Practical Strategies for Identifying and Managing Burnout in Plastic Surgeons

Strategies to Improve Resident Wellness in Plastic Surgery Training

Residency is known to be a challenging time in a surgeon's career. Surgical residents must learn the breadth of their field and develop technical skills while maintaining relationships and well-being outside their training. High burnout rates are well documented among all medical specialties, particularly during residency. Proven strategies in medical education that help decrease burnout and improve resident well-being, while maintaining quality patient care, have been reported in the medical education literature. However, little has been published specific to plastic surgery training programs. We discuss strategies that can be implemented into the curricula and workflow at plastic surgery residency programs to maximize resident well-being. We advocate for a multifaceted approach that includes a night float system, day call, integrating advanced practice providers to offload noneducational resident tasks, and establishing a wellness program. It is our hope that these strategies may serve as a guide for plastic surgery residency programs to promote general wellness and prevent burnout among trainees.

Defining the Incidence of the Impostor Phenomenon in Academic Plastic Surgery: A Multi-Institutional Survey Study

BACKGROUND

Impostor phenomenon occurs when high-achieving individuals have persistent self-doubt despite objective measures of competence and success, and has been associated with professional burnout and attenuated career advancement in medical specialties. This study aimed to define the incidence and severity of the impostor phenomenon in academic plastic surgery.

METHODS

A cross-sectional survey containing the Clance Impostor Phenomenon Scale (range, 0 to 100; higher scores indicate greater severity of impostor phenomenon) was distributed to residents and faculty from 12 academic plastic surgery institutions across the United States. Generalized linear regression was used to assess demographic and academic predictors of impostor scores.

RESULTS

From a total of 136 resident and faculty respondents (response rate, 37.5%), the mean impostor score was 64 (SD 14), indicating frequent impostor phenomenon characteristics. On univariate analysis, mean impostor scores varied by gender (67.3 for women versus 62.0 for men; P = 0.03) and academic position (66.5 for residents versus 61.6 for attendings; P = 0.03), but did not vary by race or ethnicity; postgraduate year of training among residents; or academic rank, years in practice, or fellowship training among faculty (all P > 0.05). After multivariable adjustment, female gender was the only factor associated with higher impostor scores among plastic surgery residents and faculty (estimate 2.3; 95% CI, 0.03 to 4.6; P = 0.049).

CONCLUSIONS

The prevalence of the impostor phenomenon may be high among residents and faculty in academic plastic surgery. Impostor characteristics appear to be tied more to intrinsic characteristics, including gender, rather than years in residency or practice. Further research is needed to understand the influence of impostor characteristics on career advancement in plastic surgery.

The Current State of Plastic Surgery Residency Wellness Programs: Benefits and Barriers

Background

Wellness programs are especially important in residency. However, the resources available to plastic surgery residents through residency wellness programs have not been described. This study reports current plastic surgery residency wellness programs' organization, leadership, and resources.

Methods

An anonymous and voluntary e-mail survey was sent to 106 plastic surgery residency program directors through May and June 2022. Features of residency wellness programs were detailed, and program directors' sentiments towards residency wellness programs were evaluated.

Results

A 30.2% (32 of 106) complete response rate was achieved. Nearly 90% (87.5%, 28 of 32) of program directors indicated the presence of a wellness program. More than 75% (21 of 28) of programs are supported by the Office of Graduate Medical Education. Wellness events were offered by 92.9% (26 of 28) of programs. More than half of programs offered resources for mental health, physical health, mentorship, and protected time. Several resources were associated with the presence of wellness leadership roles, suggesting residents can positively shape wellness program offerings. Program directors strongly indicated that wellness programs are important, relevant, and effective. Additionally, 75% (24 of 32) report a desire to learn about wellness programs at other plastic surgery residency programs.

Conclusions

Resources offered through plastic surgery residency wellness programs are comparable to those in other specialties. However, plastic surgery programs vary in the resources offered to residents and barriers to access exist. Greater involvement of residents in plastic surgery wellness programs may better support physician wellness.

