Quantification of Surgical Resident Stress “On Call”

Physiological and Neurobiological Aspects of Stress and Their Relevance for Residency Training

“…Nevertheless, significantly elevated or altered levels of adrenocorticotropic hormone (ACTH), cortisol, testosterone, and luteinizing hormone have been observed post-call and are associated with increased levels of stress, anxiety, and depressive symptoms [41,42]. While on-call, surgical residents achieve stress levels of tachycardia and exhibit a significant increase in their level of circulating white blood cells [43]. Recently, Brant et al [44] found that while residents did not report a change in stress levels over the course of a rotation, they exhibited evidence of neuro-endocrine changes consistent with hypothalamic-pituitary-adrenal (HPA) axis dysregulation.…”

“…sleep, timing of physiologic sampling, residency type, etc), and lack of adequate controls. Furthermore, interpretation of findings in this area is variable, with some literature interpreting a normalization of physiologic parameters equating to better coping strategies [43]. Clearly, more research is needed to investigate the physiological effects and their associated clinically relevant health outcomes of medical training, as other relevant studies provide evidence that resident conditions promote poor health via multiple mechanisms and pathways.…”

Conscious monitoring and control (reinvestment) in surgical performance under pressure

“…Potential stressors that can disrupt the technical and decision-making components of surgical performance in simulated [2, 6] and operating room (OR) environments [2] include lack of experience [7–9], procedural complexity [7], time pressure [10–12], and distractions [10] (see [4] for review). In the domain of surgery, few studies have investigated the cognitive mechanisms that underlie the disruptive effects of these stressors; however, an extensive body of work in the domain of motor learning has discussed the underlying cause of disruptions to specialized motor skills [13–15].…”

Protected Educational Rotations: A Valuable Paradigm Shift in Surgical Internship

“…12 Lower level residents not only have worse schedules, but also they cope with stress less ably than do more senior trainees. 13 A predictable schedule with a high degree of control, ample rest, and a protected environment in the OSR contributed to high satisfaction rates and increased productivity.…”