المؤلفون: Lebares CC; Department of Surgery, University of California, San Francisco., Hershberger AO; Department of Surgery, University of California, San Francisco., Guvva EV; Department of Surgery, University of California, San Francisco., Desai A; Department of Surgery, University of California, San Francisco., Mitchell J; Osher Center for Integrative Medicine, University of California, San Francisco., Shen W; Department of Surgery, University of California, San Francisco., Reilly LM; Department of Surgery, University of California, San Francisco., Delucchi KL; Department of Psychiatry, University of California, San Francisco., O'Sullivan PS; Department of Surgery, University of California, San Francisco., Ascher NL; Department of Surgery, University of California, San Francisco., Harris HW; Department of Surgery, University of California, San Francisco.

المصدر: JAMA surgery [JAMA Surg] 2018 Oct 01; Vol. 153 (10), pp. e182734. Date of Electronic Publication: 2018 Oct 17.

نوع المنشور: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural

بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101589553 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2168-6262 (Electronic) Linking ISSN: 21686254 NLM ISO Abbreviation: JAMA Surg Subsets: MEDLINE

مواضيع طبية MeSH: Internship and Residency* , Mindfulness* , Resilience, Psychological*, General Surgery/*education , Occupational Stress/*prevention & control, Adult ; Burnout, Professional/prevention & control ; Burnout, Professional/psychology ; China ; Cognitive Behavioral Therapy/methods ; Feasibility Studies ; Female ; Humans ; Male ; Occupational Stress/psychology ; Pilot Projects ; Treatment Outcome ; Young Adult

مستخلص: Importance: Among surgical trainees, burnout and distress are prevalent, but mindfulness has been shown to decrease the risk of depression, suicidal ideation, burnout, and overwhelming stress. In other high-stress populations, formal mindfulness training has been shown to improve mental health, yet this approach has not been tried in surgery.
Objective: To test the feasibility and acceptability of modified Mindfulness-Based Stress Reduction (MBSR) training during surgical residency.
Design, Setting, and Participants: A pilot randomized clinical trial of modified MBSR vs an active control was conducted with 21 surgical interns in a residency training program at a tertiary academic medical center, from April 30, 2016, to December 2017.
Interventions: Weekly 2-hour, modified MBSR classes and 20 minutes of suggested daily home practice over an 8-week period.
Main Outcomes and Measures: Feasibility was assessed along 6 domains (demand, implementation, practicality, acceptability, adaptation, and integration), using focus groups, interviews, surveys, attendance, daily practice time, and subjective self-report of experience.
Results: Of the 21 residents included in the analysis, 13 were men (62%). Mean (SD [range]) age of the intervention group was 29.0 (2.4 [24-31]) years, and the mean (SD [range]) age of the control group was 27.4 (2.1 [27-33]) years. Formal stress-resilience training was feasible through cultivation of stakeholder support. Modified MBSR was acceptable as evidenced by no attrition; high attendance (12 of 96 absences [13%] in the intervention group and 11 of 72 absences [15%] in the control group); no significant difference in days per week practiced between groups; similar mean (SD) daily practice time between groups with significant differences only in week 1 (control, 28.15 [12.55] minutes; intervention, 15.47 [4.06] minutes; P = .02), week 2 (control, 23.89 [12.93] minutes; intervention, 12.61 [6.06] minutes; P = .03), and week 4 (control, 26.26 [13.12] minutes; intervention, 15.36 [6.13] minutes; P = .04); course satisfaction (based on interviews and focus group feedback); and posttraining-perceived credibility (control, 18.00 [4.24]; intervention, 20.00 [6.55]; P = .03). Mindfulness skills were integrated into personal and professional settings and the independent practice of mindfulness skills continued over 12 months of follow-up (mean days [SD] per week formal practice, 3 [1.0]).
Conclusions and Relevance: Formal MBSR training is feasible and acceptable to surgical interns at a tertiary academic center. Interns found the concepts and skills useful both personally and professionally and participation had no detrimental effect on their surgical training or patient care.
Trial Registration: ClinicalTrials.gov identifier: NCT03141190.

المؤلفون: Lebares, Carter C, Guvva, Ekaterina V, Ascher, Nancy L, O'Sullivan, Patricia S, Harris, Hobart W, Epel, Elissa S

المصدر: Journal of the American College of Surgeons. 226(1)

مصطلحات موضوعية: Humans, Cross-Sectional Studies, Burnout, Professional, Internship and Residency, Internet, Physicians, General Surgery, Resilience, Psychological, Mindfulness, Surveys and Questionnaires, Occupational Stress, Mental Health, Complementary and Integrative Health, Mind and Body, Depression, Clinical Research, Behavioral and Social Science, 2.3 Psychological, social and economic factors, Aetiology, Mental health, Good Health and Well Being, Clinical Sciences, Surgery

الوصف: BACKGROUND:Burnout among physicians affects mental health, performance, and patient outcomes. Surgery residency is a high-risk time for burnout. We examined burnout and the psychological characteristics that can contribute to burnout vulnerability and resilience in a group of surgical trainees. STUDY DESIGN:An online survey was distributed in September 2016 to all ACGME-accredited general surgery programs. Burnout was assessed with an abbreviated Maslach Burnout Inventory. Stress, anxiety, depression, resilience, mindfulness, and alcohol use were assessed and analyzed for prevalence. Odds ratios (ORs) were used to determine the magnitude of presumed risk and resilience factors. RESULTS:Among 566 surgical residents who participated in the survey, prevalence of burnout was 69%, equally driven by emotional exhaustion and depersonalization. Perceived stress and distress symptoms (depression, suicidal ideation, and anxiety) were notably high across training levels, but improved during lab years. Higher burnout was associated with high stress (OR 7.8; p

URL الوصول: https://escholarship.org/uc/item/0nw5g5pk