“You Remember Those Days”—A Qualitative Study of Resident Surgeon Responses to Complications and Deaths

Bamdad, Michaela C.; Vitous, C. Ann; Rivard, Samantha J.; Anderson, Milton W.; Lussiez, Alisha; Jafri, Sara M.; Roo, Ana C. De; Suwanabol, Pasithorn A.

doi:10.1016/j.jsurg.2021.09.011

Cited by 5 publications

(12 citation statements)

References 24 publications

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“…distress and injury from future stressors, or developing ambivalence toward their experiences. This coping process has previously been described as an intellectual response to a stressor (42). Suppose an individual intrinsically possesses sufficient protective factors or has acquired these through the process of prior coping responses.…”

Section: Discussionmentioning

confidence: 99%

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

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Background: There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist. Methods: We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies.A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis.Results: A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress. Conclusions:The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.

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Section: Discussionmentioning

confidence: 99%

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

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“…Deeper preoperative relationships with patients and their families can amplify the response to adverse events. 27,34,39 This response mirrors our natural tendency to be more distraught when accidents happen to loved ones rather than strangers. Among residents, the intensity of the perceived personal involvement in the patient's care increases their emotional response to complications.…”

Section: Factors Impacting the Severity Of The Responsementioning

confidence: 60%

“…Specifically, more time spent on longer hospital rotations strengthens the feeling of ownership. 39 In addition, those who tend to personalize their experiences more are prone to suffer more negative impacts of complications. 34 Although surgeons who are less directly involved in the care of a patient (such as a colleague who briefly scrubs into a case) can also be affected by their adverse event, the degree of impact is amplified by the strength of the physical and emotional connections with the patient.…”

Section: Factors Impacting the Severity Of The Responsementioning

confidence: 99%

Complication Is Inevitable, but Suffering is Optional—Psychological Aspects of Dealing with Complications in Surgery

Wolinska

Baertschiger

et al. 2023

Eur J Pediatr Surg

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Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the “second victim,” results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.

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“…then met to discuss codes and define a codebook, which was organized into 5 overarching domains. This specific report focuses on themes within the domain of “coping mechanisms.” Other reports focused on “responses to and impacts of” unwanted outcomes and “well-being resources” 31,32 . All transcripts were independently coded (M.C.B.…”

Section: Methodsmentioning

confidence: 99%

What We Talk About When We Talk About Coping

et al. 2023

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Objective: To explore how surgery residents cope with unwanted patient outcomes including postoperative complications and death. Background: Surgery residents face a variety of work-related stressors that require them to engage in coping strategies. Postoperative complications and deaths are common sources of such stressors. Although few studies examine the response to these events and their impacts on subsequent decision-making, there has been little scholarly work exploring coping strategies among surgery residents specifically. Methods: This study investigated the ways, in which general surgery residents cope with unwanted patient outcomes, including complications and deaths. Mid-level and senior residents (n = 28) from 14 academic, community, and hybrid training programs across the United States participated in exploratory semistructured interviews conducted by an experienced anthropologist. Interview transcripts were analyzed iteratively, informed by thematic analysis. Results: When discussing how they cope with complications and deaths, residents described both internal and external strategies. Internal strategies included a sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, commitment to change, and personal practices or rituals, such as exercise or psychotherapy. Conclusions: In this novel qualitative study, general surgery residents described the coping strategies that they organically used after postoperative complications and deaths. To improve resident well-being, it is critical to first understand the natural coping processes. Such efforts will facilitate structuring future support systems to aid residents during these difficult periods.

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“You Remember Those Days”—A Qualitative Study of Resident Surgeon Responses to Complications and Deaths

Cited by 5 publications

References 24 publications

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Complication Is Inevitable, but Suffering is Optional—Psychological Aspects of Dealing with Complications in Surgery

What We Talk About When We Talk About Coping

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