Abstract
Physician well-being is a critical component of sustainable health care. There are few data on the effects of multilevel well-being programs nor a clear understanding of where and how to target resources. To inform the design of future well-being interventions by exploring individual and workplace factors associated with surgical trainees' well-being, differences by gender identity, and end-user perceptions of these initiatives. This mixed-methods study among surgical trainees within a single US academic surgical department included a questionnaire in January 2019 (98 participants, including general surgery residents and clinical fellows) and a focus group (9 participants, all clinical residents who recently completed their third postgraduate year [PGY 3]) in July 2019. Participants self-reported gender (man, woman, nonbinary). Individual and organizational-level initiatives, including mindfulness-based affective regulation training (via Enhanced Stress Resilience Training), advanced scheduling of time off, wellness half-days, and the creation of a resident-driven well-being committee. Well-being was explored using validated measures of psychosocial risk (emotional exhaustion, depersonalization, perceived stress, depressive symptoms, alcohol use, languishing, anxiety, high psychological demand) and resilience (mindfulness, social support, flourishing) factors. End-user perceptions were assessed through open-ended responses and a formal focus group. Of 98 participants surveyed, 64 responded (response rate, 65%), of whom 35 (55%) were women. Women vs men trainees were significantly more likely to report high depersonalization (odds ratio [OR], 5.50; 95% CI, 1.38-21.85) and less likely to report high mindfulness tendencies (OR, 0.17; 95% CI, 0.05-0.53). Open-ended responses highlighted time and priorities as the greatest barriers to using well-being resources. Focus group findings reflected Job Demand-Resource theory tenets, revealing the value of individual-level interventions to provide coping skills, the benefit of advance scheduling of time off for maintaining personal support resources, the importance of work quality rather than quantity, and the demoralizing effect of inefficient or nonresponsive systems. In this study, surgical trainees indicated that multilevel well-being programs would benefit them, but tailoring these initiatives to individual needs and specific workplace elements is critical to maximizing intervention effects.
Highlights
IntroductionWhile risk factors have become clearer, factors that enhance physician well-being remain poorly understood.[3,4,7] Increasing evidence suggests that both individual and organizational-level interventions are necessary[3,8,9] but likely need tailoring to meet the needs of diverse individuals, groups, and settings.[10,11,12] To date, there are few data on multilevel well-being programs among surgical trainees, nor a nuanced understanding of where and how to tailor interventions to optimize the use of limited resources
Physician well-being is a critical component of sustainable health care.[1]
Women vs men trainees were significantly more likely to report high depersonalization and less likely to report high mindfulness tendencies (OR, 0.17; 95% CI, 0.05-0.53)
Summary
While risk factors have become clearer, factors that enhance physician well-being remain poorly understood.[3,4,7] Increasing evidence suggests that both individual and organizational-level interventions are necessary[3,8,9] but likely need tailoring to meet the needs of diverse individuals, groups, and settings.[10,11,12] To date, there are few data on multilevel well-being programs among surgical trainees, nor a nuanced understanding of where and how to tailor interventions to optimize the use of limited resources To address this gap, we drew on both Broaden-and-Build[13] and Job Demand–Resource[14] theories to conceive of ways in which individual and workplace factors might be associated with surgical trainee well-being. Our goal was to help to inform the design of future multilevel well-being initiatives by exploring individual and workplace factors associated with well-being, evaluating differences by gender identity, and assessing end-user experience
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