Burnout and Intention to Change Profession among Romanian Dentists during COVID-19: A Cross Sectional Study Using the Maslach Burnout Inventory

This study aims to examine the relationship between burnout and dentists' intentions to change careers during the COVID-19 pandemic. The MBI-Human Services Survey for Medical Personnel-MBI-HSS (MP) was used to measure burnout levels and investigate how they relate to dentists' intentions to change their profession. The sample included 69 Romanian dentists, 56 of whom were women and 13 of whom were men. Self-reported questionnaires provided to the participants were used to collect the data. Female participants reported higher levels of emotional Exhaustion and Depersonalisation than males. However, there were no substantial differences in Personal Accomplishment levels between genders. As for the intentions to change careers, 41 expressed a clear intention to change their profession, 15 were still determining if they would choose the same speciality, and 28 indicated they would not choose the medical field. The study's findings provide insight into how dentists' thoughts about perceived burnout during the COVID-19 pandemic significantly influenced their attitudes regarding their career paths. The results suggest concerns regarding burnout in the dental field and emphasise the necessity for burnout interventions and support services, particularly during healthcare crises. Further research and interventions to mitigate burnout and promote well-being among dentists are needed to ensure the sustainability and quality of dental healthcare services in Romania.

Creating and Implementing a Novel Wellness-Inspired Resident Educational RG (WIRE) Curriculum

The Wellness-Inspired Resident Education (WIRE) curriculum is a resident-driven educational program consisting of six formal panels or lectures that are fully incorporated into the yearly resident didactic schedule, in addition to informal events and a resident wellness retreat. The curriculum promotes personal and professional wellness, enhances resident and department camaraderie, and provides opportunities to network with leaders in the field of plastic surgery. This paper provides the context which inspired the development of this curriculum, as well as key steps for successful implementation of wellness educational programming at any institution.

Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates

Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees.

Methods

A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire.

Results

One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout.

Conclusions

Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were "protective." Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.

Indian Perspective of Burnout Among Plastic Surgeons

Introduction Over the last decade, the term “Burnout” has become familiar term in all walks of life, particularly medicine. Emotional exhaustion, depersonalization, and a low sense of personal accomplishment make up the triad. At least a third of plastic surgeons are having burnout according to the western literature. Data on burnout in Indian plastic surgeons is lacking. We have made an attempt to analyze the incidence and factors responsible for burnout among plastic surgeons in India.

Materials and Methods An online survey was conducted in India to assess burnout among plastic surgeons from June to November 2019. Consent, demographic information, stress-related factors, the abbreviated Maslach Burnout Inventory (aMBI), and Satisfaction with Medicine were all included section wise in the survey. Both used scales were validated. Data were gathered using Google forms, then uploaded to an Excel file and analyzed. A multivariable and univariable analysis of factors associated with burnout was carried out.

Results Twenty-two percent of 330 plastic surgeons who responded were assessed to have moderate to high emotional exhaustion, 5% had moderate to high depersonalization, and 3% had low personal accomplishment. The overall burnout rate was 8.2%. Seventy-three percent of plastic surgeons enjoyed a good to very good quality of life. Great over-volume of work, mid-career practicing plastic surgeons and professional satisfaction with work were found to have a significant association with burnout on multivariate analysis.

Conclusions Plastic surgeons in India suffer an overall burnout rate of 8.2% with a multifactorial etiology. This occupational hazard is preventable and reversible. Plastic surgeons need to be vigilant about this and seek help whenever required.

Workplace violence against nursing interns and patient safety: The multiple mediation effect of professional identity and professional burnout

BACKGROUND

Most nursing interns have suffered some form of workplace violence in clinical settings, which has been linked to the jeopardizing of patient safety. Although previous research studies have examined the effect of workplace violence on patient safety, few studies have examined whether workplace violence is associated with patient safety through professional identity and professional burnout among nursing interns.

AIMS

To test whether professional identity and professional burnout play mediating roles in the relationship of workplace violence and patient safety among nursing interns.

DESIGN

Cross-sectional study.

METHODS

The study included 466 nursing interns from three tertiary grade A hospitals. The Workplace Violence Scale, the Professional Identity Scale, the Maslach Burnout Inventory-General Survey, and the Patient Safety Behaviour Scale were used to gather data. Associations among workplace violence, professional identity, professional burnout, and patient safety were assessed by correlation and the serial-multiple mediation analysis.

RESULTS

Workplace violence, professional identity, professional burnout and patient safety were significantly correlated. Workplace violence can have a direct positive impact on patient safety of nursing interns, but also an indirect impact on patient safety through three paths: the independent mediating role of professional identity, the independent mediating role of professional burnout, and the chain mediating role of professional identity and professional burnout.

