference in teaching evaluations for both residents (9.1 versus 9.3, P = 0.33) and medical students (8.3 versus 8.5, P = 0.77). High versus low user groups were defined by the median muscle score (166 [Interquartile range 95.5-298.5]). High users demonstrated a statistically higher proportion of ongoing usage (75% versus 14%, P < 0.05). The final Net Promoter Score score was 25, which demonstrates program support within this group. Focus group content analysis established eight major categories: current approaches to wellness, preknowledge, reasons for participation, expected gains, program strengths, suggestions for improvement, recommendations for approaches, and sustainability. CONCLUSIONS Our pilot study highlighted certain benefits of a structured mental fitness program for academic acute care surgeons. Our mixed-methods data demonstrate significant improvement in PQ scores, ongoing usage in high user participants, as well as interpersonal benefits such as improved connectedness and creation of a shared language within participants. Future work should evaluate this program on a higher-powered scale, with a focus on intentionality in wellness efforts, increased exposure to mental fitness, and recruitment of trainees and other health-care providers, as well as identifying the potential implications for patient outcomes.
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Affiliation(s)
- Sneha G Bhat
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas.
| | - Madhuri Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Courtney Balentine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Timothy Hogan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hillary Prince
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| | - Kareem Abdelfattah
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Levi
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
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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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Wan Z, Tang J, Bai X, Cao Y, Zhang D, Su T, Zhou Y, Qiao L, Shen K, Wang L, Tian X, Wang J. Burnout among radiology residents: a systematic review and meta-analysis. Eur Radiol 2024; 34:1399-1407. [PMID: 37589905 DOI: 10.1007/s00330-023-09986-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To analyze the prevalence of burnout among radiology residents. METHOD Five databases (PubMed, Web of Science, Embase, PsycINFO, and Scopus) were searched for studies reporting burnout in radiology residents for the period up to November 7, 2022. RESULTS A total of 423 studies were identified, and eventually, 16 studies were selected for the qualitative analysis, of which 11 studies were used in the meta-analysis. There was a total of 2164 radiology residents. Six studies reported the prevalence of burnout but the data could not be pooled due to their inconsistent definitions of burnout. The mean scores of three burnout subscales indicated a moderate to high degree of severity: emotional exhaustion = 25.2 (95% CI, 22.1-28.3; I2 = 94.4%), depersonalization = 10.2 (95% CI, 8.5-11.9; I2 = 93.0%), and low perception of personal accomplishment = 32.9 (95% CI, 30.5-35.4; I2 = 94.4%). The pooled prevalence of high-degree emotional exhaustion was 49.9% (95% CI, 43.6-56.1%; I2 = 55.7%), high-degree depersonalization was 45.1% (95% CI, 38.3-52.0%; I2 = 63.2%), and high-degree diminished personal accomplishment was 58.2% (95% CI, 36.0-77.6%; I2 = 84.9%). The impact of the COVID-19 pandemic on radiology residents was not investigated. In addition, there are inconsistent findings on the effects of female sex, seniority, and social support on burnout. CONCLUSIONS About half of the radiology residents showed at least one of the three burnout manifestations (emotional exhaustion, depersonalization, and personal accomplishment), with a moderate to high degree of severity. CLINICAL RELEVANCE STATEMENT Such a high prevalence and severity of burnout among radiology residents warrant the attention of residency program directors. KEY POINTS • Burnout, not uncommon among radiology residents, has not been effectively analyzed. • Nearly half of the radiology residents experience at least one of the three manifestations of burnout to a moderate to high degree. • The high prevalence and severe degree of burnout among radiology residents warrant the attention of residency program directors.
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Affiliation(s)
- Ziqi Wan
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Eight-year program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jieying Tang
- Department of Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaoyin Bai
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihan Cao
- Department of Radiology, Mass General Brigham Salem Hospital, 81 Highland Avenue, Salem, MA, 01970, USA
| | - Dingding Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yangzhong Zhou
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lin Qiao
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kaini Shen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luo Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jinglan Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Luo S, Zhang Y, Wang P, Yang Z, Zheng J, Wang Z, Zhang J, Zhu J. The moderating role of resilience in the association between workload and depressive symptoms among radiology residents in China: results from a nationwide cross-sectional study. Eur Radiol 2024; 34:695-704. [PMID: 37566268 DOI: 10.1007/s00330-023-10021-7] [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] [Received: 01/12/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES The current study aimed to explore the moderating role of psychological resilience in the association between workload and depressive symptoms among radiology residents during standardized residency training (SRT) in China. METHODS A nationwide cross-sectional online survey was conducted among radiology residents in China. Workload was measured by working hours per week and the frequency of frontline nightwork in the last month. Resilience was assessed by the 2-item Connor-Davidson Resilience Scale. Depressive symptoms were measured by the Depression Anxiety Stress Scales. The hierarchical regression and simple slope analyses were performed to examine the moderating effect of resilience. RESULTS Among 3666 radiology residents, the mean age was 27.3 years (SD = 2.6) and 58% were female. About 24.4% of the participants reported medium to severe depressive symptoms. The hierarchical regression showed that working hours (ba = 0.11, 95%CI: 0.08, 0.14) and having frontline nightwork more than once (ba = 1.22, 95%CI: 0.67, 1.78) were positively associated with depressive symptoms; the moderating effect of resilience was significant in the association of depressive symptoms with working hours (ba = - 0.02, 95%CI: - 0.03, - 0.01) and having frontline nightwork more than once (ba = - 0.28, 95%CI: - 0.49, - 0.07). The simple slope test showed the association between workload-related variables and depressive symptoms was only significant in those with a relatively lower level of resilience. CONCLUSIONS The study found that resilience was an important modifier buffering the positive association between workload and depressive symptoms among radiology residents in China. Future medical training programs are suggested to include effective intervention components to increase personal resilience. CLINICAL RELEVANCE STATEMENT Heavy workload in clinical setting may pose adverse effect on mental health and job performance of radiology residents. The study investigated whether psychological resilience would mitigate the association between workload and depressive symptoms among Chinese radiology residents. KEY POINTS • Radiology residents with a heavier workload presented a higher level of depressive symptoms in China. • Psychological resilience mitigated the positive association between workload and depressive symptoms. • The association between workload and depressive symptoms was only statistically significant in radiology residents with a relatively lower level of resilience.
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Affiliation(s)
- Sitong Luo
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yuhang Zhang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospital, 315000, Ningbo, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospital, 315000, Ningbo, China.
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
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Fessell DP, Lexa F. Healthy Resilience Helps Misconceptions, Distinctions, and Context. J Am Coll Radiol 2024; 21:214-215. [PMID: 37640126 DOI: 10.1016/j.jacr.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 08/31/2023]
Affiliation(s)
- David P Fessell
- Faculty Associate, Ross School of Business, University of Michigan, Ann Arbor, Michigan; Retired Professor of Radiology, University of Michigan Health System, Department of Radiology, Ann Arbor, Michigan.
| | - Frank Lexa
- Professor of Radiology and Vice Chair-Faculty Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania; Chief Medical Officer, the Radiology Leadership Institute of the ACR, Reston, Virginia
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Anand A, Jensen R, Korndorffer JR. We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:1618-1640. [PMID: 37541937 DOI: 10.1016/j.jsurg.2023.07.009] [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: 02/25/2023] [Revised: 05/26/2023] [Accepted: 07/08/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation. DESIGN A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score. RESULTS A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8). CONCLUSIONS Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.
