National Survey of Burnout among US General Surgery Residents

Short-time mentoring - enhancing female medical students' intentions toward surgical careers

BACKGROUND

Women pursuing a career in surgery or related disciplines are still in the minority, despite the fact that women compose at least half of the medical student population in most Western countries. Thus, recruiting and retaining female surgeons remains an important challenge to meet the need for surgeons and increase the quality of care. The participations were female medical students between their third and fifth academic year. In this study, we applied the well-established psychological theory of planned behavior (TPB) which suggests that the intention to perform a behavior (e.g. pursuing a career in surgery) is the most critical and immediate predictor of performing the behavior. We investigated whether a two-part short-mentoring seminar significantly increases students' intention to pursue a career in a surgical or related specialty after graduation.

METHOD

The mentoring and role-model seminar was conducted at 2 days for 90 minutes by six inspiring female role models with a remarkable career in surgical or related disciplines. Participants (N = 57) filled in an online survey before (T0) and after the seminar (T1). A pre-post comparison of central TPB concept attitude towards the behavior, 2) occupational self-efficacy and 3) social norm) was conducted using a paired sampled t-test. A follow-up survey was administered 12 months later (T2).

RESULTS

The mentoring seminar positively impacted female students' attitude towards a career in a surgical specialty. Female students reported a significantly increased positive attitude (p < .001) and significantly higher self-efficacy expectations (p < .001) towards a surgical career after participating in the mentoring seminar. Regarding their career intention after the seminar, female students declared a significantly higher intention to pursue a career in a surgical specialty after graduating (p < .001) and this effect seems to be sustainable after 1 year.

CONCLUSION

For the first time we could show that short-mentoring and demonstrating role models in a seminar surrounding has a significant impact on female medical student decision´s to pursue a career in a surgery speciality. This concept may be a practical and efficient concept to refine the gender disparity in surgery and related disciplines.

Intraoperative teamwork and occupational stress during robot-assisted surgery: An observational study

Robot-assisted surgery (RAS) differs from traditional OR set-ups in several ways such as operation of technology and obstructed team communication that potentially affect surgical staff's stress experiences. The current study investigates the effects of key intraoperative job demands and resources on mental workload and perceived stress in RAS. We focused on the role of intraoperative teamwork as a resource that potentially reduces occupational stress. Combining standardized expert observations in the OR with healthcare providers' self-reports, the study involved two types of robot-assisted, urological interventions. The sample consisted of 73 observed surgeries and included 242 post-operative surveys on perceived stress and mental workload from surgeons and surgical nurses. Multilevel regression analyses reveal differential effects for stress and workload. Importantly, whereas better surgical teamwork was associated with lower stress, it was unrelated to workload. Our findings provide a nuanced picture of occupational stress in RAS, particularly regarding the role of intraoperative teamwork.

Effects of Mentorship on Surgery Residents' Burnout and Well-Being: A Scoping Review

BACKGROUND

In surgical training, a mentor is a more senior and experienced surgeon who guides a surgical trainee to meet personal, professional, and educational goals. Although mentorship is widely assumed to positively affect surgical residents' professional development, a more nuanced understanding of mentorship's impact is lacking and urgently needed as burnout rates among residents increase. This study aims to summarize the current literature on the effects of mentorship on surgical residents' burnout and well-being.

METHODS

A comprehensive literature review was performed with key terms related to "surgical resident" and "mentor" using Pubmed, Embase, and ProQuest databases for primary studies published in the United States or Canada from January 1, 2010 to December 9, 2022 that measured outcomes related to burnout and well-being. Multiple reviewers screened titles and abstracts for relevance, then full-text articles for eligibility.

RESULTS

Initial search resulted in 1,468 unique articles, and 19 articles were included after review. Only one article was a randomized controlled trial. Twelve studies described a decrease in burnout rates or in outcomes related to burnout. In contrast, 4 studies identified negative outcomes related to burnout. Six studies showed improved well-being or related outcomes. One study was not able to show a change in self-valuation between coached and noncoached residents.

CONCLUSION

High quality mentorship can be associated with improved well-being and decreased burnout in surgical residents, but the key elements of effective and helpful mentorship remain poorly characterized. This summary highlights the importance of making mentorship accessible to surgical residents, and training faculty to be effective mentors.

A Palliative Care Curriculum May Promote Resident Self-Reflection and Address Moral Injury

INTRODUCTION

There is a lack of formal palliative care education for surgical trainees, and the demanding nature of surgical training and exposure to challenging clinical scenarios can contribute to moral injury. We developed a palliative care curriculum to promote self-reflection, aiming to address moral injury in residents.

METHODS

Five 1-h palliative care sessions were delivered over the academic year to all post-graduate year (PGY) levels covering the following topics: personal awareness, delivering bad news, surgical palliation for cancer pathology, surgical palliation for noncancer pathology, and urgent palliative care. The curriculum focused on reflection and small group discussions. The Moral Injury Symptom Scale-Health Professional was administered to assess feelings of moral injury. Descriptive statistics, chi-squared analysis, and Mann-Whitney U-test were used to compare the demographics and survey responses.

RESULTS

23 participants completed the preintervention survey, and 9 participants completed it postintervention. Over 50% of participants were PGY1 or PGY2 residents. Preintervention, 52% of participants reported feeling guilt over failing to save someone from being seriously injured or dying. 30% of participants reported that the feelings of guilt, shame, or distrust impaired their ability to function in relationships, at work, or other areas of life to at least a moderate degree.

CONCLUSIONS

The described palliative care curriculum accomplishes several goals as follows: it educates residents on palliative care topics, teaches communication tools, encourages self-reflection, and provides space for building peer relationships. The ease of implementation makes this curriculum applicable across various types of institutions, offering the potential to positively impact surgical training on a national scale.

Cultivating emotional intelligence in general surgery residents through a patient-centered experience

BACKGROUND

Emotional intelligence (EI) can decrease physician burnout. EI and burnout were assessed in surgical residents through participation in Patient-Centric Resident Conferences (PCRCs), which incorporated patients in resident education. We hypothesized PCRCs would improve EI and reduce burnout.

METHODS

This was a single institution study of General Surgery residents from 2018 to 2019. Residents participated in standard didactic conferences and PCRCs. The Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) survey and an ACGME burnout survey were administered at three time points.

RESULTS

Higher EI scores correlated with lower burnout scores over three survey distributions (R2 0.35, 0.39, and 0.68, respectively). EI and burnout scores did not change significantly over time. EI and burnout were not associated with conference attendance, meaning in work, or satisfaction with teaching.

CONCLUSIONS

General Surgery resident EI and burnout scores were inversely correlated. Previously, PCRCs were shown to be associated with increased resident meaning in work. The current study demonstrates PCRCs did not have a significant impact on measures of resident EI or burnout. Further research is needed for EI and burnout in surgery.

Navigating the Neurosurgery Match Process: Insights from the National Resident Matching Program - Program Director Surveys

OBJECTIVE

Neurosurgery is one of the most competitive specialties, and navigating the match process is often challenging for aspiring applicants. Here, we analyze insights from the National Resident Matching Program Director Surveys, illustrating evolving trends in applicant selection for interviews and for the ranking process, and providing a comparison with other specialties.

METHODS

We evaluated 7 surveys administered from 2012 to 2022. Six biennial surveys reported on factors influencing interview and ranking processes, while all 7 surveys included data about the program director (PD)'s attitude toward United States Medical Licensing Examination (USMLE) test scores.

