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Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg 2024; 79:1217-1223. [PMID: 38215953 DOI: 10.1016/j.jvs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.
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Affiliation(s)
- Eric Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Leanne Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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Vasireddi N, Vasireddi N, Shah AK, Moyal AJ, Gausden EB, Mclawhorn AS, Poelstra KA, Gould HP, Voos JE, Calcei JG. High Prevalence of Work-related Musculoskeletal Disorders and Limited Evidence-based Ergonomics in Orthopaedic Surgery: A Systematic Review. Clin Orthop Relat Res 2024; 482:659-671. [PMID: 37987688 PMCID: PMC10936985 DOI: 10.1097/corr.0000000000002904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The Centers for Disease Control defines work-related musculoskeletal disorders as disorders of the nerves, muscles, tendons, joints, spinal discs, and cartilage that are caused or exacerbated by the environment or nature of work. Previous meta-analyses have characterized work-related musculoskeletal disorders among interventionists, general surgeons, and other surgical subspecialties, but prevalence estimates, prognosis, and ergonomic considerations vary by study and surgical specialty. QUESTIONS/PURPOSES (1) What is the career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons? (2) What is the treatment prevalence associated with work-related musculoskeletal disorders in orthopaedic surgeons? (3) What is the disability burden of work-related musculoskeletal disorders in orthopaedic surgeons? (4) What is the scope of orthopaedic surgical ergonomic assessments and interventions? METHODS A systematic review of English-language studies from PubMed, MEDLINE, Embase, and Scopus was performed in December 2022 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that presented prevalence estimates of work-related musculoskeletal disorders or assessed surgical ergonomics in orthopaedic surgery were included. Reviews, case reports, gray literature (conference abstracts and preprints), and studies with mixed-surgeon (nonorthopaedic) populations were excluded. The search yielded 5603 abstracts; 24 survey-based studies with 4876 orthopaedic surgeons (mean age 48 years; 79% of surgeons were men) were included for an analysis of work-related musculoskeletal disorders, and 18 articles were included for a descriptive synthesis of ergonomic assessment. Quality assessment using the Joanna Briggs Institute Tool revealed that studies had a low to moderate risk of bias, largely because of self-reporting survey-based methodology. Because of considerable heterogeneity and risk of bias, prevalence outcomes were not pooled and instead are presented as ranges (mean I 2 = 91.3%). RESULTS The career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons ranged from 37% to 97%. By anatomic location, the prevalence of work-related musculoskeletal disorders in the head and neck ranged from 4% to 74%; back ranged from 9% to 77%; forearm, wrist, and hand ranged from 12% to 54%; elbow ranged from 3% to 28%; shoulder ranged from 3% to 34%; hip and thigh ranged from 1% to 10%; knee and lower leg ranged from 1% to 31%; and foot and ankle ranged from 4% to 25%. Of orthopaedic surgeons reporting work-related musculoskeletal disorders, 9% to 33% had a leave of absence, practice restriction or modification, or early retirement, and 27% to 83% received some form of treatment. Orthopaedic surgeons experienced biomechanical, cardiovascular, neuromuscular, and metabolic stress during procedures. Interventions to improve orthopaedic surgical ergonomics have been limited, but have included robotic assistance, proper visualization aids, appropriate use of power tools, and safely minimizing lead apron use. In hip and knee arthroplasty, robotic assistance was the most effective in improving posture and reducing caloric expenditure. In spine surgery, proper use of surgical loupes was the most effective in improving posture. CONCLUSION Although the reported ranges of our main findings were wide, even on the low end of the reported ranges, work-related musculoskeletal disability among orthopaedic surgeons appears to be a substantial concern. We recommend that orthopaedic residency training programs incorporate surgical ergonomics or work injury lectures, workshops, and film review (alongside existing film review of surgical skills) into their curricula. We suggest hospitals engage in shared decision-making with surgeons through anonymous needs assessment surveys to implement wellness programs specific to surgeons' musculoskeletal needs. We urge institutions to assess surgeon ergonomics during routine quality assessment of novel surgical instruments and workflows. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Nikhil Vasireddi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
| | | | - Aakash K. Shah
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew J. Moyal