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Affiliation(s)
- Ananya Anand
- Department of Surgery, Stanford University, Stanford, California.
| | - Rachel Jensen
- Department of Surgery, Stanford University, Stanford, California
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Roman G, Yousefi-Nooraie R, Vermilion P, Cupertino A, Barnett S, Epstein R. Mindful practice with medical interpreters. Front Psychol 2023; 14:1171993. [PMID: 37954177 PMCID: PMC10637490 DOI: 10.3389/fpsyg.2023.1171993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Medical interpreters experience emotional burdens from the complex demands at work. Because communication access is a social determinant of health, protecting and promoting the health of medical interpreters is critical for ensuring equitable access to care for language-minority patients. The purpose of this study was to pilot a condensed 8-h program based on Mindful Practice® in Medicine addressing the contributors to distress and psychosocial stressors faced by medical sign and spoken language interpreters. Methods Using a single-arm embedded QUAN(qual) mixed-methods pilot study design, weekly in-person 1-h sessions for 8 weeks involved formal and informal contemplative practice, didactic delivery of the week's theme (mindfulness, noticing, teamwork, suffering, professionalism, uncertainty, compassion, and resilience), and mindful inquiry exercises (narrative medicine, appreciative interviews, and insight dialog). Quantitative well-being outcomes (mean±SEM) were gathered via survey at pre-, post-, and 1-month post-intervention time points, compared with available norms, and evaluated for differences within subjects. Voluntary feedback about the workshop series was solicited post-intervention via a free text survey item and individual exit interviews. A thematic framework was established by way of qualitative description. Results Seventeen medical interpreters (46.2 ± 3.1 years old; 16 women/1 man; 8 White/9 Hispanic or Latino) participated. Overall scores for teamwork (p ≤ 0.027), coping (p ≤ 0.006), and resilience (p ≤ 0.045) increased from pre- to post-intervention and pre- to 1-month post-intervention. Non-judging as a mindfulness component increased from pre- to post-intervention (p = 0.014). Compassion satisfaction (p = 0.021) and burnout (p = 0.030) as components of professional quality of life demonstrated slightly delayed effects, improving from pre- to 1-month post-intervention. Themes such as workshop schedule, group size, group composition, interactivity, topics to be added or removed, and culture are related to the overarching topic areas of intervention logistics and content. Integration of the findings accentuated the positive impact of the intervention. Discussion The results of this research demonstrate that mindful practice can serve as an effective resource for medical interpreters when coping with work-related stressors. Future iterations of the mindful practice intervention will further aspire to address linguistic and cultural diversity in the study population for broader representation and subsequent generalization.
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Affiliation(s)
- Gretchen Roman
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
| | - Paul Vermilion
- Department of Medicine, Palliative Care Program, University of Rochester, Rochester, NY, United States
| | - Anapaula Cupertino
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
- Department of Surgery, University of Rochester, Rochester, NY, United States
| | - Steven Barnett
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
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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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Suraju MO, McElroy L, Moten A, Obeng-Gyasi S, Alimi Y, Carter D, Foretia DA, Stapleton S, Yilma M, Reid VJ, Tetteh HA, Khabele D, Rodriguez LM, Campbell A, Newman EA. A framework to improve retention of Black surgical trainees: A Society of Black Academic Surgeons white paper. Am J Surg 2023; 226:438-446. [PMID: 37495467 DOI: 10.1016/j.amjsurg.2023.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
Attrition is high among surgical trainees, and six of ten trainees consider leaving their programs, with two ultimately leaving before completion of training. Given known historically and systemically rooted biases, Black surgical trainees are at high risk of attrition during residency training. With only 4.5% of all surgical trainees identifying as Black, underrepresentation among their peers can lend to misclassification of failure to assimilate as clinical incompetence. Furthermore, the disproportionate impact of ongoing socioeconomic crisis (e.g., COVID-19 pandemic, police brutality etc.) on Black trainees and their families confers additional challenges that may exacerbate attrition rates. Thus, attrition is a significant threat to medical workforce diversity and health equity. There is urgent need for surgical programs to develop proactive approaches to address attrition and the threat to the surgical workforce. In this Society of Black Academic Surgeons (SBAS) white paper, we provide a framework that promotes an open and inclusive environment conducive to the retention of Black surgical trainees, and continued progress towards attainment of health equity for racial and ethnic minorities in the United States.
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Affiliation(s)
- Mohammed O Suraju
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Lisa McElroy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Ambria Moten
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yewande Alimi
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Damien Carter
- Department of Surgery, Maine Medical Center, Portland, ME, United States
| | - Denis A Foretia
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sahael Stapleton
- Department of Surgery, Kaiser Permanente Vacaville Medical Center, Vacaville, CA, United States
| | - Mignote Yilma
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Vincent J Reid
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States; Department of Surgery, Mercy Medical Center Cedar Rapids, Cedar Rapids, IA, United States
| | - Hassan A Tetteh
- Department of Surgery, Uniformed Services University, Bethesda, MD, United States
| | - Dineo Khabele
- Division of Gynecologic Oncology, Washington University School of Medicine, And Alvin J. Siteman Cancer Center, St Louis, MO, United States
| | - Luz M Rodriguez
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, NCI, NIH, Bethesda, MD, United States; Department of Surgery, Walter Reed National Military Medical Center (WRNMM) Uniformed Services University (USU), Bethesda, MD, United States
| | - Andre Campbell
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Erika A Newman
- Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, The University of Michigan Medical School, United States.
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Bamdad MC, Vitous CA, Rivard SJ, Anderson M, Lussiez A, De Roo A, Englesbe MJ, Suwanabol PA. What We Talk About When We Talk About Coping: A Qualitative Study of Surgery Resident's Coping After Complications and Deaths. Ann Surg 2023; 278:e422-e428. [PMID: 36994739 PMCID: PMC10363203 DOI: 10.1097/sla.0000000000005854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To explore how surgery residents cope with unwanted patient outcomes including postoperative complications and death. BACKGROUND Surgery residents face a variety of work-related stressors that require them to engage in coping strategies. Postoperative complications and deaths are common sources of such stressors. Although few studies examine the response to these events and their impacts on subsequent decision-making, there has been little scholarly work exploring coping strategies among surgery residents specifically. METHODS This study investigated the ways, in which general surgery residents cope with unwanted patient outcomes, including complications and deaths. Mid-level and senior residents (n = 28) from 14 academic, community, and hybrid training programs across the United States participated in exploratory semistructured interviews conducted by an experienced anthropologist. Interview transcripts were analyzed iteratively, informed by thematic analysis. RESULTS When discussing how they cope with complications and deaths, residents described both internal and external strategies. Internal strategies included a sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, commitment to change, and personal practices or rituals, such as exercise or psychotherapy. CONCLUSIONS In this novel qualitative study, general surgery residents described the coping strategies that they organically used after postoperative complications and deaths. To improve resident well-being, it is critical to first understand the natural coping processes. Such efforts will facilitate structuring future support systems to aid residents during these difficult periods.
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Affiliation(s)
- Michaela C. Bamdad
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - C. Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Samantha J. Rivard
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Maia Anderson
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Alisha Lussiez
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Ana De Roo
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Michael J. Englesbe
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Pasithorn A. Suwanabol
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
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Purdie DR, Federman M, Chin A, Winston D, Bursch B, Olmstead R, Bulut Y, Irwin MR. Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation. J Clin Psychol Med Settings 2023; 30:425-434. [PMID: 35778655 PMCID: PMC10078965 DOI: 10.1007/s10880-022-09896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.
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Affiliation(s)
- Denise R Purdie
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Pediatrics, Irvine School of Medicine, University of California, Irvine, CA, USA
| | - Myke Federman
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alan Chin
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Diana Winston
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Semel 48-241, Los Angeles, CA, 90024-1759, USA
| | - Brenda Bursch
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Semel 48-241, Los Angeles, CA, 90024-1759, USA.
| | - Richard Olmstead
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Semel 48-241, Los Angeles, CA, 90024-1759, USA
| | - Yonca Bulut
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael R Irwin
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Semel 48-241, Los Angeles, CA, 90024-1759, USA
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Shin H, Oh HK, Song Y, Kim YS, Hur BY, Kim DW, Kang SB. Efficacy of the online Mindful Self-Compassion for Healthcare Communities program for surgical trainees: a prospective pilot study. Ann Surg Treat Res 2023; 104:229-236. [PMID: 37051155 PMCID: PMC10083347 DOI: 10.4174/astr.2023.104.4.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
Purpose The efficacy of the Mindful Self-Compassion (MSC) for Healthcare Communities program has not been verified. This study aims to evaluate the feasibility and efficacy of the online MSC for Healthcare Communities program on burnout, stress-related health, and resilience among surgical trainees. Methods A single-arm pilot study was conducted at a tertiary referral academic hospital in Korea. Surgical trainees were recruited through flyer postings; therefore, a volunteer sample was used. Thus, 15 participants participated, among whom 9 were women and 11 were doctor-residents. The Self-Compassion for Healthcare Communities (SCHC) program was conducted from September to October 2021 via weekly online meetings (1 hour) for 6 weeks. The efficacy of the program was evaluated using validated scales for burnout, stress, anxiety, depression, self-compassion, and resilience before and after the intervention and 1 month later. Results The results showed significantly reduced burnout, anxiety, and stress scores. After the program, high emotional exhaustion and depersonalization rates decreased, and personal accomplishment increased. Eight participants showed reduced anxiety postintervention, and 9 showed reduced stress. Improvements were observed between pre- and postintervention in resilience, life satisfaction, and common humanity. Changes in self-compassion predicted higher gains in resilience and greater reductions in burnout and stress. Conclusion The SCHC is a feasible and effective program to improve resilience, self-compassion, and life satisfaction and reduce stress, anxiety, depression, and burnout in surgical trainees. This study highlights the need to include specific mental health programs in surgical training to improve trainees' well-being.
