surgery or looking after a critically unwell patient,
especially in paediatrics when there are the added
emotions of the family and a young patient.
Burnout in surgeons
Surgeons have a high prevalence of mental health
disorders. They have an increased risk of
addiction, depression and suicide. Studies show
that surgeons early in their training are at high
risk due to high demands, long working hours
and low job autonomy. A recent analysis of UK
junior surgical trainees showed that only 5% of
their time is spent in theatre. The General
Medical Council (GMC) national training survey
2014 reported the lowest level of satisfaction
found in surgical trainees, with the literature
reporting a 1 in 5 dropout rate.
In addition, burnout symptoms among
surgeons are a pervasive health care problem
characterised by a loss of emotional and physical
energy, decreased job performance, and
depersonalisation. A comparative cross-sectional
study evaluated burnout among surgeons and
found 80% of surgeons agreed they should be
monitored for signs of burnout. Only 8% sought
professional help and 15% used prescription
medication or alcohol to combat signs and
symptoms of burnout. 10
Dealing with stress and avoiding burnout
In Germany, a randomised controlled trial
introducing stress management training to junior
surgeons, showed a statistically significant
improvement in perceived stress, resiliency,
self-efficacy, and optimism in the intervention
group compared with those in the control
group. 11 The introduction of such interventions
enhance the surgeon mindfulness, perceived
stress and mood disturbance. This in turn can
make the surgeon more resilient, improve
performance and patient care.
Kashdan and Rottenberg popularised the
concept of psychological flexibility, which
involves the ability to adapt to various situational
demands. The fascination of surgery is the
balance of life domains against patient values and
beliefs. Psychological flexibility is also affected by
positive and negative experiences. In such cases,
a ratio of three positive experiences is required to
offset a negative one. This ratio is important, and
may play a role in why surgical procedures may
come in and out of fashion. For this reason,
consultation with experts and research allows
the surgical profession to balance introduction
of new techniques against well tried and tested
procedures. 12 It is important as a profession to
nurture the strengths and positive traits of
surgeons to allow the profession to flourish and
succeed. Stress immunity as a trait and stress
management should be more widely evaluated
in surgical trainees in preparation for more
responsibility and progression through the
specialty.
The surgeon can also help manage stress by
appropriate planning of surgical procedures.
Mental imagery and preparation improves
outcomes following surgery. 13 Analysis shows
that mental imagery and planning with
colleagues and materials enabled ‘rehearsing’
of the surgical procedure. This helps to prepare
for intra-operative eventualities too and to better
handle stressful events. Low levels of intra-
operative stress may have a positive effect;
however, excessive stress can cause impaired
judgment, decision-making and communication.
Trainee surgeons are more sensitive to the
harmful effects of intra-operative stress than their
senior colleagues in general. This is likely to be
due to senior surgeons developing coping
strategies over time and having experience in
dealing with adverse events. 14
The ability to deal with stress and avoid
burnout is closely linked with job satisfaction and
organisational commitment. The value of any
health care worker is intimately linked with their
level of education, working hours and job
satisfaction. Health care services need to pay
careful attention to such facts, in order to
optimise productivity and job satisfaction. It has
been shown that perseverance for long-term goals
has an inverse relationship with burnout. Age and
gender has not been linked with burnout, but
a non-significant trend was found in consultant
surgeons compared with trainees. It is thus
hypothesised that a degree of grit, or perseverance
and stress immunity is required to complete and
continue within