Podium IIA Wellness/Other
(S030) COPING WITH WORK-RELATED TRAUMA: AN ASSESSMENT OF RESOURCES AT SURGICAL RESIDENCIES IN THE UNITED STATES
Kimberly B Golisch, MD, MS1, Whitney Jones, MD, MBA1, Leah Tatebe, MD1, Paul J Schenarts, MD2; 1Northwestern University, 2Western Michigan University
Objectives:
The cumulative impact of managing patient suffering and death contributes to psychologic stress and emotional exhaustion for physicians. Other specialties have emphasized the importance of proactively addressing these issues. Yet, there is a paucity of information on surgical training program experience with traumatic work incidents and resources available for grief and coping.
Methods:
A comprehensive list of grief, support, and crisis resources was generated through a focus group of stakeholders. A 16-question mixed-methods survey directed at obtaining data on the frequency of traumatic events at an institution, the effects on residents in the training program, and the presence and importance of specific resources was piloted and revised. After APDS approval, the survey was disseminated to program directors with public email addresses and at a Surgeons as Educators course.
Results:
Response rate was 43% (82/191); 58 programs (71%) were university-affiliated and 34 states were represented. Over half of programs (55%) estimate residents being involved in the care of a patient who dies on a weekly basis and at least one resident sought treatment for ASD/PTSD after experiencing work-related trauma at 22 programs (27%). Twenty programs (24%) do not report any formalized sessions on coping with trauma. The most frequent resources offered were a psychologist/psychiatrist through GME (80%), peer facilitator program (74%), and resources for residents to seek their own mental health services (73%). The perceived helpfulness of each resource is demonstrated in Figure 1. Open ended questions on barriers to providing resources yielded 3 qualitative themes: lack of support, low priority, and unorganized approach.
Conclusions:
There is a wide range of frequency and type of resources available to cope with work-related trauma across general surgery residencies in the US. Future work may focus on resident experience with utilizing these resources to evaluate if more standardized curricula, recommendations, and support at a national level are warranted.
(S031) AN INVESTIGATION OF THE RELATIONSHIP BETWEEN MULTITASKING ACTIVITIES, STRESS LEVELS, AND SURGICAL PERFORMANCE AMONG SURGICAL TRAINEES
Perry J Diaz1, Daniel Kong, MD2, Margaret Walkup Arnold, MD2, Jason Crowner, MD2; 1Georgetown University School of Medicine, 2MedStar Heart and Vascular Institute
Background:
Multitasking in the operating room requires the management of complex procedures, communication, and decision-making, which can elevate stress levels, impair cognitive function, and potentially compromise patient safety. We hypothesize that the traditional method of serial questioning, in which surgical trainees are questioned while performing tasks may exacerbate stress, affecting task performance and learning outcomes. This study aims to demonstrate that serial questioning compromises and prolongs tasks along with causing increased stress.
Methods:
The study included 22 general and vascular surgery residents (PGY 2-5) and fellows across 3 institutions. Participants completed standardized simulation tasks using either the fundamentals of laparoscopic surgery trainer or simulated vessel anastomosis trainers. The simulation tasks were performed in both a control room with uninterrupted completion, and a room with cognitive stress introduced through classical serial questioning involving common knowledge questions. Heart rate variability (HRV) was continuously monitored with wearable 4-lead ECG sensors and the validated State-Trait Anxiety Inventory (STAI) was administered pre- and post-task to assess subjective anxiety.
Results:
The analysis showed completion of the task in the presence of cognitive stressors led to significantly higher STAI scores (p<0.031) and poorer task performance times. HRV data further indicated greater physiological stress responses during serial questioning. Conversely, the control room allowing uninterrupted completion led to improved task accuracy and completion times. Additionally, there was less performance variation observed among fellows and senior residents.
Conclusion:
Both increased stress levels and performance times were present in the setting of serial questioning. This demonstrates that a reduction in stress in the learning environment may lead to improved task completion and thus be a better environment for intra-procedural training. These findings support our hypothesis that serial questioning can compromise and prolong tasks while increasing stress levels of the trainee, which could lead to poor knowledge acquisition. This study also underscores the importance of adaptable training methods that support diverse learning needs, promoting an inclusive educational framework that acknowledges and addresses individual stress responses and learning styles. We feel that further evaluation of integrating supportive coaching methods in surgical training could improve procedural efficiency, bolster resilience, and may improve patient outcomes.
(S032) EFFECT OF CORE STRENGTHENING ON MUSCULOSKELETAL PAIN IN GENERAL SURGERY RESIDENTS: IS ERGONOMICS AWARENESS ENOUGH?