RESULTS

The response rate of PDs decreased over the years. The most cited factor for interviews included specialty-specific recommendation letters (95%), USMLE Step 1 scores (91%), and interest in research (78%). A recent decline in emphasis on USMLE Step 1 scores coincided with a growing reliance on USMLE Step 2 scores. Award in basic science held significant esteem to a subset of programs. Personal characteristics dominated for ranking, with faculty interaction (89%), interpersonal skills (89%), and house staff interaction (85%) being the most important. Yet, PDs reported a difficulty in assessing interpersonal skills through virtual interviews.

CONCLUSIONS

Our analysis revealed the pervasive importance of specialized endorsements and academic achievements when screening applicants for the interview process. A shift in emphasis toward the USMLE Step 2 became apparent. Personal characteristics, on the other hand, seemed crucial to make a match and rank high among the pool of interviewed applicants. We uncovered difficulties in assessing these characteristics through virtual interviews.

Gender-Related Disparities Among Vascular Surgeons in Italy: Results from a Cross-Sectional Survey

BACKGROUND

To assess the presence, quality and impact of gender-related discrepancies in academic vascular surgery at a national level.

METHODS

This was an anonymous national structured nonvalidated cross-sectional survey on gender disparity perceptions, named "I love it when you call me Señorita", distributed to 645 participants from academic Italian vascular centers. Endpoints were related to job-related characteristics, satisfaction, and sexual harassment.

RESULTS

The survey yielded a 27% response rate (n = 174, 78 males and 96 females). Significant differences between male and female responders were found in terms of job satisfaction (83.3% vs. 53.1%, P < 0.001), perception of career opportunities (91.7% vs. 67.9%, P < 0.001), surgical activity in the operating theater (34.6% vs. 7.3%, P < 0.001), involvement in scientific activities (contribution in peer-reviewed articles: 37.2% vs. 9.4%, P < 0.001; scientific meeting attendance/year: 42.3% vs. 20.8%, P = 0.002), and perception of lower peer support at work (2.6% vs. 22.9%, P < 0.001). In addition, female physicians more frequently suffered sexual harassment from male peers/colleagues (10% vs. 34%, P < 0.001), male health-care workers (7% vs. 26%, P = 0.001), or patients/caregivers independently from their sex (6% vs. 38.5%, P < 0.001 for males and 5% vs. 22%, P = 0.001 for females).

CONCLUSIONS

A significant number of the female vascular surgeons in Italian academic vascular centers responding to the survey have experienced workplace inequality and sexual harassment. Substantial efforts and ongoing initiatives are still required to address gender disparities, emphasizing the need for the promotion of specific guidelines within scientific societies.

Satisfaction and wellbeing of general surgery trainees in the Saudi Arabian residency educational environment: A mixed-methods study

Background

Surgical residency training is prominently demanding and stressful. This can affect the residents' wellbeing, work-life balance and increase the rates of burnout. We aimed to assess rates of satisfaction and burn-out among GS residents in the national training programs and provide a subsequent in-depth analysis of the potential reasons.

Method

A sequential explanatory mixed-methods study was conducted using an online survey and virtual interviews. The validated abbreviated Maslach Burnout Inventory (aMBI) was used to assess burnout while satisfaction was assessed via 5-points Likert scale.

Results

After excluding incomplete responses from the total 74 received, 53 were analyzed. The average participant age was 27.4 ± 2 years, with females comprising 52 % of the sample. Junior residents made up 58.5 %, and nearly half -45 %- considered quitting GS training. Moderate to high burnout rates were noted on each aMBI subscale, ranging from 41.7 % to 62.5 %. The majority of residents expressed dissatisfaction with the level of research engagement (81.1 %), supervision, and mentorship. However, operative exposure was a source of satisfaction. Dissatisfaction rates with intra-operative learning, academia, teaching, and clinical exposure were 62.3 %, 52.8 %, 50.9 %, and 35.8 %, respectively. Interviews revealed surgical case flow and a friendly work environment as major satisfaction sources. Conversely, lack of academic supervision and suboptimal hands-on training were major dissatisfaction sources.

Conclusion

Dissatisfaction and burn-out is prevalent among national GS training programs. Sub-optimal educational delivery and low-quality hands-on operative exposure -rather than lack of exposure to cases- seem to be the culprit.

A National Survey Evaluating Burnout and Wellness During Radiology Residency

RATIONALE AND OBJECTIVES

Burnout is a serious problem during medical residency and can contribute to poorer resident and patient health. A thorough understanding of factors associated with burnout can provide insight into supporting resident well-being. The purpose of this study is to assess the prevalence of burnout and ascertain its associated factors among radiology residents in the U.S.

MATERIALS AND METHODS

This cross-sectional study involved sending an anonymous survey to radiology program directors, coordinators, and residents across the U.S. Data regarding demographics, burnout levels, and burnout-associated factors were collected in the month of August 2023. Multivariable linear regression models evaluated the association of demographic and burnout-associated variables with burnout scores in the dimensions of Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Chi-square analyses with Bonferroni correction and Kruskal-Wallis analyses were used to assess associations between program types and burnout as well as between program type and program effectiveness in managing burnout. Resident suggestions on addressing burnout were qualitatively assessed.

RESULTS

147 radiology residents responded to the survey. Emotional Exhaustion was positively associated with seeking social support (p = .03) and negatively associated with perceived program effectiveness in addressing burnout (p < .001). Respondents who identified as male experienced greater Depersonalization (p = .02). Increased frequency of physical activity was associated with higher Personal Accomplishment scores (p = .04). The most common resident suggestions related to Work Burden, Program Support, and Protected Wellness Time.

CONCLUSION

Radiology programs should consider designing interventions addressing burnout, such as enhancing avenues for feedback and tailoring resident training based on individual preferences for remote work. Understanding the unique challenges faced by radiology residents is essential to tackle burnout and improve wellness.

Assessing the efficacy and feasibility of emotional intelligence and stress management training for medical students within their third-year surgery clerkship

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.

State of Physician Unionization

OBJECTIVES

To provide an overview of the current state of physician unionization, potential factors surrounding increased unionization, and the ethical and financial issues that may arise.

DESIGN

Review article.

SETTING

Not applicable.

PARTICIPANTS

Not applicable.

RESULTS

Over the last few years, there has been a recent surge in physician unionization. Union membership among residents and fellows is also at an all-time high and continues to increase, as seven residency programs voted to unionize in 2023. The resulting threat of strikes has grown considerably over the last year as residents across 6 hospitals have threatened to strike, resulting in New York's first physician strike in over three decades. As physician practice continues to shift from private to corporate health system-based employment, more opportunities for unionization will arise. Globally, these trends have been comparable, with thousands of physicians striking across the United Kingdom, Germany, Italy, Nigeria, and New Zealand in the last year.

CONCLUSION

The current state of physician unionization is of increasing significance as more physicians are presented with opportunities for unionization. Physicians perceive a lack of autonomy, and the demand to deliver high level outcomes with diminishing resources is becoming an insurmountable challenge. Additionally, physician satisfaction with their workplace has decreased with increased burnout rates. Thus, it is important to understand the current state of unionization, potential reasons for unionization among physicians and residents, and its future impact on the field of medicine.

Representation of women among cardiothoracic surgery editorial boards: Trends over the past 2 decades

OBJECTIVE

The objective of this study was to examine representation of women on the editorial boards of cardiothoracic surgery-focused journals over the past 2 decades to identify changes over time compared with women cardiothoracic surgeon and trainee representation, and to highlight additional opportunities for improvement.

