Flourishing as a guide to intervention: a national multicenter study of general surgery residents

Abstract

Purpose Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have been limited. Here we provide early data on modifiable targets, potential interventions, and comparative impact. Methods In this cross-sectional survey-based study of mixed-level residents at 16 academic General Surgery training programs, gender-identity, race, post-graduate year, and gap years were self-reported. Correlation between our primary outcome variable, flourishing, and measures of resilience (mindfulness, personal accomplishment [PA], workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, perceived stress, anxiety, workplace demand) were assessed. Results Of 891 recipients, 300 responded (60% non-male, 41% non-white). Flourishing was significantly positively correlated with all measured resilience factors and negatively correlated with all measured risk factors. In multivariable modelling, mindfulness, PA, and workplace support were positively and significantly associated with flourishing, with PA having the strongest resilience effect. Depression and anxiety were negatively and significantly associated with flourishing, with depression having the strongest risk effect. Conclusions Our results suggest that interventions that increase mindfulness, workplace support, and PA, as well as those that decrease depression and anxiety may particularly impact flourishing (i.e., global wellbeing) in surgical trainees. These findings provide preliminary guidance on allocation of resources toward wellbeing interventions. In particular, cognitive (i.e., mindfulness) training is a feasible intervention with modest but significant association with flourishing, and potential indirect effects through influence on PA, anxiety and depression.

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

“…This scoping review is part of a larger study of surgical resident well-being conducted by our team. Through that work, our team identified targetable areas associated with increased well-being, the relative impact of these areas on global well-being, and the feasibility of intervening in these areas 31. However, to inform comprehensive decision-making, financial value must also be considered.…”

“…Through that work, our team identified targetable areas associated with increased well-being, the relative impact of these areas on global wellbeing, and the feasibility of intervening in these areas. 31 However, to inform comprehensive decision-making, financial value must also be considered. This prompted our research question, "What is known about the financial impact of surgical resident well-being on health care institutions?…”