Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review

Sauder, Matthew; Zagales, Israel; Zagales, Ruth; Das, Snigdha; Sen-Crowe, Brendon; Bilski, Tracy; Kornblith, Lucy Z.; Elkbuli, Adel

doi:10.1016/j.jsurg.2022.04.009

Cited by 10 publications

(4 citation statements)

References 140 publications

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“…The prevalence and awareness of burnout among trainees has increased over recent years. A meta-analysis of trainees showed that burnout rates are as high as 22%-52% among orthopedic surgeons and between 22%-51% [19] among OBGYN residents. Anki was reported to decrease testrelated anxiety and may help mitigate resident burnout.…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Algorithm “Anki” for Optimization of Medical Education: The Evolution of Knowledge Retention

Goldman¹,

Bryan²,

Lucke‐Wold³

2023

Preprint

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The aim of this review was to summarize the available literature regarding resident and medical student education utilizing the spaced repetition program Anki. This review enables current residents and medical students to recognize and utilize evidence-proven study techniques to increase learning efficacy. A systemic review of papers across all medical journals available on Pubmed was conducted to identify studies published without time constraints. The search was for (Anki) and (spaced repetition residency). Available outcome data was collected and discussed independently for students and residents. Many studies showed a statistically significant increase in exam performance associated with Anki use and high levels of satisfaction among residents and medical students. Further research is warranted to provide high-quality evidence of Anki’s applications and there is a need for exploration in additional residency specialties. Anki use has steadily increased with both medical students and residents. The application demonstrated consistent improvement on exam-based performance and was regarded highly by users. As burnout and time constrictions threaten educational workflow, Anki may serve as a powerful tool to improve the quality of learning. Further data needs to be collected and analyzed in specialties where Anki use may already exist.

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Section: Discussionmentioning

confidence: 99%

Evidence-Based Algorithm “Anki” for Optimization of Medical Education: The Evolution of Knowledge Retention

Goldman¹,

Bryan²,

Lucke‐Wold³

2023

Preprint

View full text Add to dashboard Cite

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“…A robust clinical practice is fundamental for early-career surgeons to build confidence and solidify their professional identity. However, some surgeons struggle to develop a practice that matches their professional goals, leading to dissatisfaction, burnout, and attrition . In one survey of new fellows of the American College of Surgeons, 44% reported having left their first job at the time of the survey after an average of 3.3 years .…”

Section: Introductionmentioning

confidence: 99%

“…However, some surgeons struggle to develop a practice that matches their professional goals, leading to dissatisfaction, burnout, and attrition. [1][2][3][4][5][6] In one survey of new fellows of the American College of Surgeons, 44% reported having left their first job at the time of the survey after an average of 3.3 years. 4 Attrition is not only disruptive to the individual surgeon, but also threatens their department's financial solvency through recruitment and onboarding costs.…”

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confidence: 99%

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Barriers and Facilitators to Clinical Practice Development in Men and Women Surgeons