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Affiliation(s)
- Hyojung Shin
- Department of Education, Ajou University, Suwon, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yungsook Song
- College of Buddhist, Dongguk University, Seoul, Korea
| | - Yang Sun Kim
- Department of Education, Ajou University, Suwon, Korea
| | - Bo Yeon Hur
- Department of Education, Ajou University, Suwon, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Rodriguez-Unda NA, Mehta I, Chopra S, Vicente-Ruiz M, Navia A, Fernandez-Diaz OF. Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4889. [PMID: 37051210 PMCID: PMC10085483 DOI: 10.1097/gox.0000000000004889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 04/14/2023]
Abstract
Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees. Methods A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire. Results One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout. Conclusions Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were "protective." Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.
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Affiliation(s)
| | - Ishan Mehta
- Division of Plastic Surgery Department of General Surgery, Baylor Scott-White, Texas A&M College of Medicine
| | - Shiv Chopra
- Global Trainee Representative to the International Confederation of Plastic Surgery Societies [ICOPLAST]
| | - Miriam Vicente-Ruiz
- Plastic, Reconstructive and Aesthetic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Alfonso Navia
- Section of Plastic and Reconstructive Surgery, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oscar F. Fernandez-Diaz
- Department of Clinical Sciences, Medical School University of Guadalajara, Guadalajara, Mexico
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Ryan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review. Front Public Health 2023; 11:1133484. [PMID: 37064688 PMCID: PMC10098100 DOI: 10.3389/fpubh.2023.1133484] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction The World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery. Methods A mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis. Results Sixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians. Conclusion The systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.
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Affiliation(s)
- Emer Ryan
- Department of Cardiothoracic Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Kevin Hore
- College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Great Ormonde Street Children's Hospital, London, United Kingdom
| | - Jessica Power
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
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Coleman JR. The Trauma Fellow's Perspective on Grit and Resilience and Its Role in Wellness. CURRENT TRAUMA REPORTS 2023; 9:1-6. [PMID: 37362904 PMCID: PMC10061407 DOI: 10.1007/s40719-023-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/03/2023]
Abstract
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.
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Affiliation(s)
- Julia R. Coleman
- Department of Surgery, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210 USA
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21
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Making the Financial Case for Surgical Resident Well-being: A Scoping Review. Ann Surg 2023; 277:397-404. [PMID: 36124776 DOI: 10.1097/sla.0000000000005719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To conduct a scoping review of literature on financial implications of surgical resident well-being. BACKGROUND Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited. METHODS Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis. RESULTS Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective. CONCLUSIONS Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.
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Golisch KB, Sanders JM, Rzhetsky A, Tatebe LC. Addressing Surgeon Burnout Through a Multi-level Approach: A National Call to Action. CURRENT TRAUMA REPORTS 2023; 9:28-39. [PMID: 36688090 PMCID: PMC9843106 DOI: 10.1007/s40719-022-00249-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
Purpose of Review Physician burnout is an epidemic and there are unique aspects of surgery that dictate rates of burnout among general surgeons and surgical trainees. This review characterizes the scope of burnout and its drivers within the field of surgery and advocates for strategies to address burnout at the individual, institutional, and national levels. Recent Findings Rates of burnout in surgery are increasing with higher numbers of young and female surgeons affected. Contributing factors are generally related to work-life balance, longer hours, and mistreatment in the workplace. Attempts have been made at implementing structured initiatives in an effort to combat work dissatisfaction and emotional exhaustion. Still, rates of burnout continue to increase. Summary General surgeons and trainees are at high risk for burnout with resulting attrition, depression, and suicidal ideation. The solution to burnout must be addressed at individual, institutional, and national levels. Further research into the factors leading to surgeon burnout and enactment of effective strategies to mitigate burnout must be pursued.
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Affiliation(s)
- Kimberly B. Golisch
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jes M. Sanders
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | | | - Leah C. Tatebe
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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23
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He Q, Xu P, Wang H, Wang S, Yang L, Ba Z, Huang H. The mediating role of resilience between perceived social support and sense of security in medical staff following the COVID-19 pandemic: A cross-sectional study. Front Psychiatry 2023; 14:1096082. [PMID: 36960462 PMCID: PMC10027772 DOI: 10.3389/fpsyt.2023.1096082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023] Open
Abstract
Background The COVID-19 pandemic not only posed a serious threat to public life and health but also had a serious impact on people's mental health, especially that of medical staff. Perceived social support is an important factor in one's sense of security. Objective Following the COVID-19 pandemic, the goal is to explore the potential mediating role of resilience in the relationship between perceived social support and the sense of security of Chinese medical personnel. Methods The multi-stage proportionally stratified convenience sampling method was adopted to select 4,076 medical professionals from 29 hospitals in Guangdong Province between September 2020 and October 2020. The Sense of Security Scale for Medical Staff, the Chinese version of the Connor-Davidson Resilience Scale, and the Perceived Social Support Scale were employed in this study. For statistical analysis and structural equation modeling (SEM), the SPSS 23.0 and Amos 24.0 software packages were used. Regression analysis was used to select the control variables to be included in the SEM. SEM analysis was conducted to verify the mediating effect of resilience on the relationship between perceived social support and a sense of security. Results Pearson's correlation analysis showed that perceived social support and resilience were positively associated with a sense of security (correlation coefficients range from 0.350 to 0.607, P < 0.01), and perceived social support (correlation coefficients range from 0.398 to 0.589, P < 0.01) was positively associated with resilience. Structural equation modeling revealed that resilience played a partial mediating role in the association between perceived social support and a sense of security (60.3% of the effect of perceived social support on security was direct, and 39.7% of the effect was mediated by resilience). Conclusions Hospital managers should make efforts to develop resilience. Interventions based on resilience should be developed to enhance the perception of social support and strengthen one's sense of security.
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Affiliation(s)
- Qingxia He
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Peng Xu
- Nursing Department, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Huajun Wang
- Nursing Department, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lulu Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhiqiong Ba
- Nursing Department, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Huigen Huang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- *Correspondence: Huigen Huang
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Prevost V, Tran T, Clarisse B, Leconte A, Duchange N, Moutel G, Gouriot M. Shared Meditation Involving Cancer Patients, Health Professionals and Third Persons: Perceptions of Participants Through a Focus Group Study. Integr Cancer Ther 2023; 22:15347354231186995. [PMID: 37452577 DOI: 10.1177/15347354231186995] [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: 07/18/2023] Open
Abstract
People with cancer often experience psychological distress and in addition, the practice of oncology is one of the most stressful areas of medicine for health professionals. Mindfulness meditation has been used to alleviate stress-related symptoms. We therefore ran a pilot study to assess the feasibility of a mindfulness intervention involving cancer patients, health professionals, and third persons together, as part of a comprehensive project aiming to evaluate the added value of 'meditating together'. Following on from our quantitative analyses of the project, we investigated its qualitative aspects through focus groups to explore the perceptions of participants regarding their experience. Focus groups conducted in 7 patients, 7 health professionals, and 8 third persons after the intervention showed that 'meditating together' was generally appreciated, particularly by patients, who found it motivating and a way to relieve their feelings of loneliness in the face of illness. All participants reported better stress management. They also shared benefits and difficulties concerning the practice of meditation and the programme's modalities. In addition, they all stated that the programme should be lasting. The opinion of the patients (our target population) will be decisive in building an optimized programme that will suit them the best. In conclusion, the protocol and the qualitative findings of the present study validate the rationale for conducting a fully powered randomized trial to demonstrate the potential added value of shared meditation and how it improves well-being by promoting bridge-building between cancer patients, health professionals and others.Trial Registration: ClinicalTrials.gov. NCT04410185. Registered on June 1, 2020.