METHODS

The editorial boards of 2 high-impact cardiothoracic surgery journals were reviewed from 2000 to 2023. Data on editorial board positions, including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared with publicly available information from the Association of American Medical Colleges on physician specialty by sex.

RESULTS

Of 3460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (1 out of 45) of editor-in-chief positions, 13.2% (78 out of 592) of senior editor positions, 11.5% (33 out of 287) of feature editor positions, and 8.3% (221 out of 2663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (P = .01). Overall, editorial board representation increased at a rate of 0.7% ± 1.3% per year, not significantly different from the growth of practicing women cardiothoracic surgeons at 0.3% ± 0.5% per year (P = .584).

DISCUSSION

Representation of women on the editorial boards of cardiothoracic surgery-focused journals has increased commensurate with the increasing proportion of practicing women cardiothoracic surgeons, although remains at 16%. Work remains to continue the recruitment of women to cardiothoracic surgery as well as to identify the key elements that can support them in positions of leadership.

Women in neurosurgery and interventional neuroradiology in Brazil and other countries: can lightning strike the same place twice?

BACKGROUND

Neurosurgery is historically a specialty with a wide male predominance. Interventional neuroradiology, considered in many countries to be a subspecialty of neurosurgery (but also radiology and neurology), has never been the setting for this discussion, but the even greater gender inequality of professionals working in this area is well known.

AIMS

The initial objective of this research was to describe the personal and professional profile of the few women in Brazil who practise neurosurgery and interventional neuroradiology, and the difficulties they encountered throughout their careers just because they are women. However, the shocking stories they experienced led the team to expand searches around the world, obtaining data from some other countries, mainly in South America. Machismo, harassment, misogyny, discrimination and wage inequality go beyond borders.

DISCUSSION

Current times do not allow these situations anymore, but which, according to the narrative descriptions of 28 interventional neuroradiology women interviewed, still occur very frequently. A more inclusive vision must be sought by interventional neuroradiology societies, and it is up to the leaders to take care of those who need more attention (which does not mean they are more fragile).

Study protocol of a systematic review and metaanalysis of stress and burnout among general surgery residents

Introduction

Chronic workplace stress and burnout are impediments to physicians' professional fulfillment, healthcare organizations' efficiency, and patient care quality/safety. General surgery residents are especially at risk due to the complexity of their training. We report the protocol of a metaanalysis of chronic stress and burnout among Accreditation Council for Graduate Medical Education (ACGME)-affiliated general surgery residents in the era after duty-hour reforms, plus downstream effects on their health and clinical performance.

Methods

The proposed systematic review and metaanalysis (PROSPERO registration CRD42021277626) will synthesize/pool data from studies of chronic stress and burnout among general surgery residents at ACGME-affiliated programs. The timeframe under review is subdivided into three intervals: (a) after the 2003 duty-hour restrictions but before 2011 reforms, (b) after the 2011 reforms but before the coronavirus pandemic, and (c) the first 3 years after the pandemic's outbreak. Only studies reporting outcomes based on validated instruments will be included. Qualitative studies, commentaries/editorials, narrative reviews, and studies not published in English will be excluded. Multivariable analyses will adjust for sample characteristics and the methodological quality of included studies.

Conclusions

The metaanalysis will yield evidence reflecting experiences of North American-based general surgery residents in the years after ACGME-mandated duty-hour restructuring.

Psychological Impact of the COVID-19 Pandemic on Canadian Surgical Residents: A Province-Wide Study

OBJECTIVES

The objective of this study was to evaluate the psychological impact of the COVID-19 pandemic on surgical residents.

DESIGN

An online survey was distributed evaluating multiple domains: demographics, health and socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health.

SETTING AND PARTICIPANTS

Surgical residents from University of British Columbia's surgical residency programs.

RESULTS

A total of 31/86 surgical residents responded to the survey. Of which, 57% and 46% reported feeling burned out or depressed, respectively. Residents who were concerned about personal protective equipment supply and who lived with family members with comorbidities had a higher risk of depression (p = 0.03, p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than the median of 2 observed in the United States national survey of residents.

CONCLUSIONS

The pandemic had a considerable negative impact on the psychological well-being of surgical residents.

Investigating First Year Surgery Residents' Expectations of Demand, Control, and Support During Training

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.

National Comparison of Burnout for a Cohort of Surgical and Nonsurgical Female Trainees

INTRODUCTION

Studies have shown that female physician trainees have an increased risk of burnout. We describe the current state of surgical and nonsurgical female trainee well-being and examine differences between surgical and nonsurgical specialties.

METHODS

Survey responses were received from 1017 female identifying trainees from 26 graduate medical education institutions across the United States. These survey responses included demographic data and well-being measures. Specifically, burnout was assessed using the Maslach Burnout Inventory. Data were analyzed using Wilcoxon rank sum test, Fisher's exact test, and Pearson's Chi-squared test data with significance defined as a P < 0.05. This survey was reported in line with strengthening the reporting of cohort studies in surgery criteria.

RESULTS

Nine-hundred ninety-nine participants completed the demographic and well-being section of the surveys and were included in analysis. Demographic data between the surgical versus nonsurgical group were similar, aside from surgeons being slightly older. Burnout was prevalent among all surveyed trainees with 63% scoring positive. Trainees also scored high in imposter syndrome and moral injury with low levels of self-compassion, although respondents also reported themselves flourishing. Surgical trainees scored higher than nonsurgical trainees in the personal accomplishment domain of burnout (P < 0.048). There was no difference between surgical and nonsurgical trainees in measures of the emotional exhaustion or depersonalization domains of burnout, or in impostor syndrome, self-compassion, moral injury, or flourishing.

CONCLUSIONS

While personal accomplishment was noted to be higher in surgical trainees as compared to nonsurgical trainees, overall rates of burnout are high among both groups. Targeted interventions for well-being, such as coaching, can help decrease the levels of burnout experienced by female physician trainees and do not need to be specialty specific.

Use of an Opt-Out vs Opt-In Strategy Increases Use of Residency Mental Health Services

Background Residents report high levels of distress but low utilization of mental health services. Prior research has shown several barriers that prevent residents from opting into available mental health services. Objective To determine the impact of a mental health initiative centered around an opt-out versus an opt-in approach to help-seeking, on the use of psychotherapy. Methods Resident use of psychotherapy was compared between 2 time frames. During the first time frame (July 1, 2020 to January 31, 2021), residents were offered access to therapy that they could self-initiate by calling to schedule an appointment (opt-in). The second time frame (February 1, 2021 to April 30, 2021) involved the switch to an opt-out structure, during which the same residents were scheduled for a session but could choose to cancel. Additional changes were implemented to reduce stigma and minimize barriers. The outcome was psychotherapy use by residents. Results Of the 114 residents, 7 (6%) self-initiated therapy during the opt-in period. When these same residents were placed in an opt-out context, 59 of the remaining 107 residents (55%) kept their initial appointment, and 23 (39%) self-initiated additional sessions. Altogether, across both phases, a total of 30 of the 114 residents initiated therapy (ie, 7 during the opt-in and 23 during the opt-out). The differences in therapy use between the 2 phases are statistically significant (P<.001 by McNemar's test). Conclusions There was a substantial increase in residents' use of psychotherapy after the opt-out initiative that included efforts to reduce stigma and encourage mental health services.

Burnout and well-being of medical and surgical residents in relation to emotional intelligence: A 3-year study

BACKGROUND

This study aims to examine the relationship of emotional intelligence to physician burnout and well-being and compare these changes between medical and surgical residents during training.

