Stress response in surgical training
Research type
Research Study
Full title
Stress response in surgical training: a study of the value of wearable technology and biomarkers in simulated clinical scenarios and the live hospital environment.
IRAS ID
254658
Contact name
Elenor Williams
Contact email
Sponsor organisation
Wales Post Graduate Medical and Dental Education Deanery
Duration of Study in the UK
0 years, 3 months, 0 days
Research summary
The current demands of surgical training produce work related pressure and emotional stress, which not only effect the well-being of trainees but likely influence clinical results and threaten patient safety and quality of care. Emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is now recognised as a syndrome termed burnout, that compromises effectiveness at work. Burnout among trainees is becoming increasingly recognised with symptoms akin to acute stress reaction and post-traumatic stress disorder, and allegedly within the UK, some two thirds of junior doctors report damaged physical or mental health associated with the intense physical and emotional burdens and intolerable strain at work.
The primary aim of this study is to assess the physiological stress response of core and higher surgical trainees in a simulated environment. A secondary aim is to validate the pilot study protocol for a proposed real time study in a live hospital setting and to determine the subsequent potential impact on clinical competence and patient care.
Pilot data from the initial study will allow the determination of the effect size, in the hope that the data and methodology will be used to inform a further study to examine the physiological effects of stress on trainees in live hospital settings. Identification and potential modification of stress responses may help improve the health and performance of trainees and subsequently improve patient welfare. Consideration will be given in follow-up studies for blood biomarker work to investigate the potential to develop a custom-made composite stress index designed to highlight those at risk phenotypes where management resource should be targeted.Purpose:
The current demands of surgical training produce work related pressure and emotional stress, which not only effect the well-being of trainees but likely influence clinical results and threaten patient safety and quality of care.
Burnout among trainees is becoming increasingly recognised with symptoms akin to acute stress reaction (ASR) and post-traumatic stress disorder (PTSD) [1] and allegedly, in the UK, some two thirds of junior doctors report damaged physical or mental health, because NHS work is associated with intense physical and emotional burdens and intolerable strain [2]. Social relationships consequently suffer, and work related stress has even been reported to increase the risk of ischaemic heart disease, stroke [3-5], substance abuse, absenteeism, divorce, depression and suicide[6-8]. Moreover, such issues have been reported in as many as 70% of general surgery US residents[9-12] and 21% of mixed-specialty Dutch post-graduate trainees[13]. Occult trainee psychological morbidity therefore, may arguably be worse than that of the general population[1]. Shanafelt et al described almost 1 in 10 US surgeons (9%) self-reported major medical errors and burnout and depression were shown to be independent predictors of error reporting, which correlated with all 3 domains of burnout[14]. Similarly, emergency medicine physicians (EP), have been reported to have burnout rates of over 50%, and EPs with high burnout were significantly more likely to report clinical dyspractice[15].
To date, no UK trainee centred and curriculum focused initiative exists, and although awareness is important, future work should focus on education and early identification to support trainees threatened by burnout.
1. Thompson, C., Naumann, D., Fellows, J., Bowley, D. and Suggett, N. (2017). Post-traumatic stress disorder amongst surgical trainees: An unrecognised risk? The Surgeon, 15(3), pp.123-130.
2. Campbell, D. (2017). Two-thirds of young hospital doctors under serious stress, survey reveals. The Guardian. [online] Available at: http://www.theguardian.com/uk-news/2017/feb/11/stressed-out-docto rs-anaesthetists-survey-nhs [Accessed 31 May 2017].
3. Eller, N., Netterstrøm, B., Gyntelberg, F., Kristensen, T., Nielsen, F., Steptoe, A. and Theorell, T. (2009). Work-Related Psychosocial Factors and the Development of Ischemic Heart Disease. Cardiology in Review, 17(2), pp.83-97.REC name
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REC reference
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