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Affiliation(s)
- Virginie Prevost
- Normandie University, UNICAEN, INSERM U1086, ANTICIPE, Caen, France
- Centre François Baclesse, Caen, France
| | - Titi Tran
- 162 rue Gabriel Péri, Gentilly, France
| | | | | | | | - Grégoire Moutel
- Normandie University, UNICAEN, INSERM U1086, ANTICIPE, Caen, France
- Espace Régional de Réflexion Ethique, CHU de Caen, Normandie University, UNICAEN, Caen, France
| | - Mylène Gouriot
- Espace Régional de Réflexion Ethique, CHU de Caen, Normandie University, UNICAEN, Caen, France
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Kratzke IM, Barnhill JL, Putnam KT, Rao S, Meyers MO, Meltzer-Brody S, Farrell TM, Bluth K. Self-compassion training to improve well-being for surgical residents. Explore (NY) 2023; 19:78-83. [PMID: 35534424 DOI: 10.1016/j.explore.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/13/2022] [Accepted: 04/30/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Burnout remains prevalent among surgical residents. Self-compassion training may serve to improve their well-being. OBJECTIVE To evaluate the impact on well-being of a self-compassion program modified for surgical residents. DESIGN This is a 3-year, mixed-methods study using pre-post surveys and focus groups to identify areas for programmatic improvement and the subsequent impact of the modifications. SETTING A single academic institution. PARTICIPANTS Surgical residents participating in a self-compassion program. INTERVENTIONS A self-compassion program adapted from a larger course to fit the needs of surgical residents. MAIN OUTCOME MEASURES Themes relating to the program's strengths and weaknesses were identified through participant focus groups. Well-being was assessed through validated measurement tools, including The Maslach Burnout Inventory (MBI), Patient Health Questionnaire-9, Perceived Stress Scale, and Spielberger State-Trait Anxiety Inventory-6. RESULTS 95 residents participated in the self-compassion program, of which 40 residents completed both surveys (total response rate: 42%). All participants demonstrated severe burnout pre-program, based on scores of at least one of the MBI subscales. Emotional exhaustion scores improved post-program, with larger improvements seen after program modifications (2018: 58% vs 2020: 71%). Focus group findings demonstrated that residents need a safe and distraction-free space to practice self-compassion, and program engagement improved following modifications.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA.
| | - Jessica L Barnhill
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7200, Chapel Hill, NC 27599-7200, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
| | - Sanjana Rao
- Physiology Graduate School, North Carolina State University, 1020 Main Campus Drive, Room 2300A, Raleigh, NC 27695-7102, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
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Kobritz M, Nofi CP, Demyan L, Farno E, Fornari A, Kalyon B, Patel V. Implementation and Assessment of Mentoring and Professionalism in Training (MAP-IT): A Humanistic Curriculum as a Tool to Address Burnout in Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2023; 80:17-29. [PMID: 36437162 DOI: 10.1016/j.jsurg.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/02/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Mentoring and Professionalism in Training (MAP-IT), a humanistic mentorship program, has demonstrated positive impact in non-surgical fields. This study assesses the feasibility of implementing MAP-IT in surgical residency and adapts MAP-IT to include residents-as-teachers (RAT). We hypothesize that MAP-IT will benefit surgical residents by building humanistic teaching skills, increasing resilience, reducing burnout, and improving connectedness. DESIGN MAP-IT was implemented monthly during protected educational time. Faculty surgeons who had previously completed MAP-IT served as facilitators. Small groups consisted of 12 trainees, two faculty facilitators, and one resident facilitator. Each session comprised 60 minutes of reflection, readings, and discussion surrounding humanistic mentoring skills. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Connor Davidson Resilience Scale (CD-RISC), and Humanistic Teaching Practices Effectiveness Questionnaire (HTPE) were administered before and after participation in MAP-IT. Qualitative interviews and surveys assessed residents' perspectives of the MAP-IT program. SETTING MAP-IT was implemented at Northwell-North Shore/LIJ in Manhasset, NY in a general surgery residency program hosted by two tertiary care hospitals within a large health system. PARTICIPANTS 55 residents participated as learners, five residents served as resident-facilitators, and 10 surgical faculty served as paired-facilitators of the MAP-IT course. RESULTS 31.6% of residents had participated in a reflective medicine curriculum prior to MAP-IT, and these residents reported greater resilience and less burnout. This disparity was eliminated after participation in MAP-IT. Frequency of burnout was reduced from 64.1% to 46.1% after MAP-IT participation. Post-program, residents reported greater effectiveness in humanistic teaching practices when compared to baseline assessments. Quantitative and qualitative feedback demonstrated that MAP-IT was well received by resident participants and addressed a gap in their surgical training. CONCLUSIONS A humanistic mentorship program involving RAT can be effectively implemented in surgical residency, is well-received by residents, and addresses a need surgical training by building skills and improving resident well-being.
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Affiliation(s)
- Molly Kobritz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork; Northwell Health North Shore/Long Island Jewish Department of Surgery, Manhasset, NewYork.
| | - Colleen P Nofi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork; Northwell Health North Shore/Long Island Jewish Department of Surgery, Manhasset, NewYork
| | - Lyudmyla Demyan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork; Northwell Health North Shore/Long Island Jewish Department of Surgery, Manhasset, NewYork
| | - Erfan Farno
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork
| | - Alice Fornari
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork
| | - Bilge Kalyon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork; Northwell Health North Shore/Long Island Jewish Department of Surgery, Manhasset, NewYork
| | - Vihas Patel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NewYork; Northwell Health North Shore/Long Island Jewish Department of Surgery, Manhasset, NewYork
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Weitlauf AS, Broderick N, Alacia Stainbrook J, Slaughter JC, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dorris K, Garrett LJ, Hopton M, Kinsman A, Morton M, Vogel A, Dykens EM, Pablo Juárez A, Warren ZE. A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes. J Autism Dev Disord 2022; 52:5403-5413. [PMID: 35040001 PMCID: PMC9289080 DOI: 10.1007/s10803-021-05399-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Neill Broderick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy G Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madeline Santulli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Dorris
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michelle Hopton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Kinsman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Morton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley Vogel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Dykens
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - A Pablo Juárez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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Server A, Suso-Ribera C, Pérez-Carrasco M, Medel J, Mesas Á, Ayora A, Gracia RM. Feasibility of a brief mindfulness-based program for burnout in pain healthcare professionals. Front Psychol 2022; 13:1009266. [DOI: 10.3389/fpsyg.2022.1009266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
IntroductionStress inherent to health care, which is characterized by work overload and shortage of specialized staff, is associated with decreased quality of life and suboptimal patient care. Mindfulness-based programs have proved to be effective in reducing stress in healthcare providers. This study aims to assess the feasibility of an 8-week mindfulness program to reduce the burnout levels of the staff of a pain clinic in a tertiary public hospital.Materials and methodsA longitudinal study with a within subject pre/post-intervention design, consisting of daily face-to-face 10-min sessions and the creation of a virtual group using a social media platform. Variables measured: burnout, mindfulness, empathy, self-compassion, and demographic characteristics.ResultsProgram feasibility (i.e., reach, adherence, acceptability, and preliminary effectiveness) was evaluated in 10 participants (6 physicians, 2 nurse practitioners, 1 nursing assistant, and 1 administrative). The results revealed a high reach (i.e., participation rate of 90%), excellent adherence to the program (daily practice 95% of times), and very good acceptability of the group format and satisfaction with most treatment components. Regarding potential effectiveness, we report the results of the Wilcoxon signed-rank tests and its associated effect size (r). We observed improvements in mindfulness and all its subscales (−2.077 ≤ Z ≤ −2.703, 0.69 ≤ r ≤ 0.90, all p < 0.05) except for non-reactivity and all subcomponents of self-compassion (−2.501 ≤ Z ≤ −2.611, 0.83 ≤ r ≤ 0.87, all p < 0.05) but not on its global self-compassion score. Empathy and burnout did not change. In an exploratory manner, however, we found significant reductions in the burnout component of emotional exhaustion, but only in physicians (Z = −2.201, p = 0.028, r = 0.73).DiscussionWe believe that the 8-week mindfulness-based program described in the present investigation might be a feasible and potentially effective method that can be easily implemented to reduce burnout and promote mindfulness in specialized pain clinics.
