Analysis of Wellness-Related Concerns Experienced by General Surgery Trainees Over Time
Margaret Siu, David B. Tashjian, Gladys L. Fernandez, Joy Isotti, Neal E. Seymour
Surgery, Baystate Medical Center-UMASS Medical School, Springfield, Massachusetts, United States
Objective: To evaluate surgical residents' wellness-related concerns and trends in these concerns over time. Design: To facilitate wellness discussion during biannual review meetings, surgery residents from all post-graduate years at an academic medical center were asked to complete a survey of common concerns, prioritizing them in order of perceived importance. Ranked items were 1) meeting needs of family/friends, 2) nonwork time for study, 3) financial obligations, 4) personal well-being needs, 5) concerns for clinical performance, and 6) administrative demands. Changes in each of these were trended over 10 review periods, spanning 5 years. Results were analyzed using Kruskal-Wallis Test. Setting: Surgery residency confers stress burdens on trainees. To monitor and mitigate these concerns, our education team implemented a biannual survey of potential stressors to facilitate meaningful discussion during each biannual review with the program director. We reviewed the initial 5-year experience to assess for trends that could better inform efforts to maintain program and individual resident well-being. Patients or other participants: General surgery residents from all post-graduate years who participated in biannual evaluations with the program director were given the survey. Participation was completely voluntary. Main outcome measures: Means of rankings of all concern items and changes in patterns of prioritization expressed by residents over successive review periods. Results: A total of 333 surveys were completed over 5 years. During this time, 12 surveys were not completed (96% completion rate). Rankings over the course of the review changed significantly for nonwork time for study (p=0.04), personal well-being needs (p=0.03) and concerns for clinical performance (p=0.004). Nonwork time for study and concerns on clinical performance were consistently ranked as the top 2 concerns over the study period, with the exception of the Spring 2020 review. Personal well-being needs ranked highest in Spring 2020, with 41% of residents placing this as 1st or 2nd ranking. During that time, a sustained decrease in concerns for clinical performance was observed and continued into the next review period. These changes corresponded to the Massachusetts COVID-19 pandemic emergency declaration. Changes in the nonwork time for study rankings were more haphazard but remained most likely to receive 1stor 2nd ranking, but again with the exception of Spring 2020 when it fell behind personal well-being needs. Conclusion: General surgery residents most commonly prioritized time for study outside the workplace and concerns for assessment of clinical performance as their highest areas of concern. However, the occurrence of an event with implications on personal health (COVID-19 pandemic) was associated with increased prioritization of personal well-being. Determination of levels of actual stress and its implications will require additional study.
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