PS3 - 04: STRESS MANAGEMENT TRAINING FOR SURGICAL RESIDENTS IMPROVES TECHNICAL PERFORMANCE IN A HIGH-STRESS SIMULATION
Michael B Goldberg, MD1, Michael Mazzei, MD1, Zoë Maher, MD1, Joel H Fish, PhD2, Richard Milner, BSc3, Daohai Yu, PhD4, Amy J Goldberg, MD1; 1Temple University Hospital, Department of Surgery, Philadelphia, PA, 2Center for Sport Psychology, Philadelphia, PA, 3Temple University Hospital, Institute for Clinical Simulation and Patient Safety, Philadelphia, PA, 4Temple University, Lewis Katz School of Medicine, Philadelphia, PA
BACKGROUND: Stress management programs improve efficacy and safety in aviation, military, and professional sports; however, similar educational strategies have not been adopted in surgical training. In the current study, we have evaluated the effectiveness of a stress management program for surgical residents.
METHODS: From 2011-2016, 137 first- and third-year general surgical residents participated in a prospective, blinded study. The intervention group (n=65) underwent training in self-awareness, focus, relaxation, positive self-talk, visualization, and team building. The control group (n=72) did not. All participants subsequently completed a high-stress trauma simulation, requiring diagnosis of a life-threatening problem and performance of a surgical procedure (cricothyroidotomy or tube thoracostomy). The primary study endpoints included physiologic measurements of anxiety (heart rate and salivary cortisol), subjective measures (State Trait Anxiety Inventory [STAI] and stress surveys), and procedural efficiency (time to correct diagnosis and OSATS accuracy checklists).
RESULTS: Both cohorts exhibited similar measures of physiologic and subjective anxiety after completing a high-stress simulation. However, residents who completed stress management training came to an accurate diagnosis 21% faster than controls (mean time to diagnosis: 2.2 vs. 2.8 min; p=0.04), and performed with significantly greater technical accuracy (mean OSAT scores: 9.4 vs. 8.9; p=0.03) during simulation.
CONCLUSIONS: Stress management education improved speed of accurate diagnosis and enhanced technical performance in surgical trainees during simulation. This underscores the need for early and comprehensive stress training in surgical residency.