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Foote DC, Evans J, Engler T, Gutterman S, Lussiez A, Amortegui D, Bilimoria KY, Johnson JK, Hu YY, Sandhu G. How Program Directors Understand General Surgery Resident Wellness. JOURNAL OF SURGICAL EDUCATION 2022; 79:e48-e60. [PMID: 35948485 DOI: 10.1016/j.jsurg.2022.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/09/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Burnout among general surgery residents is prevalent. Guidance on how program directors (PDs) can effectively intervene on general surgery resident wellness is lacking. In this study, we explore how PDs learn about burnout among their residents and support their well-being. DESIGN Semi-structured interviews were conducted with PDs. Interviews were transcribed and coded by study team dyads who utilized an inductive coding approach, and then reconciled via consensus. Interpretive description was the qualitative analytical method. SETTING Program tours to 15 general surgery programs during the exploratory phase of the SECOND Trial. PARTICIPANTS Fifteen general surgery PDs. RESULTS PDs identified the utility of contextual information in understanding resident wellness and implementing program-specific resident wellness initiatives. Three themes relating to PD awareness of resident burnout and well-being were identified: (1) PDs used conventional and novel methods to collect data from multiple information sources, including residents, faculty, staff, institutional representatives, and anonymous parties. (2) These contextualized data inspired the development of responsive strategies to effect programmatic changes that improved education and wellness. (3) Barriers to acquiring and utilizing information exist, requiring careful analysis, creative problem solving, as well as persistence and dedication to resident wellness. CONCLUSIONS Qualitative analysis of general surgery residency PDs yielded insightful knowledge about gathering and responding to information to support resident wellness, including successful strategies and areas of caution. The experience of these PDs can guide others in evaluating their wellness goals and initiatives for their own residents.
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Affiliation(s)
- Darci C Foote
- Michigan Medicine, Department of Surgery, Ann Arbor, Michigan.
| | - Julie Evans
- Michigan Medicine, Department of Surgery, Ann Arbor, Michigan
| | - Tedi Engler
- Michigan Medicine, Department of Surgery, Ann Arbor, Michigan
| | | | - Alisha Lussiez
- Michigan Medicine, Department of Surgery, Ann Arbor, Michigan
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julie K Johnson
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Gurjit Sandhu
- Michigan Medicine, Department of Surgery, Ann Arbor, Michigan.
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Pandit AS, Reka A, Horsfall HL, Marcus HJ. In Reply to Letter to the Editor Regarding "Mindfulness Training for Young Neurosurgeons: A Virtual Multicenter Prospective Pilot Study". World Neurosurg 2022; 167:246. [PMID: 36793172 DOI: 10.1016/j.wneu.2022.08.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Anand S Pandit
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Arisa Reka
- Department of Medicine, University College London, London, United Kingdom
| | - Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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31
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Li W, Meng X, Zhang KJ, Yang Z, Feng Z, Tong K, Tian J. Meditation Using a Mobile App Improves Surgery Trainee Performance: a simulation-based randomized controlled trial. Arthroscopy 2022; 39:1262-1270. [PMID: 36191734 DOI: 10.1016/j.arthro.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To primarily investigate: (1) whether a 10 min instant meditation practice using mobile app could enhance arthroscopy performance and (2) whether a 10-day app-based meditation could reduce short-term arthroscopic skills deterioration. METHODS Orthopedic residents with no previous experience in arthroscopy and meditation were randomly assigned to Groups A, B, and C. After initial standard competency-based arthroscopy training on the simulator on Day 1, a pretest was performed via simulator by all participants to assess their initial level of performance, then Groups A and B were required to practice app-based mindfulness meditation 10 min/day for 10 consecutive days, while Group C did nothing. On Day 11, all participants came back to perform a posttest. Prior to the posttest, the participants in Group A practiced app-based meditation (10 min) , whereas Groups B and C had no intervention. RESULTS 43 participants were included and reached similar level of performance after initial training phase in Day1. In Day11, participants in Group A had statistically better instant arthroscopy performance than Group B, with higher total score (Mean Difference, 3.57; P<.001), less completion time (MD, -42.89s; P=.001), shorter camera (MD, -23.38cm; P<.001) and grasper (MD, -15.23cm; P=.002) path length and less cartilage injury (MD, -1.07%; P=.012). Participants in Group B had less skills deterioration than Group C, with better total score (MD, -5.42; P<.001), less completion time (MD, 51.96s; P=.002), camera path length (MD, 28.41cm; P=.007) and cartilage injury (MD, 1.19%; P=.038). CONCLUSION Meditation training using mobile app enhanced instant simulation-based arthroscopy performance and reduced short-term skills deterioration of orthopedic residents with no arthroscopy hands-on experience. CLINICAL RELEVANCE Meditation using mobile app for clinicians and educators should be incorporated into simulation-based arthroscopy curriculums and perhaps clinical settings to improve arthroscopy performance and mental health of orthopedic residents without any prior arthroscopy experience.
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Affiliation(s)
- Wei Li
- Departments of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangqing Meng
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Kai-Jun Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhouwen Yang
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhuoxi Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Kuang Tong
- Teaching Affairs Office, Southern Medical University, Guangzhou, China.
| | - Jing Tian
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Malik H, Annabi CA. The impact of mindfulness practice on physician burnout: A scoping review. Front Psychol 2022; 13:956651. [PMID: 36204751 PMCID: PMC9530040 DOI: 10.3389/fpsyg.2022.956651] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Physician burnout is a growing phenomenon in current health systems worldwide. With the emergence of COVID-19, burnout in healthcare is progressively becoming a serious concern. Increasing emotional exhaustion, depersonalization, and reduced personal accomplishment threaten the effective delivery of healthcare. Compassion fatigue and moral injury are a considerable risk to the doctor-patient relationship. These issues can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in physicians. Methodology A scoping review was conducted to investigate the effects of mindfulness practice on physician burnout. High-ranking journals were targeted to analyze high-quality studies and synthesize common themes in the literature. Studies conducted on current practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Gray literature and studies conducted only on allied health personnel were excluded from this review. Results 31 studies were included in this scoping review. Mindfulness practice decreased emotional exhaustion and depersonalization while improving mood, responses to stress, and vigor. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to physician mindfulness practice. Conclusion Mindfulness was widely reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate physician leader will play a crucial role in addressing current practice gaps, prioritizing staff mental health, and providing a supportive platform for innovation.
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Affiliation(s)
- Hani Malik
- Department of Family Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Manama, Bahrain
- *Correspondence: Hani Malik,
| | - Carrie Amani Annabi
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland-Dubai, Dubai, United Arab Emirates
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Sauder M, Zagales I, Zagales R, Das S, Sen-Crowe B, Bilski T, Kornblith L, Elkbuli A. Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:1188-1205. [PMID: 35624025 DOI: 10.1016/j.jsurg.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout. DESIGN PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021. PARTICIPANTS Surgical Trainees and Practicing Surgeons. RESULTS We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons. CONCLUSION Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.
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Affiliation(s)
- Matthew Sauder
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Ruth Zagales
- Florida International University, Miami, Florida
| | - Snigdha Das
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Brendon Sen-Crowe
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, San Francisco, California; University of San Francisco, San Francisco, California
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Greenberg AL, Tenzing N, Ghadimi TR, Tilahun MN, Berler MH, Lebares CC. Well-Being Intervention in General Surgery: Multicenter Study of Program Director and Resident Perspectives. J Am Coll Surg 2022; 235:217-224. [PMID: 35839396 DOI: 10.1097/xcs.0000000000000250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Physician well-being is critical for optimal care, but rates of psychological distress among surgical trainees are rising. Although numerous efforts have been made, the perceived efficacy of well-being interventions is not well understood. STUDY DESIGN This qualitative thematic study included online questionnaires to Program Directors (PDs) and residents at 16 ACGME-accredited General Surgery residency programs. PDs reported active well-being interventions for surgical residents or those under consideration at their institutions. Residents shared perspectives of available well-being interventions through open-ended responses. Conventional content analysis was used to analyze responses. RESULTS Fifteen PDs, or their proxies (94% response rate), responded. Responses revealed that a majority of available well-being interventions are focused on changing the individual experience rather than the underlying workplace. PD decision-making around well-being interventions is often not based on objective data. Three hundred residents (34% response rate) responded. Of available interventions, those that increase control (eg advanced and flexible scheduling), increase support (eg mentorship), and decrease demand (eg work hour limits) were consistently identified as beneficial, but interventions perceived to increase demand (eg held during unprotected time) were consistently identified as not beneficial. Group social activities, cognitive skills training, and well-being committees were variably seen as beneficial (increasing support) or not (increasing demand). CONCLUSIONS Our findings underscore the prevalence of individual-based well-being interventions and the paucity of system-level changes. This may explain, in part, the persistence of distress among residents despite abundant effort, highlighting the imperative for system-level transformation.