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
| | | | | | - Kornelis A. Poelstra
- The Robotic Spine Institute of New Jersey, Jersey City, NJ, USA
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | - James E. Voos
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
| | - Jacob G. Calcei
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
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Morse E, Tai K, Harpel L, Born H, Krishna P, Rameau A. Female Surgical Ergonomics in Otolaryngology: A National Survey Study. Otolaryngol Head Neck Surg 2024; 170:788-794. [PMID: 37890071 PMCID: PMC10922095 DOI: 10.1002/ohn.568] [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: 07/03/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To assess the nature and impact surgical ergonomic challenges experienced by female otolaryngologists. STUDY DESIGN National survey study. SETTING Female otolaryngology residents, fellows and attendings recruited via social media posting and email distribution. METHODS We distributed a survey study to female otolaryngologists throughout the United States. The height and glove size of participants reporting difficulties with equipment and instruments were compared to those not reporting difficulties. RESULTS Ninety-six female otolaryngologists participated in our study, comprised of 43% residents, 10% fellows, and 47% attendings. Ninety percent of participants reported difficulties using equipment and 77% of participants reported difficulty with instruments, the most common being nasal endoscopic instruments (28%). The vast majority of participants reported pain during and (or) after the operation (92%). Head and neck (53%) and rhinology (44%) were identified as particularly challenging specialities, but only 25% of participants reported that ergonomics affected their career plans. Participants felt that adjustable equipment (60%), a variety of sizes of instruments (43%), and more discussion around ergonomics (47%) would help. Respondents reported adjusting the operating room to accommodate their size took extra time (44%) and was a mental burden (39%). Participants reporting difficulties with operating room equipment were significantly shorter than those without difficulties (64 inches vs 67 inches, P = .037), and those reporting difficulties with instruments had a smaller median glove size (6 vs 6.5, P = .018). CONCLUSION Surgical ergonomics represent a challenge for female otolaryngologists, particularly those with smaller hands and shorter height. Partnering with industry, we must address the needs of an increasingly diverse workforce to ensure that all surgeons can operate effectively and comfortably.
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Affiliation(s)
- Elliot Morse
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Katherine Tai
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Lexa Harpel
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Hayley Born
- Department of Otolaryngology, Columbia University Medical Center, New York, New York, USA
| | - Priya Krishna
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, California, USA
| | - Anaïs Rameau
- Department of Otolaryngology, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
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Merrill AL, Haigh PI, Lal GI. Lessons from the American Association of Endocrine Surgeons (AAES) ergonomics panel: Operating is a pain in the neck … and other places. Am J Surg 2024:S0002-9610(24)00133-8. [PMID: 38423805 DOI: 10.1016/j.amjsurg.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Andrea L Merrill
- Department of Surgery, Boston Medical Center, 830 Harrison Ave, FGH 5005, Boston, MA, 02118, USA.
| | - Philip I Haigh
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA, 90027, USA.
| | - Geeta I Lal
- Department of Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Norasi H, Hallbeck MS, Elli EF, Tollefson MK, Harold KL, Pak R. Impact of preferred surgical modality on surgeon wellness: a survey of workload, physical pain/discomfort, and neuromusculoskeletal disorders. Surg Endosc 2023; 37:9244-9254. [PMID: 37872425 PMCID: PMC10709269 DOI: 10.1007/s00464-023-10485-0] [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: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND We compared surgeons' workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). METHODS An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs. RESULTS Seventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05). CONCLUSIONS The distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Tetteh E, Wang T, Kim JY, Smith T, Norasi H, Van Straaten MG, Lal G, Chrouser KL, Shao JM, Hallbeck MS. Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. Am J Surg 2023:S0002-9610(23)00589-5. [PMID: 37981518 DOI: 10.1016/j.amjsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is still uncommon. METHODS The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons. RESULTS A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed. CONCLUSIONS The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.
