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Abahuje E, Reddy S, Rosu C, Lin KA, Mack L, Valukas C, Shapiro M, Alam HB, Halverson A, Bilimoria K, Coleman J, Stey AM. Relationship Between Residents' Physiological Stress and Faculty Leadership Skills in a Department of Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1129-1138. [PMID: 37336667 DOI: 10.1016/j.jsurg.2023.05.020] [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: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Leadership skills of team leaders can impact the functioning of their teams. It is unknown whether attending surgeons' leadership skills impact residents' physiological stress. This study sought to (1) assess the relationship between attending surgeons' leadership skills and residents' physiological stress and (2) to characterize lifestyle behaviors associated with resident physiological stress. We hypothesized that strong attending leadership skills would be associated with low resident physiological stress. STUDY DESIGN This prospective observational cohort study was conducted at a single urban, academic medical center in the US, over 12 months. Residents were enrolled during their rotation of 1 to 2 months on the Trauma and ICU services. The primary predictor was the attending surgeons' leadership skills that were measured using a weekly survey filled out by residents, using the Surgeons' Leadership Inventory (SLI). The SLI uses a 4-point Likert scale to measure surgeons' leadership skills across eight domains. The primary outcome was residents' physiological stress, which was measured by their Heart Rate Variability (HRV). We recorded the residents' HRV with a WHOOP strap that was continuously worn on the wrist or the bicep. We used multivariate repeated measures gamma regression to assess the relationship between attending leadership skills and residents' physiological stress, adjusting for hours of sleep, age, and service. RESULTS Sixteen residents were enrolled over 12 months. The median attending surgeons' leadership score was 3.8 (IQR: 3.2-4.0). The median residents' percent of maximal HRV was 70.8% (IQR: 56.7-83.7). Repeated measure gamma regression model demonstrated a minimal nonsignificant increase of 1.6 % (95% CI: -5.6, 8.9; p-value = 0.65) in the percent of maximal HRV (less resident physiological stress) for every unit increase in leadership score. There was an increase of 2.9% (95% CI= 1.6, 4.2; p-value < 0.001) in the percent of maximal HRV per hour increase in sleep and a significant decrease of 10.9% (95% CI= -16.8, -5.2; < 0.001) in the percent of HRV when working in the ICU compared to the Trauma service. CONCLUSION This study revealed that more residents' sleep was associated with lower physiological stress. Attending surgeons' leadership skills were not associated with residents' physiological stress.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts.
| | - Susheel Reddy
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Claudia Rosu
- Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts
| | - Katherine A Lin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lara Mack
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine Valukas
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hasan B Alam
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Bilimoria
- Department of Surgery, School of Medicine, Indian University, Indianapolis, Indiana
| | - Jamie Coleman
- Department of Surgery, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Abera H, Hunt M, Levin JH. Sleep Deprivation, Burnout, and Acute Care Surgery. CURRENT TRAUMA REPORTS 2023; 9:40-46. [PMID: 36721843 PMCID: PMC9880369 DOI: 10.1007/s40719-023-00253-9] [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] [Accepted: 01/03/2023] [Indexed: 01/28/2023]
Abstract
Purpose of Review To define what sleep deprivation is, how it relates to the growing problem of burnout within surgeons, and what can be done to mitigate its effects. Recent Findings There is a growing awareness that sleep deprivation, in both its acute and chronic manifestations, plays an immense role in burnout. The physical and mental manifestations of sleep deprivation are manifold, effecting nearly every physiologic system. Studies evaluating strategies at mitigating the effects of sleep deprivation are promising, including work done with napping, stimulant use, and service restructuring, but are fundamentally limited by generalizability, scale, and scope. Summary The overwhelming majority of data published on sleep deprivation is limited by size, scope, and generalizability. Within acute care surgery, there is a dearth of studies that adequately define and describe sleep deprivation as it pertains to high-performance professions. Given the growing issue of burnout amongst surgeons paired with a growing patient population that is older and more complex, strategies to combat sleep deprivation are paramount for surgeon retention and wellbeing.
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Affiliation(s)
- Hermona Abera
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN USA
| | - Maya Hunt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN USA
| | - Jeremy H. Levin
- Division of Acute Care Surgery, Department of Surgery, Indiana University School of Medicine, 1630 N. Capitol Avenue, B258, Indianapolis, IN 46202 USA
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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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Jelmini JD, Ross J, Whitehurst LN, Heebner NR. The effect of extended shift work on autonomic function in occupational settings: A systematic review and meta-analysis. J Occup Health 2023; 65:e12409. [PMID: 37287085 PMCID: PMC10247865 DOI: 10.1002/1348-9585.12409] [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] [Received: 01/21/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To examine the effect of 24-h shift work on autonomic nervous system function via heart rate variability (HRV) methodologies. METHODS Electronic databases (indexed in either PubMed, MEDLINE, CINAHL, SPORTDiscus, or OpenDissertations) were searched from January 1964 to March 2023. A modified Downs and Black checklist was used for assessing methodological quality and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Study design, study population, study sample, shift work description, and assessment of HRV metrics and methods were extracted from each study. FINDINGS A total of 58 478 study articles were identified, of which 12 articles met inclusion criteria. Sample sizes varied from eight to 60 participants, with the ratio of low- to high-frequency HRV (LF/HF) as the most common frequency-domain variable reported. Of the nine included studies that observed LF/HF, three (33.3%) demonstrated a significant increase after 24-h shift work. Moreover, of the five studies that reported HF, two (40%) noted a significant decrease after 24-h shift work. When observing risk of bias, two (16.6%) studies were low quality, five (41.7%) were moderate quality, and five (41.7%) were high quality. INTERPRETATION There were inconsistent findings demonstrating an effect of 24-h shift work on autonomic function, with a suggested shift away from parasympathetic dominance. Discrepancies in HRV methodologies, such as the duration of recordings and hardware used for measurement, may have contributed to the disparity in findings. In addition, differences in roles and responsibilities across occupations may explain the incongruence in findings across studies.
