Mastering Stress: Mental Skills and Emotional Regulation for Surgical Performance and Life

Mental skills and emotional regulation training are gaining acceptance in surgical education as vital elements of surgeon development. These skills can effectively enhance technical skill development, improve well-being, and promote career longevity. There is evidence emerging in the surgical education literature to support the incorporation of mental skills and emotional regulation training curricula in residency training. In this study, we present the existing evidence supporting the use of this training with high performers to reduce stress and optimize well-being and performance. We also consider the recent research emerging in surgical education that offers validity evidence for use of mental skills training with surgeons. Finally, we provide a framework to guide the incorporation of these skills throughout the career of a surgeon and suggest methods to promote the development of mental skills training efforts nationally

Flourishing as a Measure of Global Well-being in First Year Residents: A Pilot Longitudinal Cohort Study

Background: Physician well-being is critical to optimal learning and performance, yet we remain without validated measures to gauge the efficacy of well-being curricula for trainees. This study evaluates initial evidence of flourishing as a valid measure of global well-being in postgraduate-year-1 residents (PGY-1s), providing a means of assessing well-being intervention efficacy. Study design: In this single-site study of PGY-1s participating in Enhanced Stress Resilience Training (ESRT), an online questionnaire of published measures was administered at baseline (T1, just before PGY-1), post-ESRT (T2, 7 weeks later), and at PGY-1 end (T3, 11 months later). The Mental Health Continuum (MHC) was used to assess our primary outcome variable, flourishing, a well-established metric of psychosocial thriving in non-physicians that can be treated continuously or categorically. Correlation between flourishing and both resilience (mindfulness and workplace support) and risk (emotional exhaustion, depersonalization, stress, depressive symptoms, anxiety, and workplace demand) factors was assessed at each time-point and longitudinally. Results: Forty-five interns completed the survey at T1, 37 at T2, and 21 at T3; 21 responded at all time points. MHC score was significantly positively correlated with mindfulness (β = 1.47, SE = 0.35, P < .001) and workplace support (β = 2.02, SE = 1.01, P = .05) longitudinally, and at all time points. Flourishing was significantly negatively correlated with depressive symptoms (β = -7.48, SE = 1.68, P < .001), stress (β = -1.28, SE = 0.29, P < .001), and anxiety (β = -1.74, SE = 0.38, P < .001) longitudinally and at all time points, and significantly negatively correlated with emotional exhaustion (β = -2.65, SE = 0.89, P = .003) longitudinally and at T1 (β = -3.36, SE = 1.06, P = .003). Conclusion: Flourishing showed appropriate correlation with established resilience and risk factors, thus supporting its concurrent validity as a measure of global well-being in this population. As such, the MHC may provide a simple, meaningful assay of well-being and an effective tool for evaluating the efficacy of well-being interventions. Further validation requires a larger, multi-center study

Enhanced stress-resilience training for surgical trainees

Introduction Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. Method All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. Results Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0–11) versus 5 (1–11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0–11) versus 4 (1–10)). Discussion Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy

Enhanced stress resilience training for UK surgical trainees; Effect and evolution evaluated

Introduction Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body. Method CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories. Results Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, η p 2 =0.167], less stress [PSS-10; 19.22 (±5.91) vs. 15.79 (±5.47), F 8.740, p < 0.001, η p 2 =0.200], but more mindfulness [CAMS-R; 19.22 (±5.91) vs. 20.57 (±2.93), F 3.201, p = 0.047, η p 2 =0.084]. On multivariable analysis, Improving Surgical Training (run-through CST) program (OR 5.2 (95% CI 1.42-28.41, p = 0.022), MRCS pass (OR 17.128 (95% CI 1.48-197.11, p = 0.023) and ESRT engagement (OR 13.249, 95% CI 2.08-84.58, p = 0.006) were independently associated with NTN success. Discussion ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression

Non-operative management of pneumoperitoneum following cardiopulmonary resuscitation

Spontaneous pneumoperitoneum in a patient with a tracheostomy tube following cardiopulmonary resuscitation is exceedingly rare, with little experimental nor observational data to guide evidence-based management. We present the case of a 75-year-old woman with a tracheostomy tube who developed pneumoperitoneum following CPR. The patient experienced pulseless electrical activity arrest requiring nine rounds of chest compressions to return to spontaneous circulation. Computerized tomography demonstrated pneumothoraces, subcutaneous emphysema and extensive intraperitoneal, extraperitoneal and retroperitoneal free air without evidence of visceral perforation. The patient's abdomen was distended without tenderness, guarding or rebound. She had a white blood cell count mildly elevated from her baseline levels. The management plan of serial abdominal exams without operative intervention was chosen given the absence of clinical and laboratory signs of peritonitis. This case highlights the importance of developing a standardized management algorithm for patients with pneumoperitoneum in the setting of tracheostomy tubes without evidence of perforation