Importance of the Topic With the COVID-19 pandemic still not fully in our rear-view mirrors, the welfare of healthcare professionals remains on the forefront of public discourse. At present, healthcare professionals, including orthopaedic surgeons, are engaged daily in the management of a deadly pandemic. They are experiencing heightened levels of stress and uncertainty [8, 9]. Identifying ways of addressing their well-being is crucial, as poorer mental health among healthcare professionals has been directly associated with poorer patient outcomes, more medical errors, higher job turnover, and poor utilization of resources [10, 12]. Indeed, reducing physician burnout is arguably the fourth component of the “triple aim” for healthcare delivery, alongside improved patient outcomes, increased patient satisfaction, and reduced overall costs [15]. Healthcare professionals on the frontlines witness trauma on a daily basis and confront death and dying, all while having to remain objective and empathic at work. They then must go home and balance their day-to-day lives after likely just witnessing such trauma at their jobs. But is it ever really balanced? Previous studies have confirmed that a high proportion of healthcare professionals experience posttraumatic stress disorder and burnout [9]. In fact, studies have shown that healthcare professionals are at higher risk of suicide compared to any other profession, such that the proportion of deaths in this population being due to suicide is twice that in the general population [2, 5]. Additionally, approximately half of practicing orthopaedic surgeons suffer from burnout at any point in time, rendering them among the top five most burned-out specialties [1, 11]. Resilience may protect against burnout and the deleterious consequences of persistent workplace stress [14]. Resilience generally refers to one’s ability to maintain mental well-being despite exposure to physical and psychological stressors [3]. The concept of resilience has been variably defined, ranging from a static personality trait to a dynamic process to an outcome. As a result, measurements of resilience have not been standardized, rendering this a difficult aspect to study [3]. Upon Closer Inspection This Cochrane review summarizes the evidence surrounding the effectiveness of psychological interventions at promoting resilience and well-being, as well as reducing depression, stress, and anxiety scores among healthcare professionals [3]. In aggregate, the effects they observed were modest and short-lived. The authors included parallel-arm randomized controlled trials that evaluated various interventions, mostly consisting of face-to-face group-based strategies compared to no intervention or wait-list controls. A meta-analysis of 12 studies identified only a moderate effect of these interventions on improving resilience, and that this effect was not sustained beyond 3 months of follow-up. The authors of the Cochrane review also observed that the findings were of moderate heterogeneity, meaning there was large variability of the effects (both presence and absence of effects and effect sizes) across the studies they surveyed, likely owing to the variability in the definition and measurement tools used to assess resilience. Because of this, the authors described the evidence on resilience as being of very low certainty. The interventions were also found to have a moderate effect on stress reduction, a small reduction in depression scores, and no effect on quality of life. The authors highlight the need for a unified definition of “resilience” and a standardized method of measuring it, as seven scales were used to measure resilience across 21 studies in this review. The studies largely focused on middle-aged women nurses in high-income countries. Therefore, future studies should aim to diversify the study populations they evaluate by including physicians and allied health professionals at various stages of training. Additionally, the studies were weakened by small sample sizes and lack of power calculations, lack of active comparators, and inadequate reporting of methods. Despite these shortcomings, the authors have identified a trend toward improved resilience and well-being through the implementation of resiliency training interventions, most commonly delivered in a group setting [3]. The beneficial effects of such interventions may be diluted by the small sample sizes of included studies and heterogeneity in the interventions used. This is promising and highlights the need for more research to truly identify the effective aspects of the interventions used and how individuals and organizations may capitalize on them to improve healthcare professionals’ well-being. Take-home Messages Based on findings from this review as well as others, we believe that a multitargeted approach to improving wellness among health professionals is required [3, 6, 7, 13]. While one aspect of resilience focuses on the individual, emerging research has highlighted the importance of organizational-level interventions at improving well-being through promoting autonomy, collegiality, and mentorship [6, 7]. This may be achieved through engaging individuals in policy and schedule making, group-based discussions, and coaching programs. Perhaps combining resiliency training with the aforementioned strategies would be superior at fostering wellness and improving the secondary outcomes of depression, stress, anxiety, and quality of life [3, 6, 7]. However, future research should first aim to generate a homogenous definition for resilience and a unified tool to measure it so as to be able to draw more reliable conclusions. This field of research would also benefit from improved study methods and reporting, including proper randomization techniques, the use of active comparators, and a priori sample size calculations. Given that the individual and organizational stressors may also vary by specialty, as well as the fact that orthopaedic surgeons suffer from higher rates of burnout despite ranking among the top five physician groups for resiliency scores [1, 14], clinical trials evaluating interventions to improve wellness and resilience among orthopaedic surgeons in particular are necessary, as it is possible that the effectiveness of these interventions also varies by specialty. Addressing these gaps in knowledge is crucial, especially since we are still in the COVID-19 pandemic and already seeing increased rates of suicide, job turnover, and early retirement among healthcare professionals [4, 9, 13].
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Open Access
Apr 1, 2024
Shaimaa A. A. M. Amer + 7