Houwert, R Marijn

Vriens, Menno R

PubMed

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INVITED COMMENTARYInvited Commentary: Nationwide Study on Stress PerceptionAmong Surgical ResidentsR. Marijn Houwert1 • Menno R. Vriens1Accepted: 28 March 2022 / Published online: 16 April 2022 The Author(s) 2022We congratulate colleagues Guglielmetti et all foraddressing the important theme of stress during surgicalresidency [1]. For a long time surgeons have been knownfor their indefatigable ‘can-do’ mentality. Demonstratingvulnerability to people outside the surgical community wasnot something surgeons did. Luckily, more and moreattention has been given to stress and burnout, not onlyamong surgical residents but also among surgical attend-ings. An actual PubMed search with terms [surgeon] AND[burnout] reveals 635 matches. Guglielmetti et all did anationwide survey among all surgical residents inSwitzerland at the time of their yearly examination. Theaim of the study was to measure the perceived stress levelsof surgical residents, considering sex, age, nationality, andcountry of graduation. Stress was described as the mental,emotional, or physical reaction caused by internal andexternal stimuli. Depending on the individual reaction,stress factors may cause positive (eustress) or negative(distress) stress. If a situation is evaluated as overwhelm-ing, uncontrollable, and impossible to cope with, distressinevitably occurs. Chronic stress can lead to burnout: anemotional exhaustion and depersonalization that reducesefficiency at work. Levels of burnout were not consideredin the current study.Over a study period of 5 years, Guglielmetti et al. askedall surgical residents in Switzerland (general, thoracic,cardiac, orthopedics, hand & plastic, pediatric, maxillofa-cial surgery, and urology) to fill out a questionnaire duringtheir yearly board exam; 1694 (95.7%!!) returned theirforms and were included in the current analysis. They useda 10-item questionnaire (PSS-10), which is designed toassess how unpredictable, uncontrollable, and overloadedthe respondents value their work lives over the past month.Two subscores are included in the PSS: perceived help-lessness and perceived self-efficacy (which has a reversescale: high value indicates low level of perceived self-ef-ficacy). Perceived helplessness emphasizes the individual’sreaction to stress, while perceived self-efficacy denotes theself-assessed ability to cope with these stressors. 43.5% ofthe Swiss surgical residents in the present study werewomen. In their multivariable regression analysis, male sexindependently predicted better PSS-10 and PH score.Longer duration of training was an independent predictorfor decreasing levels of PSS and PH. Since Switzerland isan immigration country, 37.4% of the Swiss medicalworkforce did not graduate in Switzerland; those of Italiancitizenship and native language or graduating from acountry not adjacent to Switzerland reported higher stressand lower self-efficacy. They conclude that perceivedstress levels are high in this prospective and representativecohort study of Swiss surgical residents. Females enduredsignificantly worse stress and helplessness levels thanmales. These figures are worrisome as they may directlycontribute to the declining attractivity of surgical residen-cies. Detailed sex specific analysis and correction ofstressors are urgently needed to improve residencyprograms.Although Guglielmetti et all don’t go into detail when itcomes to the potential causes, they have several sugges-tions to avoid the perceived stress levels: proper informa-tion and transparent expectations for incoming residents onthe structure, requirements, and overall organization of theresidency programs is one of the easier actions to under-take. Mentorship and physician assistance programs are afurther way to improve residency: they can be used to& Menno R. Vriensmvriens@umcutrecht.nl1 Department of Surgery, University Medical Center Utrecht,Utrecht, The Netherlands123World J Surg (2022) 46:1623–1624https://doi.org/10.1007/s00268-022-06560-7attract medical student towards surgical specialties and,most importantly, to retain residents in training. Structuredassistance and counseling aimed at improving work-lifeintegration, supporting family life, increasing access tomental health support, and supporting career transitionshave been shows to improve residents’ attrition rate andoverall well-being.Causes for high stress and low self-efficacy are notalways clear and often multifactorial; for example, theCOVID-19 pandemic has had an enormous negative impacton healthcare workers. In a recent paper in this journal,bullying, discrimination, harassment, and sexual harass-ment (BDHS) were demonstrated to be often experiencedby residents during surgical training, which have beenassociated with burnout, anxiety, and depression. Themajority of residents who experienced BDHS did not reportit due to fear of retaliation. Residency programs need todevise methods to have a platform for residents to safelyvoice complaints and issues [2].In a cross-sectional national survey of general surgeryresidents administered with the 2018 American Board ofSurgery In-Training Examination, Hu et all assessedmistreatment, burnout and suicidal thoughts during the pastyear. Weekly burnout symptoms were reported by 38.5%of residents, and 4.5% reported having had suicidalthoughts during the past year. They concluded thatmistreatment occurs frequently among general surgeryresidents, especially for women, and is associated withburnout and suicidal thoughts [3].So again, we like to congratulate Guglielmetti et all fortheir timely study of this important topic. We would like toemphasize the great importance of having open discussionswith the next generation of surgeons: what are theirexpectations? How do they want to build their careers?What is their preferred work-life integration? Workingacross generations of surgeons to assure any BDHS is nolonger occurring in surgery, and focusing on ‘energygivers’ instead of ‘energy takers’ will likely reduce stressand burnout among our trainees.Open Access This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.References1. Guglielmetti LC, Gingert C, Holtz A et al (2022) Nationwide studyon stress perception among surgical residents. World J Surg.https://doi.org/10.1007/s00268-022-06521-02. Gianakos AL, Freischlag JA, Mercurio AM et al (2022) Bullying,discrimination, harassment, sexual harassment, and the fear ofretaliation during surgical residency training: a systematic review.World J Surg. https://doi.org/10.1007/s00268-021-06432-63. Hu YY, Ellis RJ, Hewitt DB et al (2019) Discrimination, abuse,harassment, and burnout in surgical residency training. N Engl JMed 381(18):1741–1752Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.1231624 World J Surg (2022) 46:1623–1624

Invited Commentary: Nationwide Study on Stress Perception Among Surgical Residents

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Invited Commentary: Nationwide Study on Stress Perception Among Surgical Residents

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