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Ho JW, Cerier EJ, Diaz CM, Hu YY, Tatebe LC, Alam HB, Johnson JK, Halverson AL. Residents Need a Dynamic Approach to Leadership Education: A Qualitative Study. JOURNAL OF SURGICAL EDUCATION 2024; 81:794-803. [PMID: 38664171 DOI: 10.1016/j.jsurg.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Leadership is an essential skill for surgeons, but it is not systematically taught in residency. The objective of this study was to explore the current experiences, motivators, and perspectives on leadership training of general surgery residents. DESIGN/SETTING/PARTICIPANTS Semi-structured focus groups were conducted with 20 general surgery residents at an academic training program. Six in-person sessions (one for each postgraduate year and research) were recorded, transcribed, and de-identified. Data were inductively coded by 2 independent researchers and analyzed thematically. Discrepancies were discussed and resolved through consensus. RESULTS Participants described developing their leadership skills prior to residency through formal (e.g., job and military) and informal (e.g., extracurricular) experiences. Most reported that leadership development during residency occurred informally (e.g., emulating mentors, trial-and-error). Evolving responsibilities and expectations shaped residents' leadership values: junior residents focused on student and task management and adaptation to new teams; mid-level residents emphasized emotional intelligence and delivery of resident feedback; and senior residents stressed team engagement, inspiring the team, and teaching/mentoring. Major transition periods between residency levels were identified as critical times for leadership training as they allow for self-reflection, motivating residents to participate in a leadership curriculum. Employing level appropriate and immediately applicable content during this time would encourage curriculum attendance and prepare residents for new roles. CONCLUSIONS There is a lack of formal leadership training in general surgery residency. There is an opportunity to design and implement leadership training that engages surgical residents with level-relevant content and strategies. Transition periods offer optimal timing for maximal curricula uptake.
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Affiliation(s)
- Jessie W Ho
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Emily J Cerier
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carmen M Diaz
- Kellogg School of Management, Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES) Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leah C Tatebe
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hasan B Alam
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julie K Johnson
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES) Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy L Halverson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Anand A, Jensen R, Korndorffer JR. We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:1618-1640. [PMID: 37541937 DOI: 10.1016/j.jsurg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/26/2023] [Accepted: 07/08/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation. DESIGN A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score. RESULTS A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8). CONCLUSIONS Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.
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Affiliation(s)
- Ananya Anand
- Department of Surgery, Stanford University, Stanford, California.
| | - Rachel Jensen
- Department of Surgery, Stanford University, Stanford, California
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Iwai Y, Yu AYL, Thomas SM, Quinsey CS, Beasley GM, Sudan R, Fayanju OM. Survey Study of Clerkship Curriculum on Learner's Choice to Pursue Surgery: Positive Impact of Extracurricular Opportunities. JOURNAL OF SURGICAL EDUCATION 2023; 80:1221-1230. [PMID: 37442696 PMCID: PMC10806402 DOI: 10.1016/j.jsurg.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Prior studies have focused on the role of the learning environment on students' decisions to pursue surgery, but few have analyzed the impact of the clerkship curriculum. This study assessed surgical clerkship curricula across United States (US) medical schools and their impact on students' likelihood of pursuing a surgical residency. DESIGN A cross-sectional survey was developed to assess surgery clerkship characteristics. Questions included clerkship duration, number of offered and required surgical services, method of service assignment, and number of advanced clinical electives (e.g., fourth-year sub-internships) and additional surgical clinical opportunities (e.g., surgical elective rotations). Survey results were merged by the Association of American Medical Colleges with the percentages of students who matched into a surgical specialty. Linear regression models estimated the association of covariates with the percentage of students who (1) matched in surgical specialties, (2) were interested in surgery at medical school matriculation and ultimately matched into surgical residency (retention rate), and (3) were not interested in surgery at medical school matriculation but ultimately matched into surgical residency (recruitment rate). SETTING The survey was distributed to clerkship directors and coordinators at 66 medical schools through the Association for Surgical Education (ASE) from 5/1/2021 to 8/1/2021. PARTICIPANTS All US medical schools in the ASE. RESULTS A total of 21 medical schools responded (34.8% response rate). The overall retention rate was 36.4%, and the overall recruitment rate was 25.0%. Clerkships were 4 to 12 weeks. In 81% of programs, students submitted preferences and were assigned services. The percentage of students applying to surgical specialties was not associated with clerkship duration (p=0.79) or the number of required services (p=0.15), subspecialty services offered (p=0.33), or advanced clinical electives (p=0.24) but was associated with a program's having additional surgical clinical opportunities (p=0.02). Most of these factors were not associated with retention or recruitment rates. CONCLUSIONS Offering more extracurricular surgical clinical opportunities was associated with having more students pursue surgical careers. Though limited by a relatively small sample size, our findings suggest that having shorter clerkships or limited subspecialty offerings may not have a significant influence on students' career choices.
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Affiliation(s)
- Yoshiko Iwai
- Department of Surgery, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
| | - Alice Yunzi L Yu
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois.
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Carolyn S Quinsey
- Department of Neurosurgery, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Georgia M Beasley
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina; Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Ranjan Sudan
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Oluwadamilola M Fayanju
- Division of Breast Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania; Rena Rowan Breast Center, Abramson Cancer Center, Philadelphia, Pennsylvania; Penn Center for Cancer Care Innovation (PC3I), The University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, Pennsylvania.
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Rasic G, Morris-Wiseman LF, Ortega G, Dent D, Nfonsam V, Arora TK. Effective Mentoring Across Differences-Best Practices and Effective Models to Address the Needs of Underrepresented Trainees in Surgical Residency Programs. JOURNAL OF SURGICAL EDUCATION 2023; 80:1242-1252. [PMID: 37460368 DOI: 10.1016/j.jsurg.2023.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/01/2023] [Accepted: 06/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Mentorship plays a critical role in the career development of surgical trainees and faculty. As the surgical workforce continues to diversify, mentoring trainees who differ) race, ethnicity, country of origin, socioeconomic status, educational background, religion, gender, sexual orientation or ability) can pose challenges to the experience for both mentor and mentee. OBJECTIVE The aim of this manuscript is to introduce surgical educators to the systemic barriers faced by trainees and to models of effective mentorship. METHODS At the 2022 APDS Meeting, a panel convened to highlight the current challenges of mentoring across differences and effective models for surgical educators. This paper highlights and expands the summary of this panel. RESULTS Examples of novel mentoring models are described. CONCLUSIONS Acknowledgment of barriers, Implementation of deliberate mentoring strategies, and collaboration with national surgical organizations and surgery departments and faculty may help to reduce physician attrition.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Lilah F Morris-Wiseman
- Division of Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gezzer Ortega
- Department of Surgery, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel Dent
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, Georgia.
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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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