PREPARING SURGICAL TRAINEES FOR HIGH-STRESS WORK: AN OUTLINE OF LEARNING ISSUES

Introduction
The practice of surgery is associated with significant emotional and psychological stress. Surgical complications in particular may place the surgeon at risk for depression and burnout. During surgical training, emphasis is placed on the medical aspects of managing surgical complications. Emotional and psychological effects on the surgeon and trainees are rarely discussed.

Objectives:
The aims of our study were 1) to assess current attitudes of surgical trainees toward the emotional and psychological impact of surgical complications on the surgeon, and 2) to identify ways of approaching this subject during residency training.

Methods
We conducted a prospective study of trainees enrolled in the general surgery program at the University of Montreal (Montreal, Canada). All trainees were invited to answer a 20 item questionnaire conceptually divided into 5 categories: emotional aspects of surgical complications, legal aspects of surgical complications, intra operative crisis management, disclosure of adverse events, and coping strategies. Respondents indicated their level of agreement with the statements in the questionnaire on a 4 point Likert scale (1- strongly disagree; 4- strongly agree). The study was approved by our institutional ethics review board.

Results
17 out of 18 (94%) participants answered the questionnaire. Results were not associated with sex or level of training. Respondents overwhelmingly agreed that surgical complications have a significant negative emotional and psychological impact on the surgeon (Mean score 3,65 +/- 0,49). Most respondents also felt that the ability to deal with complications increases predictably with experience and years in practice (mean score 2,82 +/- 0,529). Intra operative crisis situations emerged as a particularly significant source of stress. All respondents (13/13, 100%) felt that the priority in dealing with such situations was organizing an efficient team around a team leader, although many (7/16, 44%) were unaware that no established protocols exist. Theoretical training and simulation were considered essential in preparing to deal with intra operative crisis situations. The majority (10/16, 63%) of respondents felt that group discussions were the best way to approach the subject of stress related to surgical complications during training. Three respondents suggested workshops, and two suggested morbidity-mortality conferences.

Conclusions
- Trainees consider emotional and psychological effects of complications on the surgeon as an important part of surgical practice and training.
- Trainees consider intra operative crisis as a particularly significant source of stress.
- Simulation and group discussion were highlighted as potentially effective ways of addressing this issue during surgical training.