METHODS

The longitudinal study used survey data, collecting measures on burnout and emotional intelligence in residents. Postgraduate year 1 residents at a community-based Michigan hospital completed the following surveys: Maslach Burnout Inventory, Physician Wellness Inventory, and Trait Emotional Intelligence Questionnaire-Short Form survey. These measures were given quarterly in postgraduate year 1 and once during subsequent years.

RESULTS

Seventy-seven residents completed measurements during their first 3 years. Forty-two (54.5%) were in the medical resident group; the remaining 35 (45.5%) were in the surgical resident group. Significant increases in measured burnout during the first year improved in subsequent years but did not return to baseline (P < .01). Emotional exhaustion (Maslach Burnout Inventory-Emotional Exhaustion) increased a relative 44% the first year (P = .000) and decreased 23% by the third year (P < .01). The Physician Wellness Inventory subscales also had significant decreases (P = .01) but less than the Maslach Burnout Inventory subscales (improvement ≤25%). Both medical and surgical groups had similar decreases in the Physician Wellness Inventory subscales (-25%) in their first year. The emotional intelligence score significantly correlated with exhaustion (Maslach Burnout Inventory-Emotional Exhaustion: r = -0.243; P = .002) and distress (Physician Wellness Inventory-Distress: r = -0.197; P = .014).

CONCLUSION

The risk for burnout increased sharply at the beginning of training for this hospital resident participant group and remained high throughout residency. Emotional intelligence is an important factor associated with less emotional exhaustion during residency.

Sex Disparities in Ophthalmology From Training Through Practice: A Systematic Review

Importance

Sex-based research in medicine has revealed inequities against females on almost every metric at almost every career stage; ophthalmology is no exception.

Objective

To systematically review the experiences of females in ophthalmology (FiO) from training through practice in high-income countries (HICs).

Evidence Review

A systematic review of English-language studies, published between January 1990 and May 2022, relating to FiO in HICs was performed. PubMed, MEDLINE, and Embase electronic databases were searched, as well as the Journal of Academic Ophthalmology as it was not indexed in the searched databases. Studies were organized by theme at each career stage, starting in medical school when an interest in ophthalmology is expressed, and extending up to retirement.

Findings

A total of 91 studies, 87 cross-sectional and 4 cohort, were included. In medical school, mentorship and recruitment of female students into ophthalmology was influenced by sex bias, with fewer females identifying with ophthalmologist mentors and gender stereotypes perpetuated in reference letters written by both male and female referees. In residency, females had unequal learning opportunities, with lower surgical case volumes than male trainees and fewer females pursued fellowships in lucrative subspecialties. In practice, female ophthalmologists had lower incomes, less academic success, and poorer representation in leadership roles. Female ophthalmologists had a greater scholarly impact factor than their male counterparts, but this was only after approximately 30 years of publication experience. Pervasive throughout all stages of training and practice was the experience of greater sexual harassment among females from both patients and colleagues. Despite these disparities, some studies found that females reported equal overall career satisfaction rating with males in ophthalmology, whereas others suggested higher burnout rates.

Conclusions and Relevance

Ophthalmology is approaching sex parity, however, the increase in the proportion of females in ophthalmology had not translated to an increase in female representation in leadership positions. Sex disparities persisted across many domains including recruitment, training, practice patterns, academic productivity, and income. Interventions may improve sex equity in the field.

Novel Application of a Dynamic, In-room Survey Platform to Measure Surgical Team Satisfaction

OBJECTIVE

To elucidate the potential usage of continuous feedback regarding team satisfaction and correlations with operative performance and patient outcomes.

BACKGROUND

Continuous, actionable assessment of teamwork quality in the operating room (OR) is challenging. This work introduces a novel, data-driven approach to prospectively and dynamically assess health care provider satisfaction with teamwork in the OR.

METHODS

Satisfaction with teamwork quality for each case was assessed utilizing a validated prompt displayed on HappyOrNot Terminals placed in all ORs, with separate panels for circulators, scrub nurses, surgeons, and anesthesia providers. Responses were cross-referenced with OR log data, team familiarity indicators, efficiency parameters, and patient safety indicator events through continuous, semiautomated data marts. Deidentified responses were analyzed through logistic regression modeling.

RESULTS

Over a 24-week period, 4123 responses from 2107 cases were recorded. The overall response rate per case was 32.5%. Greater scrub nurse specialty experience was strongly associated with satisfaction (odds ratio: 2.15, 95% CI: 1.53-3.03, P < 0.001). Worse satisfaction was associated with longer than expected procedure time (odds ratio: 0.91, 95% CI: 0.82-1.00, P = 0.047), nighttime (0.67, 95% CI: 0.55-0.82, P < 0.001), and add-on cases (0.72, 95% CI: 0.60-0.86, P < 0.001). Higher material costs (22%, 95% CI: 6-37, P = 0.006) were associated with greater team satisfaction. Cases with superior teamwork ratings were associated with a 15% shorter length of hospital stay (95% CI: 4-25, P = 0.006).

CONCLUSIONS

This study demonstrates the feasibility of a dynamic survey platform to report actionable health care provider satisfaction metrics in real-time. Team satisfaction is associated with modifiable team variables and some key operational outcomes. Leveraging qualitative measurements of teamwork as operational indicators may augment staff engagement and measures of performance.

See One, Do One, Improve One's Wellness: Resident Autonomy in US General Surgery Programs, A Mixed-methods Study

OBJECTIVE

We sought to examine the factors associated with resident perceptions of autonomy and to characterize the relationship between resident autonomy and wellness.

BACKGROUND

Concerns exist that resident autonomy is decreasing, impacting competence.

METHODS

Quantitative data were collected through a cross-sectional survey administered after the 2020 ABSITE. Qualitative data were collected through interviews and focus groups with residents and faculty at 15 programs.

RESULTS

Seven thousand two hundred thirty-three residents (85.5% response rate) from 324 programs completed the survey. Of 5139 residents with complete data, 4424 (82.2%) reported appropriate autonomy, and these residents were less likely to experience burnout [odds ratio (OR) 0.69; 95% CI 0.58-0.83], suicidality (OR 0.69; 95% CI 0.54-0.89), and thoughts of leaving their programs (OR 0.45; 95% CI 0.37-0.54). Women were less likely to report appropriate autonomy (OR 0.81; 95% CI 0.68-0.97). Residents were more likely to report appropriate autonomy if they also reported satisfaction with their workload (OR 1.65; 95% CI 1.28-2.11), work-life balance (OR 2.01; 95% CI 1.57-2.58), faculty engagement (OR 3.55; 95% CI 2.86-4.35), resident camaraderie (OR 2.23; 95% CI, 1.78-2.79), and efficiency and resources (OR 2.37; 95% CI 1.95-2.88). Qualitative data revealed that (1) autonomy gives meaning to the clinical experience of residency, (2) multiple factors create barriers to autonomy, and (3) autonomy is not inherent to the training paradigm, requiring residents to learn behaviors to "earn" it.

CONCLUSION

Autonomy is not considered an inherent part of the training paradigm such that residents can assume that they will achieve it. Resources to function autonomously should be allocated equitably to support all residents' educational growth and wellness.

Female representation in orthopedic surgery: where do we stand in Belgium ?