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Affiliation(s)
- Anya L Greenberg
- From the UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
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Noda Y, Asano K, Shimizu E, Hirano Y. The mediating effect of symptoms of posttraumatic stress disorder and depression on the relationship between personality traits and quality of life in emergency service workers. Compr Psychiatry 2022; 116:152327. [PMID: 35643052 DOI: 10.1016/j.comppsych.2022.152327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Emergency service workers are often exposed to fatalities during accidents or disasters. Therefore, they may be more prone to experiencing posttraumatic stress disorder (PTSD) and depression. It has been shown that these comorbid disorders are related to personality traits and quality of life (QOL). METHODS We hypothesized that mental disorders, such as symptoms of PTSD and depression, mediate the relationship between personality traits, as measured on the 10-Item Personality Inventory (TIPI), and QOL, as measured on the MOS 36-item Short-Form Health Survey (SF-36). RESULTS Participants were aged 23-61 years. Questionnaires were sent to 373 participants, 220 of whom returned responses. A direct effect was found between two subscales of the TIPI (Extraversion and Emotional stability) and mental component summary scores of the SF-36 (Extraversion: β = 0.154, p < .001; Emotional stability: β = 0.179, p < .001), which indicated partial mediation. A significant indirect effect was revealed between two personality traits and mental health summary scores (Extraversion: β = 0.058, p < .001; Emotional stability: β = 0.087, p < .001). We also found a direct effect of extraversion scores of the TIPI on role/social component summary scores of the SF-36 (β = 0.084, p < .05). However, none of the 95% confidential intervals was significant, which indicated full mediation, and the indirect effect was significant (β = 0.023, p < .01). Sensitivity analysis indicated that a direct effect between extraversion scores of the TIPI and role/social component summary scores of the SF-36 was significant, which indicated partial mediation. CONCLUSIONS The findings of direct and indirect effects highlight the importance of identifying effective methods for protecting individuals from developing symptoms of PTSD and depression; moreover, they may help improve QOL. The capacity of dealing with incidents among emergency service workers may vary depending on their personality traits. Therefore, the screening of mental health states that includes a personality trait inventory may be valuable.
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Affiliation(s)
- Yoshikazu Noda
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan; Department of Nursing, Teikyo University of Science, 34-1 Senjumotomachi, Adachi-ku, Tokyo 120-0041, Japan.
| | - Kenichi Asano
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan; United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan; United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan
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Cooper L, Papavasiliou T, Uppal L, Bain C. Implementing mindfulness meditation in hand surgery training: a feasibility study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022; 45:959-966. [PMID: 35729966 PMCID: PMC9187336 DOI: 10.1007/s00238-022-01962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Background Surgery can be stressful, requiring decision-making and performance under pressure. The COVID-19 pandemic has further challenged surgeons’ well-being and training. Excess stress adversely affects well-being, technical and non-technical performance, and, by extension, patient care. Little emphasis has been placed on interventions to improve individual surgeons’ stress resilience despite mindfulness training being robustly linked to resilience, well-being, and improved executive function and performance. This feasibility study aimed to evaluate the effect and acceptability of a mindfulness meditation session on a group of surgical trainees during a hand fracture fixation course. Methods All participants of a single-day hand fracture fixation course were invited to take part in the study, and randomised into two groups. The intervention group experienced a 10-min guided meditation session before their assessment, while the control group did not. Basic demographics, inherent ‘trait’ mindfulness, change in mood, and perceived acceptability were compared between the two groups. Results The 17 participants were demographically similar, as were their self-reported mood scores until after the meditation, where they diverged significantly (p < .01, t-test), with the meditation group feeling more relaxed and calm. Meditation as an intervention was considered largely acceptable. Conclusions Mindfulness meditation is established in improving stress resilience, relevant to surgeon well-being, performance, and patient care. This feasibility study suggests benefit and acceptability, and potential for further research in designing a targeted programme for surgeons, to reduce stress sensitivity, and improve performance, joy, and well-being within surgical training. Level of evidence: Level III, Therapeutic study. Supplementary Information The online version contains supplementary material available at 10.1007/s00238-022-01962-1.
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Affiliation(s)
- Lilli Cooper
- Plastic Surgery Department, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, SE1 7EH UK
| | - Theodora Papavasiliou
- Plastic Surgery Department, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, SE1 7EH UK
| | - Lauren Uppal
- Plastic Surgery Department, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, SE1 7EH UK
| | - Charles Bain
- Plastic Surgery Department, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, SE1 7EH UK
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Pandit AS, Reka A, Layard Horsfall H, Marcus HJ. Mindfulness Training for Young Neurosurgeons: A Virtual Multicenter Prospective Pilot Study. World Neurosurg 2022; 164:e446-e457. [PMID: 35533949 DOI: 10.1016/j.wneu.2022.04.128] [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: 03/10/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Burnout is prevalent among neurosurgeons and can negatively impact both technical and nontechnical skills and subsequent patient care. Mindfulness training has previously been shown to ameliorate the effects of burnout and improve performance in health care workers and high-stress occupations, but no such evaluation has been formally conducted for neurosurgeons. We aimed to determine the effectiveness and feasibility of a virtual mindfulness-based intervention (MBI) in neurosurgeons. METHODS A prospective trial of an MBI was implemented and hosted from our tertiary academic unit, running virtually from October to December 2020. Practicing neurosurgeons of all grades were recruited from 9 neurosurgical centers. Participants underwent 8 weeks of 90-minute MBI classes and suggested daily practice. Psychometric measures related to burnout, stress, wellbeing, and mindfulness competencies were assessed at baseline and on course completion. RESULTS Twenty-one neurosurgeons participated in the study (attendings = 2, residents = 18, interns = 1, mean age = 30.3 [standard deviation 3.9] years). Significant improvements after intervention were present in perceived stress (Z = -2.54, P = 0.04) and emotional exhaustion (Z = -2.41, P = 0.04). Mindfulness training was associated with improved mindfulness skills (Z = -2.58, P = 0.006), self-compassion (t = -4.4, P = 0.002), resilience (Z = -3.18, P = 0.004), and choice response times (Z = -2.13, P = 0.03). All neurosurgeons who completed the postintervention assessment stated they would recommend the course and agreed that it was relevant to their surgical practice. CONCLUSIONS Preliminary evidence from this trial cautiously supports the effectiveness and feasibility of a virtual MBI for dealing with stress, burnout, and improving dexterity among young neurosurgeons. Further research is warranted to validate these findings.
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Affiliation(s)
- Anand S Pandit
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Arisa Reka
- Department of Medicine, University College London, London, United Kingdom
| | - Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Pandit AS, de Gouveia M, Horsfall HL, Reka A, Marcus HJ. Efficacy of a Mindfulness-Based Intervention in Ameliorating Inattentional Blindness Amongst Young Neurosurgeons: A Prospective, Controlled Pilot Study. Front Surg 2022; 9:916228. [PMID: 35599807 PMCID: PMC9122266 DOI: 10.3389/fsurg.2022.916228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Human factors are increasingly being recognised as vital components of safe surgical care. One such human cognitive factor: inattention blindness (IB), describes the inability to perceive objects despite being visible, typically when one's attention is focused on another task. This may contribute toward operative 'never-events' such as retained foreign objects and wrong-site surgery. Methods An 8-week, mindfulness-based intervention (MBI) programme, adapted for surgeons, was delivered virtually. Neurosurgical trainees and recent staff-appointees who completed the MBI were compared against a control group, matched in age, sex and grade. Attention and IB were tested using two operative videos. In each, participants were first instructed to focus on a specific part of the procedure and assessed (attention), then questioned on a separate but easily visible aspect within the operative field (inattention). If a participant were 'inattentionally blind' they would miss significant events occurring outside of their main focus. Median absolute error (MAE) scores were calculated for both attention and inattention. A generalised linear model was fitted for each, to determine the independent effect of mindfulness intervention on MAE. Results Thirteen neurosurgeons completed the mindfulness training (age, 30 years [range 27-35]; female:male, 5:8), compared to 15 neurosurgeons in the control group (age, 30 years [27-42]; female:male, 6:9). There were no significant demographic differences between groups. MBI participants demonstrated no significant differences on attention tasks as compared to controls (t = -1.50, p = 0.14). For inattention tasks, neurosurgeons who completed the MBI had significantly less errors (t = -2.47, p = 0.02), after adjusting for participant level and video differences versus controls. We found that both groups significantly improved their inattention error rate between videos (t = -11.37, p < 0.0001). In spite of this, MBI participants still significantly outperformed controls in inattention MAE in the second video following post-hoc analysis (MWU = 137.5, p = 0.05). Discussion Neurosurgeons who underwent an eight-week MBI had significantly reduced inattention blindness errors as compared to controls, suggesting mindfulness as a potential tool to increase vigilance and prevent operative mistakes. Our findings cautiously support further mindfulness evaluation and the implementation of these techniques within the neurosurgical training curriculum.