Annmarie Butare, DO, DPT, Emma Blount, Alexa Burnett, Sarah Johnson, DPT, Shelly Zsoldos, DPT, Chia-Cheng Lin, PhD, PT, Nicole Garcia, MD; East Carolina University
Introduction
The rate of musculoskeletal injury among surgeons is nearly 90%. Innate features of General Surgery Residency, such as hierarchical culture and work hours, introduce an increased risk of musculoskeletal injury for trainees. Despite a recent upsurge of interest in surgical ergonomics education, the physical demands of surgery are often unavoidable. We sought to determine the feasibility of completing a core strengthening exercise program (CSEP) amongst busy General Surgery Residents (GSR) and to assess for changes in core strength and work-related musculoskeletal pain.
Methods
All GSR at one program were invited to participate. Pre-intervention surveys and validated core strength assessments were completed prior to a 6-week program consisting of a 5-minute home exercise program 4 times a week and a 10-minute group exercise session once weekly. Surveys related to demographic information and pain occurrence, as well as strength assessments including Biering-Sorenson test (BST), Front Plank Hold (FPH), Side Plank (SP), and Single Leg Stance (SLS) were measured. Individual pre- and post- intervention scores were compared using paired T-tests.
Results
23 residents were enrolled and 17 (11 male, 6 female) completed all Pre/Post assessments. Post-graduate year was distributed as follows: 7 PGY-1, 5 PGY-2, 3 PGY-3, 3 PGY-5. Pre-intervention, 71% (n=12) reported pain after work “occasionally”; 29% (n=5) reported pain after work “most days”; zero residents responded “never” to having pain after working. All but 3 residents reported worry of career longevity. Significant differences between pre- and post- scores were seen in BST (pre: 39.37sec, post: 55.28sec, p<0.001), FPH (pre: 38.61sec, post 50.21sec, p<0.001), SP (pre: 45.96sec, post: 53.63 sec, p=0.003), and SLS (pre: 38.51sec, post: 45.00sec, p=0.045). Frequency of back pain following intervention decreased (2.52 to 1.94 times a week, p=0.013) and there was a trend toward reduced back pain severity (1.38/4 to 0.88/4, p=0.052).
Conclusion
Implementation of CSEP for surgical residents is feasible and shows improved strength and reduced frequency and severity of back pain. Core strength equips the surgeon with the foundation necessary to prevent pain and injury in the setting of fatigue or unfavorable ergonomic circumstances. Further research is needed to correlate these findings with surgeon burnout.
(S033) “I DON’T WANT TO BE SEEN AS A COMPLAINER”: FEAR OF RETALIATION AND DISRESPECT IN SURGICAL RESIDENCY
Jennifer H Chen1, Alyssa Pradarelli2, Julie Evans2, Niki Matusko2, Norah Naughton2, Roy Phitayakorn3, John T Mullen3, Lily Chang4, Melissa Johnson5, Thavam Thambi-Pillai6, Jon Ryckman6, Melissa Alvarez-Downing7, Nell Maloney Patel8, Sebastiano Cassaro9, Felicia Ivascu10, David T Hughes2, Gurjit Sandhu2; 1Baylor College of Medicine, 2University of Michigan, 3Massachusetts General Hospital, 4Virginia Mason Medical Center, 5Gundersen Health System, 6University of South Dakota Sanford School of Medicine, 7Rutgers New Jersey Medical School, 8Rutgers Robert Wood Johnson Medical School, 9Kaweah Health, 10Oakland University William Beaumont School of Medicine
Background: The stressful nature of surgical training can trigger mistreatment and incivility towards learners. Retaliation, the act of punishing others for speaking up, and fear of retaliation itself have not been well characterized in surgery. We aimed to examine trainee experiences with fear of retaliation and disrespect in surgical residency.
Methods: This was a qualitative study of surgical trainees from nine institutions (4 University-based, 3 Community-based, and 2 Community-based/University-affiliated) from Oct 2023-May 2024. Participants were recruited for semi-structured interviews via purposive sampling. Transcripts were coded inductively and thematic analysis was performed using interpretive description.
Results: A total of 25 surgery trainees were included. Trainees consisted of 52% (13) female, 52% (13) junior residents (PGY1-3), 48% (12) from non-academic institutions, and 28% (7) racial/ethnic minorities. Four themes were identified – 1) retaliation is real, 2) root causes of fear, 3) perceived negative consequences of reporting, and 4) disrespect in the workplace. Trainees described experiencing retaliation from medical students and faculty as well as witnessing retaliation against peers and faculty. Fear of retaliation was often rooted in hearsay and flipped power dynamics where learners were perceived to hold more power over educators. When trainee mistreatment and acts of disrespect did occur, potential negative consequences of reporting served as a major barrier. Trainees expressed concerns over potential loss of future learning opportunities, damaging career advancement, and establishing a reputation of complaining and causing problems at their program. These sentiments combined with the burden of reporting and the desire to ‘forget’ traumatic events contributed to an overall low intention to report mistreatment amongst trainees. Lastly, trainees recounted acts of disrespect and incivility, such as being ignored by co-residents and faculty or use of joking as an excuse to indirectly insult or bully learners.
