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 intraoperative 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 a surgical specialty . This brings into question what are hospitals and the profession doing to nurture and support surgeons ?
Increased civility at work Research has demonstrated civility can be increased at work , and in so doing leads to an enduring reduction in burnout . Improving the effectiveness of both the academic content and supervised practice enhances the social dynamics of healthcare teams . Team-based structures provide a support network and continuity to avoid potential pitfalls , and to recover from unavoidable strains . Emotional wellness and job satisfaction can be implemented with policy engagement , within a supportive team-based environment .
The role of emotions both positive ( joy ) and negative ( anger ) also play an important factor in stress immunity and burnout . Surgeons are more likely to absorb emotions from their colleagues , emphasising the importance of the team dynamics within the department . Building resilience to stressful events needs to be an integral part of health care practice . Programmes to develop these coping strategies are fundamental to maintain high level of job satisfaction , wellbeing and patient care . Wetzel et al implemented a stress management programme for surgeons focusing on coping strategies , mental rehearsal and relaxation . The intervention group was shown to improve teamwork , coping skills and even lower heart rate during surgical procedures , compared to the control group . 15 Healthcare services and hospitals can help improve stress immunity and reduce the risk of burnout by valuing surgeons and employing achievable goal-based practice . Resilience training for all professionals will create an environment akin to herd immunity , yielding greater reductions in surgical burnout .
Conclusions Further studies need to evaluate the personality traits and the variation in personality scores within the surgical profession and how these influence or impact on the doctor – patient relationship and outcomes of surgery .
15 HHE 2018 | hospitalhealthcare . com
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