Resident Perspectives on Effective Surgical Training: Incivility, Confidence, and Mindset

Babchenko, Oksana; Scott, Kaylee; Jung, Sarah; Frank, Sarah E.; Elmaraghi, Shady; Thiagarajasubramanian, Shruthi; Rendell, Victoria R.; Poore, Samuel O.; Bentz, Michael L.; Garland, Catharine B.

doi:10.1016/j.jsurg.2020.04.002

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…Particularly harmful in surgery, incivility can lead to hostile, toxic work environments that stifle creativity and collaboration, leading to ineffective learning and potentially unsafe clinical environments. [26][27][28] In our cross-sectional study across 16 different institutions in the U.S., unfortunately, over 90% of respondents experienced some form of incivility in the past year. Although no differences in incivility were detected between trainees and faculty, our findings suggest that women surgeons and Asian American surgeons are disproportionately experiencing incivility compared to other individuals.…”

Section: Discussionmentioning

confidence: 99%

Incivility, Work Withdrawal, and Organizational Commitment Among US Surgeons

Santosa¹,

Hayward

Matusko³

et al. 2021

Annals of Surgery

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Objective: To evaluate the prevalence of incivility among trainees and faculty in cardiothoracic surgery, general surgery, plastic surgery, and vascular surgery in the U.S, and to determine the association of incivility on job and work withdrawal and organizational commitment. Background: Workplace incivility has not been described in surgery and can negatively impact the well-being of individuals, teams, and organizations at-large. Methods: Using a cross-sectional, web-based survey study of trainees and faculty across 16 academic institutions in the U.S., we evaluated the prevalence of incivility and its association with work withdrawal and organizational commitment. Results: There were 486 (18.3%) partial responses, and 367 (13.8%) complete responses from surgeons [including 183 (56.1%) faculty and 143 (43.9%) residents or fellows]. Of all respondents, 92.2% reported experiencing at least 1 form of incivility over the past year. Females reported significantly more incivility than males (2.4 ± 0.91 versus 2.05 ± 0.91, P < 0.001). Asian Americans reported more incivility than individuals of other races and ethnicities (2.43 ± 0.93, P = 0.003). After controlling for sex, position, race, and specialty, incivility was strongly associated with work withdrawal (β = 0.504, 95% CI: 0.341–0.666). There was a significant interaction between incivility and organizational commitment, such that highly committed individuals had an even greater impact of incivility on the outcome of job and work withdrawal (β = 0.178, 95% CI: 0.153–0.203). Conclusions: Incivility is widespread in academic surgery and is strongly associated with work withdrawal. Leaders must invest in strategies to eliminate incivility to ensure the well-being of all individuals, teams, and organizations at-large.

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Section: Discussionmentioning

confidence: 99%

Incivility, Work Withdrawal, and Organizational Commitment Among US Surgeons

Santosa¹,

Hayward

Matusko³

et al. 2021

Annals of Surgery

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“…To that end, we aimed to determine if a mindfulness-based intervention (MBI) reduced inattention blindness among young neurosurgeons, namely, those in training or who had recently been appointed as staff. That this particular group tend to incur more operative complications (14), adopt differing learning mindsets (15) and use different training resources ( 16) as compared to experienced consultants marks their unique characteristics and potential for improvement with mindfulness training.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a Mindfulness-Based Intervention in Ameliorating Inattentional Blindness Amongst Young Neurosurgeons: A Prospective, Controlled Pilot Study

et al. 2022

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BackgroundHuman factors are increasingly being recognised as vital components of safe surgical care. One such human cognitive factor: inattention blindness (IB), describes the inability to perceive objects despite being visible, typically when one’s attention is focused on another task. This may contribute toward operative ‘never-events’ such as retained foreign objects and wrong-site surgery.MethodsAn 8-week, mindfulness-based intervention (MBI) programme, adapted for surgeons, was delivered virtually. Neurosurgical trainees and recent staff-appointees who completed the MBI were compared against a control group, matched in age, sex and grade. Attention and IB were tested using two operative videos. In each, participants were first instructed to focus on a specific part of the procedure and assessed (attention), then questioned on a separate but easily visible aspect within the operative field (inattention). If a participant were ‘inattentionally blind’ they would miss significant events occurring outside of their main focus. Median absolute error (MAE) scores were calculated for both attention and inattention. A generalised linear model was fitted for each, to determine the independent effect of mindfulness intervention on MAE.ResultsThirteen neurosurgeons completed the mindfulness training (age, 30 years [range 27–35]; female:male, 5:8), compared to 15 neurosurgeons in the control group (age, 30 years [27–42]; female:male, 6:9). There were no significant demographic differences between groups. MBI participants demonstrated no significant differences on attention tasks as compared to controls (t = −1.50, p = 0.14). For inattention tasks, neurosurgeons who completed the MBI had significantly less errors (t = −2.47, p = 0.02), after adjusting for participant level and video differences versus controls. We found that both groups significantly improved their inattention error rate between videos (t = −11.37, p < 0.0001). In spite of this, MBI participants still significantly outperformed controls in inattention MAE in the second video following post-hoc analysis (MWU = 137.5, p = 0.05).DiscussionNeurosurgeons who underwent an eight-week MBI had significantly reduced inattention blindness errors as compared to controls, suggesting mindfulness as a potential tool to increase vigilance and prevent operative mistakes. Our findings cautiously support further mindfulness evaluation and the implementation of these techniques within the neurosurgical training curriculum.

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“…Surgical education has classically emphasized teaching the knowledge and technical components surrounding procedural skills, but fostering growth mindsets within residents and their training environments is important for promoting healthy motivation for learning and resilience throughout training . Recent surveys of surgical residents suggest that trainees are intuitively aware of the importance of mindsets: for example, residents reported that having attending surgeons who provided constructive feedback and encouragement helped them excel in the operating room . A recent survey study in the field of neurosurgery found that residents and attending physicians may be more likely to have fixed—instead of growth—mindsets about intelligence in comparison with medical students or the general population .…”

mentioning

confidence: 99%

“…4 Recent surveys of surgical residents suggest that trainees are intuitively aware of the importance of mindsets: for example, residents reported that having attending surgeons who provided constructive feedback and encouragement helped them excel in the operating room. 5 A recent survey study in the field of neurosurgery found that residents and attending physicians may be more likely to have fixedinstead of growth-mindsets about intelligence in comparison with medical students or the general population. 6 The nature of the association between mindsets and surgical specialties remains unclear and must be further investigated.…”

mentioning

confidence: 99%