Stress Management Training for Surgeons—A Randomized, Controlled, Intervention Study

Background:Stress and coping influence performance. In this study, we evaluate a novel stress management intervention for surgeons. Methods:A randomized control group design was used. Sixteen surgeons were allocated to either the intervention or control group. The intervention group received training on coping strategies, mental rehearsal, and relaxation. Performance measures were obtained during simulated operations and included objective-structured assessment of technical skill, observational teamwork assessment for surgery, and end product assessment rated by experts. Stress was assessed using the state-trait-anxiety-inventory, observer rating, coefficient of heart rate variability (C_HRV), and salivary cortisol. The number of applied surgical coping strategies (number of coping strategies [NC]) was assessed using a questionnaire. A t test for paired samples investigated any within-subject changes, and multiple linear regression analysis explored between-subject effects. Interviews explored surgeons' perceptions of the intervention. Results:The intervention group showed enhanced observational teamwork assessment for surgery performance (t = –2.767, P < 0.05), and increased coping skills (t = –4.690, P < 0.01), and reduced stress reflected inheart rate variability (t = –4.008, P < 0.01). No significant changes were identified in the control group. Linear regression analysis confirmed a significant effect on NC (&bgr; = –0.739, P < 0.01). Qualitative data analysis revealed improved technical skills, decision making, and confidence. Conclusions:The intervention had beneficial effects on coping, stress, and nontechnical skills during simulated surgery.

[1]  R. Reznick.  Surgical simulation: a vital part of our future. , 2005, Annals of surgery.

[2]  Ara Darzi,et al.  Observational Assessment of Surgical Teamwork: A Feasibility Study , 2006, World Journal of Surgery.

[3]  Hubertus Feussner,et al.  Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy , 2004, Surgical Endoscopy And Other Interventional Techniques.

[4]  Martha Reeves,et al.  Evaluation of Training , 1993 .

[5]  K. Moorthy,et al.  The effect of stress-inducing conditions on the performance of a laparoscopic task , 2003, Surgical Endoscopy And Other Interventional Techniques.

[6]  H. C. Veldenz,et al.  Impaired residents: identification and intervention. , 2003, Current surgery.

[7]  Jane Kidd,et al.  The effects of stress on surgical performance. , 2006, American journal of surgery.

[8]  C G Tribble,et al.  Intern call schedules and their relationship to sleep, operating room participation, stress, and satisfaction. , 1999, Surgery.

[9]  Jean Ker,et al.  Guidelines for evaluating papers on educational interventions , 1999, BMJ.

[10]  Marc Immenroth,et al.  Mental Training in Surgical Education: A Randomized Controlled Trial , 2007, Annals of surgery.

[11]  Urie Bronfenbrenner,et al.  The Ecology of Human Development , 1981 .

[12]  K Moorthy,et al.  Simulation based training , 2005, BMJ : British Medical Journal.

[13]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[14]  S. Hamstra,et al.  Teaching technical skills to surgical residents: a survey of empirical research. , 2006, Clinical orthopaedics and related research.

[15]  Luke P Brewster,et al.  Management of adverse surgical events: a structured education module for residents. , 2005, American journal of surgery.

[16]  G. Hanna,et al.  The Effects of Stress and Coping on Surgical Performance During Simulations , 2010, Annals of surgery.

[17]  Kathleen A. Martin,et al.  Imagery Use in Sport: A Literature Review and Applied Model , 1999 .

[18]  T. Marteau,et al.  The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). , 1992, The British journal of clinical psychology.

[19]  J. Wolfe,et al.  Competence assessment of senior vascular trainees using a carotid endarterectomy bench model , 2007, The British journal of surgery.

[20]  Linda Hutchinson,et al.  Evaluating and researching the effectiveness of educational interventions , 1999, BMJ.

[21]  A. Darzi,et al.  Evaluation of a Framework for Case Development and Simulated Patient Training for Complex Procedures , 2006, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[22]  R. Reznick,et al.  Teaching surgical skills--changes in the wind. , 2006, The New England journal of medicine.

[23]  Jian-ping Liu,et al.  [Qualitative research and evidence-based medicine]. , 2008, Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine.

[24]  Mark Sadoski,et al.  Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students. , 2004, American journal of obstetrics and gynecology.

[25]  J. Bligh,et al.  Evaluating educational interventions , 1999, BMJ.

[26]  L. Sjodahl.  Evaluation of Training. , 1975 .

[27]  A. L. Schueneman,et al.  Neuropsychologic predictors of operative skill among general surgery residents. , 1984, Surgery.

[28]  B. Böhm,et al.  A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection. , 2001, Archives of surgery.

[29]  R. Flin,et al.  Non-technical skills for surgeons in the operating room: a review of the literature. , 2006, Surgery.

[30]  J. Firth‐Cozens,et al.  Hours, sleep, teamwork, and stress , 1998, BMJ.

[31]  A Zielke,et al.  Negative stress‐coping strategies among novices in surgery correlate with poor virtual laparoscopic performance , 2006, The British journal of surgery.