Female underrepresentation in Orthopedic Surgery and Traumatology is a well-known issue worldwide, including in Belgium. Most of the literature comes from northern America. This two-part study aims to quantify the female workforce in orthopedic surgery in Belgium and assess the presence of unconscious biases among active orthopedic surgeons. Epidemiological data from national registries, orthopedic societies and universities in Belgium were analyzed. This included data on medical students, residents, active orthopedic surgeons and awards given by a Belgian orthopedic society. Additionally, a questionnaire was administered to Belgian orthopedic surgeons, assessing their perceptions of gender stereotypes and potential unconscious biases. 90 participants responded with 70% of men and mean age was 36 years old. The data revealed that 12% of active orthopedic surgeons in Belgium were women in 2020. However, the representation f women was higher among residents, with a thirty percent distribution. In one university, women had a slightly higher chance of getting accepted in the orthopedic training then men. The questionnaire results indicated the presence of unconscious bias regarding subspecialties, which aligned with the actual distribution. Women tend to specialize more in upper limb surgery and pediatrics while men focus more frequently on lower limb surgery. The findings highlight the need for addressing the underrepresentation of women in orthopedic surgery and traumatology in Belgium. If the current rate of progress continues, it is projected that 30% of active orthopedic surgeons will be female by the year 2074. Identifying and addressing factors contributing to the underrepresentation, such as lack of mentorship, unconscious biases, visibility issues, and discrimination, is crucial for empowering future female orthopedic surgeons and fostering diversity in the field. Collaboration among European universities and orthopedic societies can play a vital role in reducing barriers and promoting gender equality in orthopedic surgery and traumatology.

[Burnout in hospital-based surgeons. Approaches for prevention?]

BACKGROUND

Burnout among physicians is increasingly recognized as a public health issue including its scientific, political, and societal relevance. The effects of burnout go far beyond physician health as they affect the quality of care, patient safety, medical errors, and efficiency of health care.

OBJECTIVE

Assessment of the risk of burnout for hospital-based surgeons as well as associations between surgeon burnout and several work-related and person-related factors.

METHODS

From the representative Saxony physician survey from 2019, we utilized the subsample of 231 hospital-based surgeons. We conducted a regression analysis with workload, job satisfaction, work-life balance (WLB), resilience, inability to recover and health complaints as predictors of burnout (Maslach burnout inventory-General survey, MBI-GS).

RESULTS

Nearly half of the sample were female (49.4%), the average age was 42.0 years, 4.8% of participants exhibited burnout, 45.9% with some symptoms and 49.4% no burnout. Multivariate analysis showed significant positive associations between health complaints, inability to recover, a lack of job-based self-fulfillment and burnout. There were significant negative connections between WLB, the wish to remain in the job and burnout.

CONCLUSION

Burnout is a serious problem for surgeons. Preventive measures should focus on risk factors associated with the workplace and organization of work. Interventions targeted at the individual level should start at an early career stage.

Burnout and turnover intention of primary health care providers during the COVID-19 pandemic in China

OBJECTIVES

This study explored the changes and new characteristics of burnout and turnover intention of primary health care (PHC) providers during the COVID-19 pandemic in China.

STUDY DESIGN

This was a cross-sectional study.

METHODS

This study investigated 1326 PHC providers during the COVID-19 outbreak in 2022 in one district of Shanghai, China. Independent t-test or one-way analysis of variance (ANOVA) test were used to analyse the between-group variation of variables associated to burnout and turnover intention. Then, hierarchical regression analysis was used to further determine the impact of certain variables on burnout and turnover intention, the relationship of burnout on turnover intention and the possible moderating effect.

RESULTS

The results showed that there was no significant change in the prevalence of overall burnout of PHC providers compared to the pre-epidemic period; however, there was a significant increase in high-level burnout. No significant change in turnover intention at the moderate level and above was observed. During the COVID-19 pandemic, PHC providers who were older, married, local and had a higher skill level had higher burnout, while PHC providers who were male, unmarried, non-local and separated from their family had a higher turnover intention. It was shown that burnout, with its three sub-dimensions, was a good predictor of turnover intention. The impact of burnout on turnover intention was shown to be alleviated by certain variables, including being married, living locally and receiving benefit packages, including the preferential education policy for children and talent incentive policies.

CONCLUSIONS

Results from this study have highlighted the importance of paying attention to vulnerable groups of PHC providers, for example those who are separated from their families, during emergency situations. Various incentive tools could be comprehensively used to ensure the stability and efficiency of PHC human resources.

Burnout Among US Gastroenterologists and Fellows in Training: Identifying Contributing Factors and Offering Solutions

BACKGROUND

Consequences of physician burnout include medical errors, higher rate of staff turnover, and decreased patient satisfaction. We examined the prevalence of burnout and identified the contributing factors in gastroenterologists and fellows in training.

METHODS

We performed 3 separate surveys through the American College of Gastroenterology. (1) A national survey of practicing gastroenterologists in the United States that measured burnout and contributing factors, (2) a survey of gastroenterology fellows in training to determine self-identified burnout, as well as mitigating and exacerbating factors, and (3) a follow-up survey of fellows during the COVID-19 pandemic.

RESULTS

One thousand and twenty-one persons responded (9.2% response rate) to the first survey, including 756 individuals who completed the Maslach Burnout Inventory survey. Overall, the prevalence of high burnout was 49.3%. Factors associated with high burnout included female sex, younger age, shorter duration in practice, considering the electronic health record non-user-friendly, 2 or more hours of patient-related work at home per day, 8 or more hours of outpatient time per day, 6 or more inpatient consults per day, taking call with procedures 10 or more times per year, and having children at home. With regard to lifestyle factors, taking 20 days or more of vacation time was associated with a lower rate of burnout. The level of burnout for fellows was observed to be high (42.7% in survey 2 and 35.3% in survey 3).

CONCLUSIONS

Burnout is high in gastroenterologists and fellows in training. Specific contributing factors were both systems based and personal and provide insight into changes that can be made to address burnout.

Lifestyle Medicine Practitioners Implementing a Greater Proportion of Lifestyle Medicine Experience Less Burnout

PURPOSE

To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice.

DESIGN

Analysis of mixed methods data from a large, cross-sectional survey on LM practice.

SETTING

Web-based survey platform.

PARTICIPANTS

Members of an LM medical professional society at the time of survey administration.

METHODS

Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression.

RESULTS

Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%).

CONCLUSION

Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.

We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency

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.

Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training

Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.

Quality of Life and Working Conditions of Hand Surgeons-A National Survey

Background and Objectives: Providing high-quality care for patients in hand surgery is an everyday endeavor. However, the quality of life (QoL) and working conditions of hand surgeons ensuring these high-quality services need to be investigated. The aim of this study was to evaluate the QoL and working conditions of Swiss hand surgeons. Materials and Methods: A national survey with Swiss hand surgeons was conducted. Standardized questionnaires were completed anonymously online. Core topics included working conditions, QoL, satisfaction with the profession, and aspects of private life. Results: A total of 250 hand surgeons were invited to participate, of which 110 (44.0%) completed the questionnaire. Among all participants, 43.6% stated that they are on call 4-7 days per month, versus 8.2% never being on call. Overall, 84.0% of the residents, 50.0% of the senior physicians, 27.6% of the physicians in leading positions, and 40.6% of the senior consultants/practice owners, as well as 55.1% of the female and 44.3% of the male respondents, felt stressed by their job, even during holidays and leisure time. Out of all participants, 85.4% felt that work affects private relationships negatively. Despite the reported stress, 89.1% would choose hand surgery as a profession again. Less on-call duty (29.1%) and better pay (26.4%) are the most prioritized factors for attractiveness of a position at a hospital. Conclusions: The QoL of Swiss hand surgeons is negatively affected by their workload and working hours. Residents, senior physicians and female surgeons suffer significantly more often from depression, burnout or chronic fatigue in comparison to leading positions, senior consultants/practice owners and male surgeons. Better pay or less on-call duty would make the work more attractive in acute care hospitals.