Finn,

Syvyk,

Bakillah

et al. 2024

JAMA Surg

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ImportanceMany early-career surgeons struggle to develop their clinical practices, leading to high rates of burnout and attrition. Furthermore, women in surgery receive fewer, less complex, and less remunerative referrals compared with men. An enhanced understanding of the social and structural barriers to optimal growth and equity in clinical practice development is fundamental to guiding interventions to support academic surgeons.ObjectiveTo identify the barriers and facilitators to clinical practice development with attention to differences related to surgeon gender.Design, Setting, and ParticipantsA multi-institutional qualitative descriptive study was performed using semistructured interviews analyzed with a grounded theory approach. Interviews were conducted at 5 academic medical centers in the US between July 12, 2022, and January 31, 2023. Surgeons with at least 1 year of independent practice experience were selected using purposeful sampling to obtain a representative sample by gender, specialty, academic rank, and years of experience.Main Outcomes and MeasuresSurgeon perspectives on external barriers and facilitators of clinical practice development and strategies to support practice development for new academic surgeons.ResultsA total of 45 surgeons were interviewed (23 women [51%], 18 with ≤5 years of experience [40%], and 20 with ≥10 years of experience [44%]). Surgeons reported barriers and facilitators related to their colleagues, department, institution, and environment. Dominant themes for both genders were related to competition, case distribution among partners, resource allocation, and geographic market saturation. Women surgeons reported additional challenges related to gender-based discrimination (exclusion, questioning of expertise, role misidentification, salary disparities, and unequal resource allocation) and additional demands (related to appearance, self-advocacy, and nonoperative patient care). Gender concordance with patients and referring physicians was a facilitator of practice development for women. Surgeons suggested several strategies for their colleagues, department, and institution to improve practice development by amplifying facilitators and promoting objectivity and transparency in resource allocation and referrals.Conclusions and RelevanceThe findings of this qualitative study suggest that a surgeon’s external context has a substantial influence on their practice development. Academic institutions and departments of surgery may consider the influence of their structures and policies on early career surgeons to accelerate practice development and workplace equity.

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Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions

Reeves,

Goldhaber,

Hollandsworth

et al. 2024

JAMA Surg

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ImportanceSince work-hour restrictions were instituted in 2003, sustainably complying with duty-hour regulations remains a challenge for general surgery residency programs across the nation.ObjectiveTo determine whether industry-based process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a general surgery residency.Design, Setting, and ParticipantsThis quality improvement project using Lean methodology was conducted from October to November of the 2021 to 2022 academic year. The setting was a university-based general surgery residency program in southern California with rotations across 5 regional hospitals. The program trains 7 categorical general surgery residents per postgraduate year (PGY) and offers an optional 1 to 3 years for research and career development.InterventionsProgrammatic structures were examined, current and target states were analyzed, opportunities for improvement were identified, root-cause analyses were conducted, and targeted interventions were developed.Main Outcomes and MeasuresResident time logs and annual Accreditation Council for Graduate Medical Education resident and faculty surveys were reviewed from academic years 2019/2020 to 2022/2023. Attending faculty were surveyed on resident preparedness using a 5-point Likert scale. Differences between means and proportions were calculated with corresponding 95% CIs.ResultsThe web-based survey responses of 29 residents (residents per PGY, 7 [PGY1], 14 [PGY2/3], 8 [PGY4/5]; 17 female [54.7%]) were included in this study. Root causes included maxed baseline schedules, late in shift work, culture, service variability, clinical volume, and inefficient workflows. Fifteen multifactorial interventions impacting call and weekend scheduling, work practices and efficiencies, intern and service orientations, and faculty and cultural expectations were implemented. The mean number of residents per block who logged more than 80 hours per week decreased by 3.6 violations per block (95% CI, 2.98-4.22), from 4.4 (12.4%) to 0.8 (2.2%) for a difference of 10.2% (95% CI, 8.4%-16.2%). On the annual resident survey, perceived compliance with 80 hours was 72%, 83%, 83%, and 88%, respectively, over the following study periods: 2019 to 2020, 2020 to 2021, 2021 to 2022, and 2022 to 2023. Faculty perception of resident preparedness for the case increased from a mean (SD) of 2.6 (0.8) to 3.0 (0.5), with a difference of 0.47 (95% CI, −0.52 to 0.68). There were no statistically significant differences in technical skill, clinical judgment, sense of responsibility, efficiency, or sense of well-being.Conclusions and RelevanceResults of this quality improvement study suggest that through Lean methodology, surgical residency programs can improve working environments. This novel approach can increase compliance with resident work hours by engaging front line trainees in the process.

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Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review

Cited by 10 publications

References 140 publications

Evidence-Based Algorithm “Anki” for Optimization of Medical Education: The Evolution of Knowledge Retention

Evidence-Based Algorithm “Anki” for Optimization of Medical Education: The Evolution of Knowledge Retention

Barriers and Facilitators to Clinical Practice Development in Men and Women Surgeons

Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions

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