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Affiliation(s)
- Anand S. Pandit
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Melissa de Gouveia
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Arisa Reka
- UCL Medical School, London, United Kingdom
| | - Hani J. Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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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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Ramachandran HJ, Bin Mahmud MS, Rajendran P, Jiang Y, Cheng L, Wang W. Effectiveness of mindfulness‐based interventions on psychological well‐being, burnout and post‐traumatic stress disorder among nurses: A systematic review and meta‐analysis. J Clin Nurs 2022; 32:2323-2338. [PMID: 35187740 DOI: 10.1111/jocn.16265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/23/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate the effectiveness of mindfulness-based interventions on psychological well-being, burnout and post-traumatic stress disorder symptoms among working registered nurses. BACKGROUND Nurses account for nearly half of the global healthcare workforce and are considered significant contributors in multi-disciplinary healthcare teams. Yet, nurses face high levels of psychological distress, leading to burnout and post-traumatic stress disorder. Mindfulness-based training is a strategy that has been introduced to foster a state of awareness of present physical, emotional and cognitive experiences to regulate behaviour. DESIGN This systematic review of randomised controlled trials was designed according to PRISMA guidelines. Eligible studies were screened and extracted. Methodological quality was evaluated by two researchers, independently. RevMan 5.4 was used to conduct the meta-analysis. RESULTS Fourteen studies including a total of 1077 nurses were included, of which only eleven were included in the meta-analysis as the remaining had missing or incomplete data. Meta-analysis revealed that MBI was more effective than passive comparators in reducing psychological distress, stress, depression and burnout-personal accomplishment. When compared to active comparators, MBI was also found to be more effective in reducing psychological distress and was as effective in reducing stress, anxiety, depression and burnout. Evidence on the effects of MBIs on PTSD was scarce. CONCLUSION Mindfulness-based interventions can effectively reduce psychological distress, stress, depression and some dimensions of burnout. However, evidence remains scarce in the literature. There is a need for more methodologically sound research on mindfulness-based training among nurses. RELEVANCE FOR CLINICAL PRACTICE An important aspect that relates to the success of mindfulness-based interventions is the continued and dedicated individual practice of the skills taught during mindfulness training amidst demanding clinical work environments. Therefore, relevant support for nurses must be accounted for in the planning, design and implementation of future mindfulness-based interventions.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
| | - Muhammad Shaheed Bin Mahmud
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
| | - Priyadharshni Rajendran
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
| | - Li Cheng
- School of Nursing Hubei University of Medicine Shiyan China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
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Lebares CC, Greenberg AL, Gonzales PA, Boscardin CK. Validity evidence for flourishing as a measure of global wellbeing: a national multicenter study of academic general surgery residents. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:1. [PMID: 38624941 PMCID: PMC8832420 DOI: 10.1007/s44186-022-00008-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 10/28/2022]
Abstract
Purpose Physician wellbeing is critical to high-quality sustainable healthcare and optimal patient experience. Few objective measures exist to assay wellbeing (as opposed to just pathology) in surgery, or to evaluate the efficacy of wellbeing interventions. Flourishing (as measured by the Mental Health Continuum, MHC) has been suggested as a concise measure of global wellbeing in surgeons. We aimed to establish validity evidence for flourishing in a large national sample of surgical trainees, explore differences by gender and race, and confirm support for the underlying constructs. Methods This cross-sectional study of all General Surgery residents at 16 ACGME-accredited academic programs included an online survey of published measures distributed in February 2021. The Mental Health Continuum (MHC), a three-factor model, assesses emotional, social, and psychological wellbeing and is an established metric of psychosocial thriving in non-physicians. A global score cut-off exists for flourishing which represents high wellbeing. Correlation between flourishing and established measures of risk and resilience in surgery were assessed for validity evidence. Differences by gender and race were explored. A confirmatory factor analysis (CFA) was performed to confirm the three-factor structure in surgical trainees. Results 300 residents (60% non-male, 41% non-white) responded to the survey. For the overall group, flourishing was significantly positively correlated with all wellbeing resilience factors and negatively correlated with all risk factors. This held true for race and gender subgroups based on interaction analyses. CFA and sensitivity analysis results supported the three-factor structure. Conclusions Our findings offer validity evidence for flourishing as a measure of global wellbeing and confirm the three-factor structure of emotional, social, and psychological wellbeing in surgical trainees. Thus, the MHC may be a concise tool for assaying wellbeing, within and across subgroups, and for assessing wellbeing intervention effectiveness within the surgery.
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Affiliation(s)
- Carter C. Lebares
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - Anya L. Greenberg
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - Paul A. Gonzales
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - Christy K. Boscardin
- Departments of Medicine and Anesthesia, Univeristy of Carlifornia San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
| | - and the General Surgery Research Collaborative on Resident Wellbeing
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
- Departments of Medicine and Anesthesia, Univeristy of Carlifornia San Francisco, 513 Parnassus Avenue, HSW 1601, 0790, San Francisco, CA 94143 USA
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Effects of Meditation for Surgeons: A Systematic Review of the Scientific Literature. Ann Surg 2022; 275:1074-1077. [PMID: 35081577 DOI: 10.1097/sla.0000000000005398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the available evidence about meditation's effects on surgeons. SUMMARY BACKGROUND DATA Meditation and Mindfulness are positively associated with better mental health and performance in different types of workers and professionals needing high levels of concentration. Surgery is one of the activities with the greatest need for high concentration.Even though these findings are supported by a number of studies, evidence is lacking on the effect of meditation on surgeons. METHODS We searched PubMed for meditation-related studies that focused on surgeons. A total of 243 articles were retrieved and after screening 8 were selected for data extraction. Four of these studies were pilot studies; 3 of them were randomized controlled trials. RESULTS Meditation was found to be beneficial for surgeons. Benefits span from motor skills to mental and physiological improvements. CONCLUSION More awareness and attention on this subject could improve surgeons' well-being as well as patients' outcomes.
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A Group Intervention to Promote Resilience in Nursing Professionals: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020649. [PMID: 35055470 PMCID: PMC8775927 DOI: 10.3390/ijerph19020649] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 01/07/2023]
Abstract
In this study, a new group intervention program to foster resilience in nursing professionals was tested for efficacy. In total, 72 nurses were recruited and randomised to either an intervention condition or to a wait list control condition. The study had a pre-test, post-test, follow-up design. The eight-week program targeted six resilience factors: cognitive flexibility, coping, self-efficacy, self-esteem, self-care, and mindfulness. Compared to the control group, the intervention group reported a significant improvement in the primary outcome mental health (measured with the General Health Questionnaire) from pre-test (M = 20.79; SD = 9.85) to post-test (M = 15.81; SD = 7.13) with an estimated medium effect size (p = 0.03, η2 = 0.08) at post-test. Further significant improvements were found for resilience and other resilience related outcomes measures. The individual stressor load of the subjects was queried retrospectively in each measurement. Stress levels had a significant influence on mental health. The intervention effect was evident even though the stress level in both groups did not change significantly between the measurements. Follow-up data suggest that the effects were sustained for up to six months after intervention. The resilience intervention reduced mental burden in nurses and also positively affected several additional psychological outcomes.
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Chen JY, Vedantham S, Lexa FJ. Burnout and work-work imbalance in radiology- wicked problems on a global scale. A baseline pre-COVID-19 survey of US neuroradiologists compared to international radiologists and adjacent staff. Eur J Radiol 2022; 155:110153. [DOI: 10.1016/j.ejrad.2022.110153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022]
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Alavi M, Najafi M, Akbari M, Gezelbash S. The effectiveness of self-compassion based training program on resilience of mothers of children with type 1 diabetes in Isfahan, Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:193-197. [PMID: 36237958 PMCID: PMC9552585 DOI: 10.4103/ijnmr.ijnmr_69_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/31/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022]
Abstract
Background: Concerns about the complications of diabetes and the responsibility of constantly managing a child's blood glucose are stressful for parents, especially for mothers, and can reduce their resilience. This study aimed to investigate the effectiveness of a self-compassion-based training program on the resilience of mothers of children with type 1 diabetes. Materials and Methods: This is a randomized clinical trial study. The statistical population of the study consisted of all mothers of children with type 1 diabetes who were being treated at the Isfahan Endocrine and Metabolism Research Centre, Iran. The study samples were recruited conveniently, 64 of whom were randomly divided into two groups (compassion training program = 32; control group = 32). The intervention group participated in eight training sessions. Data were analyzed using t-test, and Analysis of Covariance (ANCOVA) tests for between-group comparisons of dependent variables. Results: There was no significant difference between the mean scores of resilience before intervention (p > 0.05). Mean scores of resilience in the intervention group were significantly higher than the control group immediately (F1,60 = 9.726 p = 0.003) and 1 month after intervention (F1, 60 = 13.146, p = 0.001). Conclusions: It may be worthwhile to suggest compassion-based training program for mothers of children with type 1 diabetes to improve their resilience.
