Nationwide study on stress perception among surgical residents

Abstract

Abstract Objective Declining number of applicants and high attrition of residents are a dire reality. Surgeons in training are confronted to various stressors which interfere with their performance and may promote burnout. This study measures stress levels of Swiss surgical residents while considering age, gender, specialty, position, native language, and experience. Methods Swiss surgery residents taking the Surgical Basic Exam from 2016 to 2020 completed the Perceived Stress Scale 10 (PSS). The PSS measures how unpredictable, uncontrollable, and overloaded respondents evaluate their work life. Scores up to 13 are normal and scores around 20 are highly pathologic. High subscores of helplessness (PH) and lower subscores of self-efficay (PSE) indicate distress. Results 1694 questionnaires were evaluated (return rate 95.7%). Resident median (m) age was 29 years, 56.5% were male and 43.5% female. 72.7% of the residents were in their first 2 years of training, aiming for orthopedic (24%), general surgery (23.8%), urology (6%), or plastic surgery (5.6%). Residents reported a high PSS (m = 15), a high PH (m = 9), and an ordinary PSE (m = 5). Females reported worse PSS (p < 0.001), PH (p < 0.001), and PSE (p = 0.036) than males. Visceral and orthopedic surgeons had significantly better PSS, PH, and PSE. In multivariable analysis, male sex (p < 0.001), aiming at orthopedic (p = 0.017) or visceral surgery (p = 0.004), and French as a mother tongue (p = 0.037) predicted lower stress levels, while graduating from a country not adjacent to Switzerland led to higher stress (p = 0.047). Similarly, male sex (p < 0.001), visceral surgery (p = 0.032), French mother tongue (p = 0.018), and more than 5 years in training independently predicted lower PH. Last, PSE was not influenced by gender, while residents in training for orthopedic (p = 0.004), visceral (p = 0.007) and urology (p = 0.014) specialities, as well as Italian native speakers (p = 0.017) reported less PSE. Conclusion Perceived stress levels are high in both genders in this large, prospective and representative cohort study of Swiss surgical residents. Females endured significantly worse stress and helplessness levels than males. These figures are worrisome as they may directly contribute to the declining attractivity of surgical residencies. Detailed and gender specific analysis of stressors during residency are urgently needed to improve residency programs.