Conclusion: Fear of retaliation and disrespect have pervasive negative impacts on surgical trainees that are ultimately detrimental to learning. Recognition of both in the workplace and identification of barriers to reporting serve as first steps in promoting a psychologically safe environment for trainees.
(S034) COMPARATIVE ANALYSIS OF CONTINUOUS VS. INTENSIVE TRAINING APPROACHES IN BASIC LAPAROSCOPIC SKILLS AMONG SURGICAL RESIDENTS AND MEDICAL INTERNS
Catalina Ortiz-monasterio, Er Jean-Silver, MD, Ac Perez-Ortiz, MPH, MD; ABC Medical Center
Background: Simulation techniques reduce patient risk by providing training, practice, and assessment opportunities in a controlled environment. While simulation-based training is known to improve in vivo laparoscopic skills, the ideal duration and intensity for optimal skill acquisition remain unclear. This study evaluated the difference between continuous and intensive training regimes in laparoscopic simulation.
Methods: This study was a randomized, non-blinded, parallel controlled trial featuring sixty-three participants, including general surgery and gynecology residents at various training levels (first through fifth-year) and undergraduate medical interns. Participants were randomized into two groups based on academic level. The intervention group received continuous training (10 minutes per day, 5 days a week, for one month; n=31), while the control group received intensive training (50 minutes once a week for one month; n=32). Baseline and post-intervention performance were evaluated using Fundamentals of Laparoscopic Surgery (FLS) exercises.
Results: Group comparison was done with a stratified mixed-effects linear regression, and chi-square and student t-tests were measured. We found that both training regimens led to overall improvements in FLS performance. However, the intensive training group demonstrated statistically significant enhancements in performance times and error reduction compared to the continuous training group, particularly in the extracorporeal knot-tying task. These improvements were especially evident among first- and second-year residents, indicating that intensive training sessions may better support skill acquisition and retention for less experienced residents.
Conclusion: Intensive training provides distinct advantages in laparoscopic skill acquisition, with statistically significant improvement in efficiency and error reduction. Integrating intensive sessions into laparoscopic curricula could optimize skill proficiency, yielding valuable benefits for early-stage residents and enhancing surgical education outcomes.
Keywords: Surgical education, laparoscopic skills, simulation training, skill acquisition, intensive training, residency.
(S035) IMPLEMENTING A COMPREHENSIVE FAMILY LEAVE AND PREGNANCY POLICY IN GENERAL SURGERY RESIDENCY
Melissa M Rangel, MD, Jamie Chang, MD, Sarah Beckwith, Lily Lunt, Andrea Madrigrano; Rush University Medical Center
Background: An increasing number of surgical residents are starting families during training. Despite this, there is still significant stigma for both birthing and non-birthing parents around taking parental leave. Most surgery residents report having no family leave policy or only vague guidelines, despite 50% of general surgery program directors reporting a formal family leave policy. Additionally, many residents are unfamiliar with the American Board of Surgery (ABS) leave policy. There is a need for greater transparency and support regarding family leave in surgical residency. Creating such culture shifts may help to reduce stigma around family planning as a surgical resident.
Methods: We drew on best practices from peer institutions and reviewed literature on pregnancy outcomes and trends during surgical residency. Our institution’s policy development was a resident-driven process that involved multiple meetings including residents and faculty, with targeted invitations to ensure balanced representation across genders and family planning goals. These meetings were also open to any interested individuals and were widely advertised within the residency program. Policy drafts were reviewed with program leadership and distributed throughout the residency for feedback.
Results: Key aspects of the policy included clearly outlining time allowed for parental leave that was in line with ABS policy, explanation of when training would need to be extended, equal leave for both birthing and non-birthing parents, flexible scheduling for prenatal and postnatal medical appointments and restrictions on in house call for pregnant residents (12-hour call beyond week 36, no call beyond week 38 and an emergency back up call coverage system). Additionally, a support system featuring designated faculty was established to assist residents during their leave and facilitate a smooth transition back to work.
Conclusions: The new family leave and pregnancy policy has allowed for improved planning for resident parental leave and support for both birthing and non-birthing parents. This policy underscores the importance of institutional support in fostering a more inclusive and supportive training environment, enhancing residents' professional development and overall satisfaction. Our initiative highlights the commitment to promoting a culture of inclusivity and work-life balance essential for the long-term success and well-being of our residents.