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Sekhar P, Tee QX, Ashraf G, Trinh D, Shachar J, Jiang A, Hewitt J, Green S, Turner T. Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors. Cochrane Database Syst Rev 2021; 12:CD013740. [PMID: 34890044 PMCID: PMC8664003 DOI: 10.1002/14651858.cd013740.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mindfulness interventions are increasingly popular as an approach to improve mental well-being. To date, no Cochrane Review examines the effectiveness of mindfulness in medical students and junior doctors. Thus, questions remain regarding the efficacy of mindfulness interventions as a preventative mechanism in this population, which is at high risk for poor mental health. OBJECTIVES: To assess the effects of psychological interventions with a primary focus on mindfulness on the mental well-being and academic performance of medical students and junior doctors. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and five other databases (to October 2021) and conducted grey literature searches. SELECTION CRITERIA: We included randomised controlled trials of mindfulness that involved medical students of any year level and junior doctors in postgraduate years one, two or three. We included any psychological intervention with a primary focus on teaching the fundamentals of mindfulness as a preventative intervention. Our primary outcomes were anxiety and depression, and our secondary outcomes included stress, burnout, academic performance, suicidal ideation and quality of life. DATA COLLECTION AND ANALYSIS: We used standard methods as recommended by Cochrane, including Cochrane's risk of bias 2 tool (RoB2). MAIN RESULTS: We included 10 studies involving 731 participants in quantitative analysis. Compared with waiting-list control or no intervention, mindfulness interventions did not result in a substantial difference immediately post-intervention for anxiety (standardised mean difference (SMD) 0.09, 95% CI -0.33 to 0.52; P = 0.67, I2 = 57%; 4 studies, 255 participants; very low-certainty evidence). Converting the SMD back to the Depression, Anxiety and Stress Scale 21-item self-report questionnaire (DASS-21) showed an estimated effect size which is unlikely to be clinically important. Similarly, there was no substantial difference immediately post-intervention for depression (SMD 0.06, 95% CI -0.19 to 0.31; P = 0.62, I2 = 0%; 4 studies, 250 participants; low-certainty evidence). Converting the SMD back to DASS-21 showed an estimated effect size which is unlikely to be clinically important. No studies reported longer-term assessment of the impact of mindfulness interventions on these outcomes. For the secondary outcomes, the meta-analysis showed a small, substantial difference immediately post-intervention for stress, favouring the mindfulness intervention (SMD -0.36, 95% CI -0.60 to -0.13; P < 0.05, I2 = 33%; 8 studies, 474 participants; low-certainty evidence); however, this difference is unlikely to be clinically important. The meta-analysis found no substantial difference immediately post-intervention for burnout (SMD -0.42, 95% CI -0.84 to 0.00; P = 0.05, I² = 0%; 3 studies, 91 participants; very low-certainty evidence). The meta-analysis found a small, substantial difference immediately post-intervention for academic performance (SMD -0.60, 95% CI -1.05 to -0.14; P < 0.05, I² = 0%; 2 studies, 79 participants; very low-certainty evidence); however, this difference is unlikely to be clinically important. Lastly, there was no substantial difference immediately post-intervention for quality of life (mean difference (MD) 0.02, 95% CI -0.28 to 0.32; 1 study, 167 participants; low-certainty evidence). There were no data available for three pre-specified outcomes of this review: deliberate self-harm, suicidal ideation and suicidal behaviour. We assessed the certainty of evidence to range from low to very low across all outcomes. Across most outcomes, we most frequently judged the risk of bias as having 'some concerns'. There were no studies with a low risk of bias across all domains. AUTHORS' CONCLUSIONS: The effectiveness of mindfulness in our target population remains unconfirmed. There have been relatively few studies of mindfulness interventions for junior doctors and medical students. The available studies are small, and we have some concerns about their risk of bias. Thus, there is not much evidence on which to draw conclusions on effects of mindfulness interventions in this population. There was no evidence to determine the effects of mindfulness in the long term.
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Affiliation(s)
- Praba Sekhar
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Qiao Xin Tee
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Gizem Ashraf
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Darren Trinh
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Shachar
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Jiang
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jack Hewitt
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Green
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Young JQ, Thakker K, John M, Friedman K, Sugarman R, van Merriënboer JJG, Sewell JL, O'Sullivan PS. Exploring the relationship between emotion and cognitive load types during patient handovers. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1463-1489. [PMID: 34037906 DOI: 10.1007/s10459-021-10053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Krima Thakker
- Division of Education and Training, Zucker Hillside Hospital at Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 10543, USA
| | - Majnu John
- Division of Research, Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA
| | - Karen Friedman
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | | | - Jeroen J G van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Justin L Sewell
- Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Patricia S O'Sullivan
- Department of Medicine & Office of Research and Development in Medical Education, University of California at San Francisco School of Medicine, San Francisco, CA, USA
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Nituica C, Bota OA, Blebea J, Cheng CI, Slotman GJ. Factors influencing resilience and burnout among resident physicians - a National Survey. BMC MEDICAL EDUCATION 2021; 21:514. [PMID: 34587948 PMCID: PMC8479707 DOI: 10.1186/s12909-021-02950-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/11/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Residency training exposes young physicians to a challenging and high-stress environment, making them vulnerable to burnout. Burnout syndrome not only compromises the health and wellness of resident physicians but has also been linked to prescription errors, reduction in the quality of medical care, and decreased professionalism. This study explored burnout and factors influencing resilience among U.S. resident physicians. METHODS A cross-sectional study was conducted through an online survey, which was distributed to all accredited residency programs by Accreditation Council of Graduate Medical Education (ACGME). The survey included the Connor-Davidson Resilience Scale (CD-RISC 25), Abbreviated Maslach Burnout Inventory, and socio-demographic characteristics questions. The association between burnout, resilience, and socio-demographic characteristics were examined. RESULTS The 682 respondents had a mean CD-RISC score of 72.41 (Standard Deviation = 12.1), which was equivalent to the bottom 25th percentile of the general population. Males and upper-level trainees were more resilient than females and junior residents. No significant differences in resilience were found associated with age, race, marital status, or training program type. Resilience positively correlated with personal achievement, family, and institutional support (p < 0.001) and negatively associated with emotional exhaustion and depersonalization (p < 0.001). CONCLUSIONS High resilience, family, and institutional support were associated with a lower risk of burnout, supporting the need for developing a resilience training program to promote a lifetime of mental wellness for future physicians.
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Affiliation(s)
- Cristina Nituica
- Department of Surgery, College of Medicine, Central Michigan University, 912 S Washington Ave, Suite 1, Saginaw, MI, 48601, USA.
| | - Oana Alina Bota
- Department of Psychology, Education and Teacher Training, Faculty of Psychology and Education Sciences, Transylvania University, 56 Nicolae Balcescu, 500019, Brasov, BV, Romania
| | - John Blebea
- Department of Surgery, College of Medicine, Central Michigan University, 912 S Washington Ave, Suite 1, Saginaw, MI, 48601, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial, and Data Sciences, Central Michigan University, 1200 S. Franklin St., Mount Pleasant, Saginaw, MI, 48859, USA
| | - Gus J Slotman
- Department of Surgery, Inspira Medical Center Vineland, Inspira Medical Group Surgical Oncology, 1505 West Sherman Avenue, Suite B, Vineland, NJ, 08360, USA
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Luton OW, James OP, Mellor K, Eley C, Hopkins L, Robinson DBT, Lebares CC, Powell AGMT, Lewis WG, Egan RJ. Enhanced stress-resilience training for surgical trainees. BJS Open 2021; 5:6330409. [PMID: 34323917 PMCID: PMC8320339 DOI: 10.1093/bjsopen/zrab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. Method All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. Results Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0–11) versus 5 (1–11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0–11) versus 4 (1–10)). Discussion Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.
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Affiliation(s)
- O W Luton
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - K Mellor
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - C Eley
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - L Hopkins
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - D B T Robinson
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - C C Lebares
- University of California, San Francisco, California, USA
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - W G Lewis
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
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