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Affiliation(s)
- Jacob D. Jelmini
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
| | - Jeremy Ross
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
| | | | - Nicholas R. Heebner
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
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Tjønnås MS, Guzmán-García C, Sánchez-González P, Gómez EJ, Oropesa I, Våpenstad C. Stress in surgical educational environments: a systematic review. BMC MEDICAL EDUCATION 2022; 22:791. [PMID: 36380334 PMCID: PMC9667591 DOI: 10.1186/s12909-022-03841-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance. METHODS A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682). RESULTS Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance. CONCLUSIONS The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
- SINTEF Digital, Health Department, Trondheim, Norway.
| | - Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Enrique Javier Gómez
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Cecilie Våpenstad
- SINTEF Digital, Health Department, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Vaysburg DM, Delman AM, Sisak S, Turner KM, Ammann AM, Cortez AR, Shah SA, Quillin III RC. Biophysiological stress and sleep deprivation among abdominal transplant surgery fellows: A prospective multi-institutional study using a wearable device. Am J Surg 2022; 225:962-966. [DOI: 10.1016/j.amjsurg.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
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Abstract
Research has demonstrated that first responders may develop psychological trauma/ posttraumatic stress disorder (PTSD) in the performance of their duties. Often overlooked in these studies of police, firefighters, and paramedics is an additional group of providers in this health care delivery system: the trauma surgeons, who receive the victims transported by the first responders. Although limited in scope, the research literature does identify the presence of PTSD in trauma surgeons. These studies have repeatedly cited the need for further information about psychological trauma for trauma surgeons. This paper addresses that need with a brief overview of psychological trauma, where surgeons may encounter victims, and how to cope with its aftermath.
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Affiliation(s)
- Raymond B Flannery
- Harvard Medical School, Boston, MA, USA. .,The University of Massachusetts Medical School, Worcester, MA, USA. .,Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge street, Cambridge, MA, 02139, USA.
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Niotis K, Saif N, Simonetto M, Wu X, Yan P, Lakis JP, Ariza IE, Buckholz AP, Sharma N, Fink ME, Isaacson RS. Feasibility of a wearable biosensor device to characterize exercise and sleep in neurology residents. Expert Rev Med Devices 2021; 18:1123-1131. [PMID: 34632903 DOI: 10.1080/17434440.2021.1990038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research suggests optimizing sleep, exercise and work-life balance may improve resident physician burnout. Wearable biosensors may allow residents to detect and correct poor sleep and exercise habits before burnout develops. Our objectives were to evaluate the feasibility of a wearable biosensor to characterize exercise/sleep in neurology residents and examine its relationship to self-reported, validated survey measures. We also assessed the device's impact on well-being and barriers to use. METHODS This prospective cohort study evaluated the WHOOP Strap 2.0 in neurology residents. Participants completed regular online surveys, including self-reported hours of sleep/exercise, and validated sleep/exercise scales at 3-month intervals. Autonomic, exercise, and sleep measures were obtained from WHOOP. Changes were evaluated over time via linear regression. Survey and WHOOP metrics were compared using Pearson correlations. RESULTS Sixteen (72.7%) of 22 eligible participants enrolled. Eleven (68.8%) met the minimum usage requirement (6+ months) and were classified as 'consecutive wearers.' Significant increases were found in sleep duration and exercise intensity. Moderate-to-low correlations were found between survey responses and WHOOP measures. Most (73%) participants reported a positive impact on well-being. Barriers to use included 'Forgetting to wear' (20%) and 'not motivational' (23.3%). CONCLUSION Wearable biosensors may be a feasible tool to evaluate sleep/exercise in residents.
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Affiliation(s)
- Kellyann Niotis
- 2019-2020 McGraw Fellow in Neurology Research; Department of Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Nabeel Saif
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Marialaura Simonetto
- Departments of Internal Medicine and Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Xian Wu
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and Department of Healthcare Policy & Research, New York-Presbyterian, New York, NY, USA
| | - Peter Yan
- Department of Neurology, Beth Israel Deaconess Hospital-Milton Center for Specialty Care, Milton, MA, USA
| | - Jessica P Lakis
- Office of Development, New York-Presbyterian, New York, NY, USA
| | | | - Adam P Buckholz
- Department of Internal Medicine, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | | | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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