CONCLUSIONS

Our findings suggest that workplace violence can affect patient safety through decreasing professional identity and increasing professional burnout among nursing interns. Interventions aimed at decreasing workplace violence among nursing interns would be beneficial for professional attitude and patient safety.

The Accreditation Council for Graduate Medical Education Milestones in Integrated Plastic Surgery Programs: How Competency-Based Assessment Has Been Implemented

BACKGROUND

The plastic surgery milestones are a central component of resident assessment. The authors performed a survey to evaluate how milestones have been implemented across integrated plastic surgery programs and how faculty perceive the Milestones Project has impacted their program.

METHODS

A 25-question survey was directed to the head of the clinical competency committee of all 82 integrated plastic surgery programs through the American Council of Academic Plastic Surgeons. The survey queried the composition of the committee, how ratings are generated, and the data used in generating these ratings.

RESULTS

Committee leaders from 57 programs (69.5 percent) responded to the survey. For most programs (73 percent), one faculty member completed milestone ratings for each resident and reviewed them with the residents. To determine milestone ratings, 92 percent utilized resident assessment after every rotation, and 63 percent utilized in-service examination scores. For documented resident assessment overall, 96 percent of programs assess residents after every rotation; 37 percent asses after every procedure. Feedback is most frequently provided to residents after every rotation (52 percent), rather than only during committee reviews (32 percent) or after every documented assessment (16 percent). Sixty-four percent of respondents did not believe that milestones have helped in the mentorship role.

CONCLUSIONS

Implementation of the milestones has varied among integrated plastic surgery programs. Structured training for core faculty directed to methods of assessment will make milestones a more effective a tool by which to improve resident evaluation and education. These findings provide a key data set by which to revise the milestones for their second iteration.

Coping and Recovery in Surgical Residents after Adverse Events: The Second Victim Phenomenon

The second victim phenomenon is the distress felt by healthcare providers after a medical error. Although the phenomenon is a significant risk factor for burnout, little has been written about it in surgery, especially among residents.

Surgical education in the COVID-19 era: What did the General Surgery Residents' report in Argentina leave us? Part 1

Social distancing to curb the COVID-19 pandemic has impacted medical and surgical education. This health crisis led us to raise doubts, controversies, and dilemmas in health care in general, and in surgery in particular, understanding that residents are possibly as or more vulnerable than all health professionals. During the 32nd International Congress of General Surgery in Cordoba, which was the first general surgery congress held in Argentina during 2021; The Association of Residents and Concurrent Surgery of Córdoba presented its official report about the current challenges faced by residents during their surgical training.

Mistreatment, discrimination and burn-out in Neurosurgery

OBJECTIVE

Issues concerning harassment, bullying and discrimination are not unknown to medical specialties and are likely to be present in neurosurgery as well. The aim of this study was to estimate the extent to which neurosurgeons are faced with issues pertaining to this mistreatment.

METHODS

A survey consisting of fourteen questions was distributed among members of the Congress of Neurological Surgeons (CNS). The survey consisted of three parts: 1) demographics; 2) exposure to mistreatment; 3) experienced burnout symptoms.

RESULTS

In total 503 out of the 5665 approached CNS members filled in a survey (response rate 8.9 %). Respondents consisted for 85.9 % out of neurosurgeons and for 13.9 % out of residents. Overall, 61.4 % of the respondents was a victim of form of abusive behavior, while 47.9 % was a victim of at least one form of discrimination. Most reported sources of these mistreatments were other neurosurgeons or (family of) patients. Overall, 49.9 % of the respondents experienced burnout symptoms. Multivariable logistic regression analysis showed that female respondents had higher odds of being a victim of abuse (OR 2.5, 95 % CI 1.4-4.6). Female respondents (OR 19.8, 95 % CI 8.9-43.9) and ethnic minorities (OR 3.8, 95 % CI 2.3-6.2) had higher odds of being a victim of discrimination. Furthermore, victims of abuse were at higher odds (OR 1.7, 95 % CI 1.1-2.6) of having burnout symptoms.

CONCLUSIONS

Mistreatment and experiencing burnout symptoms frequently occurs among neurosurgeons and residents.