AOA Critical Issues: Gender Justice in Academic Medicine: What It Might Look Like in Orthopaedic Surgery

ABSTRACT

As the number of women entering medicine has increased, so has the number of women entering orthopaedics; however, many orthopaedic programs struggle to create an equitable space for women, particularly in leadership. Struggles experienced by women include sexual harassment and gender bias, lack of visibility, lack of well-being, disproportionate family care responsibilities, and lack of flexibility in the criteria for promotions. Historically, sexual harassment and bias has been a problem faced by women physicians, and often the harassment continues even when the issue has been reported; many women find that reporting it results in negative consequences for their career and training. Additionally, throughout medical training, women are less exposed to orthopaedics and lack the mentorship that is given to their colleagues who are men. The late exposure and lack of support prevent women from entering and advancing in orthopaedic training. Typical surgery culture can also result in women orthopaedic surgeons avoiding help for mental wellness. Improving well-being culture requires systemic changes. Finally, women in academics perceive decreased equality in promotional considerations and face leadership that already lacks representation of women. This paper presents solutions to assist in developing equitable work environments for all academic clinicians.

Surgical Fellowships Demonstrate Variable Improvement in Gender Representation Despite Greater Female Enrollment in General Surgery Residencies

OBJECTIVE

Despite increasing female representation in General Surgery (GS) residency training programs, proportional improvement of female enrollment in surgical fellowships has yet to be quantified. We aimed to assess if female enrollment in surgical fellowships has improved at an equivalent rate in 7 different surgical fellowship options after GS.

DESIGN AND SETTING

Data were collected from Accreditation Council for Graduate Medical Education (ACGME) resources which disclosed active resident and fellow characteristics. Gender identification was self-reported by residents to ACGME. Gender data collected for GS programs and surgical fellowships including Surgical Critical Care, Colon, and Rectal Surgery, Pediatric Surgery, Plastic Surgery, Surgical Oncology, Thoracic Surgery, and Vascular Surgery from annual reports. Pearson Chi-squared analysis was conducted between GS residencies and fellowship programs in their corresponding years using Stata15 software.

RESULTS

In all years examined, fellowships in Vascular, Thoracic, and Plastic Surgery had significantly lower female enrollment in proportion to the number of female GS residents (p = <0.02). In all years examined, Surgical Oncology, Pediatric, Colon and Rectal, and Surgical Critical Care had female enrollment that was, at minimum, proportional to female enrollment in GS residency, indicating equitable gender representation. Surgical Oncology (2016), Pediatric (2020) and Surgical Critical Care (2016) fellowships each had 1 year where female enrollment was significantly higher than General Surgery.

CONCLUSIONS

The enrollment of female surgeons in Plastic, Vascular, and Thoracic Surgery fellowships has not improved proportionally despite an increase in female GS residents. These results suggest the possibility of persistent factors that deter female enrollment in Vascular, Thoracic and Plastic Surgery fellowships that are not present to the same degree in fields with equitable fellowship female enrollment. Female representation in surgical fellowships is vital to improving gender diversity in all disciplines of surgery, particularly academic surgery.

Examination of the Novel National Institutes of Health-Supported Relative Citation Ratio, a Measure of Research Productivity, Among Academic Plastic Surgeons

BACKGROUND

Considerable interest has been devoted to quantifying research productivity for the purposes of academic appointment and promotion in plastic surgery. A novel bibliometric, the relative citation ratio (RCR), integrates features unavailable in prior metrics, such as the h-index, including the ability to compare researchers in distinct fields. This investigation examines the RCR in relation to established measures of academic productivity and provides the benchmark data in plastic surgery.

METHODS

Online sources were queried to identify the characteristics of 955 academic plastic surgeons from 94 programs, ie, academic rank, gender, degrees, and fellowships. Bibliometric data were acquired using the iCite and Scopus databases. Comparative and correlational analyses of variables were performed.

RESULTS

Academic plastic surgeons were exceptionally productive, with a mean RCR of 1.20 (interquartile range, 0.79-1.67) and a weighted RCR of 17.68 (interquartile range, 5.14-52.48). Increased mean RCR was significantly associated with advanced academic rank and fellowship training. Increased weighted RCR was significantly associated with advanced academic rank, male gender, PhD acquisition, publication experience, and fellowship training. The h-index was weakly correlated with mean RCR but strongly correlated with weighted RCR and publication experience.

CONCLUSIONS

The RCR was associated with established markers of academic productivity, indicating its validity as a reliable field-normalized measure for the evaluation of plastic surgery faculty. Because scholarly output is a potential factor with respect to decisions of hiring, promotion, and allocation of funding, this modality of standardized comparison is paramount for plastic surgeons who exist within a larger general surgery department.

Implementation, Feasibility, and Perception of Facilitated Process Groups in Surgical Residency

OBJECTIVE

Recent studies have demonstrated burnout in surgeons, with trainees affected at alarming levels. However, few studies have focused on specific wellbeing initiatives in surgical residency. We implemented facilitated process groups at our residency program and aimed to understand the feasibility and perception of this program.

DESIGN

We recruited a psychologist to conduct weekly process groups. Each postgraduate year (PGY) class was scheduled for a rotating 1-hour session every 6 weeks during protected didactic time. A presurvey was conducted shortly following program commencement for PGY1-5 residents (11/2020-1/2021) and a postsurvey conducted after 9 to 10 months of implementation for PGY2-5 residents. Surveys included demographics, a 2-item Maslach Burnout Inventory, and questions about stress, lifestyle, and perception of the process groups, including qualitative feedback.

SETTING

The study took place at within the General Surgery Residency at Massachusetts General Hospital, a tertiary-care institution in Boston, Massachusetts.

PARTICIPANTS

Participants in process groups were all General Surgery residents during the timeframe of the study. Participation in the presurvey and postsurvey was voluntary for residents.

RESULTS

A total of 32 and 35 residents completed the presurveys and postsurveys, respectively. Groups were similar with regards to gender and race. A total of 97% and 57% of postsurvey respondents attended ≥1 and ≥3 process groups, respectively, with 95% citing clinical/other obligations as the cause of missing sessions. Perception of process groups was highly positive and persisted across both surveys. There were no significant differences in perception or burnout questions, except for a slight decrease in "I think process groups might help me process personal challenges" on postsurvey. Of 15 qualitative postsurvey responses, 73% were positive and the remainder were neutral.

CONCLUSIONS

Based on current measures, it is feasible to implement facilitated process groups for surgical residents. Resident perception of these groups was persistently positive.

Routine Assessment of Surgical Resident Wellness-Related Concerns During Biannual Review

BACKGROUND

Surgery residency confers stress burdens on trainees. To monitor and mitigate areas of concerns, our education team implemented a 6-item biannual survey querying potential stressors. We reviewed the initial 5-year experience to assess for trends and improve efforts in maintaining resident well-being.

STUDY DESIGN

Surgery residents from all postgraduate years were asked to complete a survey of common concerns, prioritizing them in order of importance. The items to be ranked were: needs of family/friends; nonwork time for study; financial concerns; personal well-being needs; concerns for clinical performance; and administrative demands. Changes in ranking were trended across 10 review periods. Results were analyzed using a Kruskal-Wallis test.

