Resilience, hope and flourishing are inversely associated with burnout among members of the Society for Gynecologic Oncology

Purpose: In this study we sought to: 1) determine rates of burnout and other associated indices of psychosocial distress such as alcohol and substance abuse, 2) establish the baseline performance of gynecologic oncologists on several positive psychology metrics, 3) determine if increased hope, resilience, and flourishing are associated with decreased burnout. Methods: A survey of members of the Society of Gynecologic Oncology (SGO) was conducted in spring of 2017. Participants were sent an electronic questionnaire consisting of 82 items measuring burnout, depression, substance abuse, flourishing, resilience, hope, and psychological wellbeing. Results: A total of 1745 members were invited and 374 (21.4%) responded. Overall, 23.0% of respondents scores above clinical cutoffs indicating burnout. Almost 50.0% of participants screened positive for depression, 17.0% screened positive for alcohol abuse and 12.0% screened positive for substance abuse. Respondents meeting criteria for burnout were more likely to screen positive for depression (p < .001) and substance abuse (p < .001). Participants not meeting criteria for burnout had higher resilience, flourishing, hope, and wellbeing scores (p < .001). Male respondents had higher levels of hope, resilience, and wellbeing while married participants had higher flourishing and wellbeing scores than their unmarried counterparts. Parents had higher levels of resilience and wellbeing compared to non-parents. Conclusion(s): Burnout and associated indices of physiological distress continue to affect a large segment of SGO membership. Participants not meeting the criteria for burnout had higher scores on resilience, flourishing, hope, and wellbeing metrics. This suggests new targets for evidence-based interventions to mitigate burnout among members of SGO. Keywords: Burnout, Resilience, Flourishing, Wellbein

Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered

Incorporating Resident/Fellow Training into a Robotic Surgery Program.

With the rapid uptake of the robotic approach in gynecologic surgery, a thorough understanding of the technology, including its uses and limitations, is critical to maximize patient outcomes and safety. This review discusses the role of training modalities and development of curricula for robotic surgery. Furthermore, methods for incorporating the entire surgical team and the process of credentialing/maintaining privileges are described. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc

Surgical Science-Simbionix Robotic Hysterectomy Simulator: Validating a New Tool.

STUDY OBJECTIVE: To gather validity evidence for and determine acceptability of Surgical Science-Simbionix Hysterectomy Modules for the DaVinci Xi console simulation system (software; 3D Systems by Simbionix [now Surgical Science-Simbionix], Littleton, CO, and hardware; Intuitive Surgical, Inc., Sunnyvale, CA) and evaluate performance benchmarks between novice and experienced or expert surgeons. DESIGN: Prospective education study (Messick validity framework). SETTING: Multicenter, academic medical institutions. PARTICIPANTS: Residents, fellows, and faculty in obstetrics and gynecology were invited to participate at 3 institutions. Participants were categorized by experience level: fewer than 10 hysterectomies (novice), 10 to 50 hysterectomies (experienced), and more than 50 hysterectomies (expert). A total of 10 novice, 10 experienced, and 14 expert surgeons were included. INTERVENTIONS: Participants completed 4 simulator modules (ureter identification, bladder flap development, colpotomy, complete hysterectomy) and a qualitative survey. Simulator recordings were reviewed in duplicate by educators in minimally invasive gynecologic surgery using the Modified Global Evaluative Assessment of Robotic Skills (GEARS) rating scale. MEASUREMENTS AND MAIN RESULTS: Most participants felt that the simulator realistically simulated robotic hysterectomy (64.7%) and that feedback provided by the simulator was as or more helpful than feedback from previous simulators (88.2%) but less helpful than feedback provided in the operating room (73.5%). Participants felt that this simulator would be helpful for teaching junior residents. Simulator-generated metrics correlated with GEARS performance for the bladder flap and ureter identification modules in multiple domains including total movements and total time for completion. GEARS performance for the bladder flap module correlated with experience level (novice vs experienced/expert) in the domains of interest and total score but did not consistently correlate for the other procedural modules. Performance benchmarks were evaluated for the bladder flap module for each GEARS domain and total score. CONCLUSION: The modules were well received by participants of all experience levels. Individual simulation modules appear to better discriminate between novice and experienced/expert users than overall simulator performance. Based on these data and participant feedback, the use of individual modules in early residency education may be helpful for providing feedback and may ultimately serve as 1 component of determining readiness to perform robotic hysterectomy