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Affiliation(s)
- Emmanuel Tetteh
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianke Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Y Kim
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianqi Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | | | - Geeta Lal
- Department of Surgery, University of Iowa, Iowa City, USA
| | | | - Jenny M Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Hamilton BC, Dairywala MI, Highet A, Nguyen TC, O'Sullivan P, Chern H, Soriano IS. Artificial intelligence based real-time video ergonomic assessment and training improves resident ergonomics. Am J Surg 2023; 226:741-746. [PMID: 37500299 DOI: 10.1016/j.amjsurg.2023.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Surgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents. METHODS Surgery residents performed simulated laparoscopic tasks before and after a review of the SCORE ergonomics curriculum while filmed with a sensorless app from Kinetica Labs that calculates joint angles as a metric of ergonomics. A survey was completed before the session and a focus group was conducted after. RESULTS Thirteen surgical residents participated in the study. The brief intervention took little time and residents improved their ergonomic scores in neck and right shoulder angles. Residents expressed increased awareness of ergonomics based on the session content and AI information. All trainees desired more training in ergonomics. CONCLUSIONS Ergonomic assessment AI software can provide immediate feedback to surgical trainees to improve ergonomics. Additional studies using sensorless AI technology are needed.
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Affiliation(s)
- Barbara Cs Hamilton
- Department of Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94117, USA.
| | - Mohammed I Dairywala
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, McGovern Medical School, 6400 Fannin St Suite 2850, Houston, TX, 77030, USA
| | - Alexandra Highet
- Department of Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Tom C Nguyen
- Department of Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Hueylan Chern
- Department of Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Ian S Soriano
- Department of Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94117, USA
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Yadav SK, Lal G, Jain SB, Jha CK, Corwin C, Van Gorp B, Sharma CK, Kumar A, Sinha DK. Indian surgery Trainee's perspective on surgical ergonomics principles and education: A long road ahead. Am J Surg 2023; 226:735-740. [PMID: 37308348 DOI: 10.1016/j.amjsurg.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aimed to determine the baseline knowledge and beliefs, along with the impact of incorporating surgical ergonomics lectures during a residency. METHODS A cohort of 123 Indian surgical residents participated in this educational intervention, which consisted of two educational webinars on ergonomics. Both pre- and post-intervention surveys were electronically sent to the participants. These included questions related to their demographics, prevalence of musculoskeletal (MSK) symptoms, and factors affecting participant awareness of ergonomic recommendations. RESULTS Seventy-one residents responded to the pre-webinar survey. Eighty-five percent of respondents reported MSK symptoms, with the most common being pain (70%) and stiffness (40%), which the residents attributed to their surgical training. Forty-six residents completed the post-webinar survey. The majority of respondents strongly agreed or agreed that surgical ergonomic educational sessions improved their understanding of the fundamental causes of MSK symptoms and increased their awareness of options available for prevention MSK injuries. CONCLUSION The rate of MSK symptoms and/or injury was high among this cohort of surgical residents. These surveys and educational session demonstrated there is limited awareness of the comprehension of ergonomics related to surgical procedures. Our study shows that a simple surgical ergonomic educational intervention can lead to improved understanding of prevention and ergonomic changes.
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Affiliation(s)
| | - Geeta Lal
- Adult Inpatient, Division of Surgical Oncology and Endocrine Surgery, University of Iowa, USA
| | - Sapana Bothra Jain
- Consultant (Endocrine and Breast Surgery), Mahatma Gandhi Institute of Medical Sciences, Jaipur, India
| | - Chandan Kumar Jha
- Department of Surgery, All India Institute of Medical Sciences, Patna, India
| | - Claudia Corwin
- Department of Internal Medicine, Carver College of Medicine, University of Iowa Employee Health, University of Iowa Hospitals and Clinics, USA
| | - Barbara Van Gorp
- Iowa Orthopedic Sports Medicine and Rehabilitation, Iowa Carver College of Medicine, Dept of Physical Therapy and Rehabilitation Science, University of Iowa, USA
| | - Chitresh Kumar Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, India
| | - Amit Kumar
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India
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Lin E, Young R, Shields J, Smith K, Chao L. Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2023; 35:361-367. [PMID: 37144567 DOI: 10.1097/gco.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW To evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery. RECENT FINDINGS Factors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics. SUMMARY Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.
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Affiliation(s)
- Emily Lin
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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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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