RESULTS

A completion rate of 96.5% was rendered from the completion of 333 surveys. Rankings changed significantly for nonwork time for study (p = 0.04), personal well-being needs (p = 0.03) and concerns for clinical performance (p = 0.004). Nonwork time for study and concerns on clinical performance were consistently ranked as top two stressors over study period, except for spring 2020. Personal well-being needs ranked highest in spring 2020; 41% of residents placed this as top 2 rankings. A decrease in concerns for clinical performance was observed in spring 2020, corresponding to the coronavirus disease 2019 (COVID-19) pandemic emergency declaration.

CONCLUSIONS

Surgery residents generally prioritized time for study and concerns for assessment of clinical performance as highest areas of concern. With the occurrence of a pandemic, increased prioritization of personal well-being was observed. Used routinely with biannual reviews, the survey was able to identify plausible changes in resident concerns. Determination of levels of actual stress and actual association with the pandemic requires additional study.

Surgeon Burnout and Usage of Personal Communication Devices: Examining the Technology "Empowerment/Enslavement Paradox"

INTRODUCTION

Access to patients' electronic medical records (EMRs) on personal communication devices (PCDs) is beneficial but can negatively impact surgeons. In a recent op-ed, Cohen et al. explored this technology "empowerment/enslavement paradox" and its potential effect on surgeon burnout. We examined if there is a relationship between accessing EMRs on PCDs and surgeon burnout.

METHODS

This was a cohort study with retrospective and prospective arms. Trainees and attendings with a background in general surgery completed the Maslach Burnout Index for Medical Personnel, a validated survey scored on three areas of burnout (emotional exhaustion, depersonalization, and low personal accomplishment). Data on login frequency to EMRs on PCDs over the previous 6 mo were obtained. Pearson correlation coefficients were calculated to determine if burnout and login frequency were associated.

RESULTS

There were 52 participants included. Residents were 61.5% (n = 32) of participants. The mean login frequency over 6 mo was 431.0 ± 323.9. The mean scores (out of 6) for emotional exhaustion, depersonalization, and personal accomplishment were 2.3 ± 1.1, 1.9 ± 1.2, and 4.9 ± 0.8, respectively. There was no correlation between burnout and logins. Residents had higher median depersonalization scores (2.3 versus 1.2, P = 0.03) and total logins (417.5 versus 210.0, P < 0.001) than attendings. Participants who overestimated logins had higher median emotional exhaustion and depersonalization scores than those who underestimated (2.6 versus 1.4, P = 0.03, and 2.4 versus 0.8, P = 0.003, respectively).

CONCLUSIONS

Using EMRs on PCDs is common, but frequency of logins did not correlate with burnout scores in this study. However, perception of increased workload may contribute to experiencing burnout.

Efficacy of the online Mindful Self-Compassion for Healthcare Communities program for surgical trainees: a prospective pilot study

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.

"Sip & Share": Building Resilience in Surgery Residency Through Moral Distress Rounds

OBJECTIVE

Resident moral distress rounds were instituted during the COVID-19 pandemic to provide a safe zone for discussion, reflection, and the identification of the ethical challenges contributing to moral distress. The sessions, entitled "Sip & Share," also served to foster connectedness and build resilience.

DESIGN

A baseline needs assessment was performed and only 36% of general surgery residents in the program were satisfied with the current non-technical skills curriculum. Only 62% were comfortable with navigating ethical issues in surgery. About 72% were comfortable with leading a goals-of-care discussion, and 63% of residents were comfortable with offering surgical palliative care options. Case-based discussions over video conferencing were organized monthly. Each session was structured based on the eight-step methodology described by Morley and Shashidhara. Participation was voluntary. The sessions explored moral distress, and the ethical tensions between patient autonomy and beneficence, and beneficence and non-maleficence.

SETTING

Large general surgery residency in an urban tertiary medical center.

PARTICIPANTS

General surgery residents.

RESULTS

A post-intervention survey was performed with improvement in the satisfaction with the non-technical skills curriculum (70% from 36%). The proportion of residents feeling comfortable with navigating ethical issues in surgery increased from 62% to 72%. A survey was performed to assess the efficacy of the moral distress rounds after eight Sip & Share sessions over ten months. All thirteen respondents agreed that the discussions provided them with the vocabulary to discuss ethical dilemmas and define the ethical principles contributing to their moral distress. 93% were able to apply the templates learned to their practice, 77% felt that the discussions helped mitigate stress. All respondents recommended attending the sessions to other residents.

CONCLUSIONS

Moral distress rounds provide a structured safe zone for residents to share and process morally distressing experiences. These gatherings mitigate isolation, promote a sense of community, and provide a support network within the residency. In addition, residents are equipped with the vocabulary to identify the ethical principles being challenged and are provided practical take-aways to avoid similar conflicts in the future.

Gamification of robotic simulation to train general surgery residents

BACKGROUND

Gamification applies game design elements to non-game contexts in order to engage participation and increase learner motivation. Robotic surgery is gaining popularity in general surgery but requires specialized technical skills. We sought to determine whether gamification of robotic simulation training could increase robotic simulator utilization among general surgery residents.

METHODS

General surgery residents were recruited and sent weekly progress on simulator performance including leaderboards for 4 weeks during the intervention periods. There were also two control periods setup in an ABAB study design. Usage time and mean scores were compared between the control periods and intervention periods. A post-study qualitative assessment interview using semi-structured interviews determined barriers and motivational components of simulator usage.

RESULTS

Fifteen general surgery residents enrolled in the study (n = 15). Intervention increased total simulator usage time 9.7-fold from 153 to 1485 min. Total simulator days increased threefold from 9 to 27 days. Resident participation increased from 33 to 53%. Median average scores were higher during the intervention periods (58.8 and 81.9 vs 44.0). During the first intervention period, median individual-level simulator usage time increased 17 min (P = 0.03). However, there was no individual-level increase in median usage minutes or days during the second intervention period. Qualitative assessment determined barriers to be limited time due to clinical duties, and simulator availability while motivational factors included competitive factors such as leaderboards and gaming aspects. Potential improvements were increasing attending visibility of scores to increase recognition of progress by the residents and creating dedicated time for training.

CONCLUSION

Gamification of robotic simulation training increased general surgery resident participation, usage time and scores. Impact was not durable. Instituting dedicated practice time and more attending engagement may increase trainee motivation and performance.

Introduction to surgical coaching

Surgical coaching is a new approach to continuous professional development (CPD). Advocates claim that coaching improves surgical and non-technical skills, leading to enhanced performance and reduced stress and burnout. Widespread acceptance of coaching in the surgical community is limited due to a paucity of evidence, surgery-specific obstacles and lack of resources. This narrative review introduces what 'surgical coaching' is and describes its origins. Coaching techniques are based on live or video observation of procedures, followed by collaborative analysis, reflection and goal planning in a non-competitive setting aided by an expert, peer or lay coach. Technical skills improvements have been reported using coaching techniques, yet long-term influence on non-technical competencies, overall performance and surgeon wellbeing are largely hypothetical. There are clear potential benefits in the application of surgical coaching to daily surgical practice. However, significant knowledge gaps remain. Dedicated research into the short-term applicability and the long-term effects of surgical coaching are required.

"The Story I Will Never Forget": Critical Incident Narratives in Surgical Residency

OBJECTIVE

We sought to better understand what defines a critical incident experience for the surgical trainee.

SUMMARY BACKGROUND DATA

Critical incidents are formative moments stamped indelibly on one's memory that shape professional identity. The critical incident technique-using participants' narratives to identify patterns and learn from their perceptions-has been explored in some healthcare settings, but there has been no inquiry within surgery.

METHODS

Surgical residents at 5 residency programs (1 community, 1 university-affiliated, 3 university) were surveyed using an online questionnaire from November to December 2020. Convenience sampling was used to identify the study population. Participants were invited to write about formative, impactful experiences in training. Interpretive description was the qualitative methodology used to locate information, analyze, and record patterns in the data. Individual responses were categorized and assessed for overlying themes.

RESULTS

Overall, 28 narratives were collected from surgery residents in 3 specialties (general surgery, plastic surgery, and urology), with postgraduate year representation of post-graduate years 1 to 6. Respondents were 40% female. Nineteen of the narratives reported a negative experience. Four themes were identified from responses: 1) growth through personal self-reflection, 2) difficult interpersonal interactions, 3) positive team dynamics as a psychological safety net, and 4) supportive program cultures that promote learning.

CONCLUSIONS

Critical incident narratives among surgical residents indicate that unforgettable and formative experiences-both positive and negative- occur in 4 domains: within the individual, within a relationship, among a team, and within a program. Further exploring these domains in surgical training will inform optimal educational programming to support trainee development and wellbeing.

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

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.

The Impact of Surgical Boot Camp on Medical Student Confidence and Imposter Syndrome

INTRODUCTION

Transitioning from medical student to surgical intern is accompanied by increased responsibility, stress, and clinical burden. This environment lends itself to imposter syndrome (IS), a psychological condition grounded in self-doubt causing fear of being discovered as fraud despite adequate abilities. We hypothesized a 2-week surgical boot camp for fourth year medical students would improve confidence in technical skills/knowledge and IS.

METHODS

Thirty medical students matching into surgical specialties completed the boot-camp in February 2020. Presurveys/postsurveys assessed confidence levels using a 1-5 Likert scale regarding 32 technical skills and knowledge points. The Clance Impostor Phenomenon Scale (CIPS) assessed IS, where increasing scores correlate to greater IS.

RESULTS

Median (interquartile range [IQR]) subject age was 27 y (26, 28), 20 (66.7%) were male, and 21 (70%) were Caucasian. Of the 30 students, 23 (76.7%) had a break in training with a median [IQR] of 2 [1, 3] y outside of medicine. Confidence scores were significantly improved in all five assessment categories (P < 0.05); however, there was no change in CIPS in median [IQR] presurveys versus postsurveys (65.5 [52, 75] versus 64 [52, 75], P = 0.70). Females had higher mean (standard deviation) pre-CIPS than males (68.4 [15.2] versus 61.6 [14.9], P = 0.02). There was no strong correlation between age and CIPS in the presurvey (Spearman Rank Correlation Coefficient [SRCC]: 0.29, P = 0.19) or postsurvey (SRCC: 0.31, P = 0.10). While subjects who worked outside of medicine had a stronger relationship with IS (SRCC: 0.37, P = 0.05), multivariable regression analysis did not reveal any significant differences.

CONCLUSIONS

We advocate for surgical boot-camp training courses to improve trainee skill and confidence. As IS is not improved by boot camp, additional research is needed to identify opportunities to improve IS among surgical trainees.

Stress and cataract surgery: A nationwide study evaluating surgeon burnout

BACKGROUND

We aimed to evaluate the nationwide prevalence of stress induced burnout among cataract surgeons. We believe that knowledge of these factors can help formulate a solution to this underreported problem.

METHODS

A three-part nationwide cross-sectional survey was disseminated with via the Royal College of Ophthalmologists (RCOphth) in the United Kingdom(UK). All consultants, trainees and specialty doctors and associate specialists(SAS) were invited to participate. We evaluated burnout using the Maslach Burnout Inventory (MBI). Logistic regression modelling was completed to look at factors linked to high level burnout in certain domains.

RESULTS

A total of 406 respondents completed our survey. Prevalence of cataract surgery-related high burnout was estimated at 3.45% (Section A and/or B) and 40% within Personal Accomplishment (PA)(Section C of the MBI). Multiple factors were associated with increased burnout within PA: Increasing age: 61+ OR: 2.99 (1.02-8.78, p = 0.05), Number of cataract operations completed: >3000 OR 2.98 (1.03-8.64, p = 0.04), Lists per week: 2: OR 2.99 (1.38-6.47, p < 0.01), 2.5: OR 8.95 (2.58-31.02, p < 0.01), 3 or more: OR 2.64 (1.07-6.54, p = 0.04). Sleeping 8 h or more was found to be protective OR 0.52 (0.28-0.96, p = 0.04). 17% of respondents indicated they would be willing to give up cataract surgery if given the opportunity.

CONCLUSION

The prevalence of stress induced burnout by cataract surgery appears to be present in a minority of surgeons. There appears to be a significant reduction in the feeling of personal achievement within the profession. A large proportion of this cohort appears to be willing to give up surgical responsibilities.

Muffins and Meditation: Combatting Burnout in Surgical Residents

OBJECTIVE

To quantify the prevalence of burnout in our surgical residency program and to assess the impact of a weekly wellness program for surgical residents through validated tools measuring mindfulness, self-compassion, flourishing, and burnout. Our hypothesis was that participants with more frequent attendance would: (1) be more mindful and self-compassionate and (2) experience less burnout and more flourishing.

DESIGN

An optional one-hour weekly breakfast conference was facilitated by a senior surgical faculty member with the time protected from all clinical duties. Following a guided meditation, participants were given time for reflection and dialogue about their training experiences or led in a wellness exercise. TRANCE (tolerance, respect, anonymity, nonretaliation, compassion, egalitarianism) principles were utilized to create a safe and open environment. Residents were surveyed at the end of the study period, which was from March 2017 through June 2018.

SETTING

The conference and data analysis was conducted at Denver Health Medical Center, affiliated with the University of Colorado School of Medicine.

PARTICIPANTS

This study analyzed survey responses from 85 surgical residents.

RESULTS

Following the wellness program, when answering the 2-question Maslach Burnout Inventory, 35.7% of residents reported feeling burned out by their work once a week or more, and 29.7% reported feeling more callous toward people once a week or more. After multivariate analysis, the only independent predictors of increased burnout were "not being married or in a committed relationship," lower positive affect, and higher negative affect. Written feedback was overwhelmingly positive, and residents expressed gratitude for the conference, the opportunity for self-reflection, and open dialogue with attendings and colleagues.

CONCLUSIONS

The prevalence of burnout is high among surgical residents. Allowing time to practice a mindfulness meditation while providing space for residents to share their experiences may be protective, and efforts should be made to reduce barriers to participation.

How well do we understand our patients' perioperative experience? A qualitative analysis of themes derived from patient-centric resident conferences

BACKGROUND

Patient-centric resident conferences (PCRCs) provide meaningful time to connect with and learn from patients. This qualitative study explores themes of patients' perioperative experiences from PCRCs through patient and resident perspectives.

METHODS

General Surgery residents participated in six PCRCs, which include condensed standard didactics to accommodate a patient panel regarding their perioperative experience. Panel transcripts and resident survey responses describing what they learned were coded using grounded theory methodology. Themes were evaluated and compared.

RESULTS

76 identified codes were grouped into major categories: "Medical/Surgical Knowledge," "Patient Perspective," "Patient-Physician Relationship," and "Communication." Themes from resident responses predominantly paralleled patient discussion, with common themes including "impact of disease and surgery on patient" and "compassion/empathy." "Medical/surgical knowledge" was only present in resident responses while themes regarding quality of life were more frequent in patient transcripts.

CONCLUSIONS

PCRCs are a valuable tool in resident education to understand patients' perioperative experiences. Themes from patient panels complement, but do not replace, information covered in didactic lectures.