Enhanced Stress Resilience Training for Faculty
Condition: Burnout, Professional
MeSH terms: Burnout, Professional
Study type: Interventional

Summary: 
      Mounting evidence shows that burnout, a critical metric for dissatisfaction and distress, is
      a growing problem within medicine. Burnout is a syndrome associated with worse physician
      performance, patient outcomes, and hospital economics. Furthermore, researchers are coming to
      understand that burnout, diminished performance and the development of mental and physical
      illness are related. It has been proposed that chronic and overwhelming stress, in the
      absence of adequate coping skills, promotes performance deficits from surgical errors to poor
      professionalism due to the effects of stress on cognition.

      Notably, in small studies of physicians and other high-stress/high-performance groups
      mindfulness-based interventions have shown exceptional promise in improving burnout and
      distress symptoms, protecting cognition, and enhancing meaningfulness and satisfaction in
      work. Nevertheless, in spite of promising results in various populations the translation of
      mindfulness-based interventions to real-world settings has been slow.

      There is a paucity of quality research examining individually-based interventions, formal
      mindfulness training in physicians, or either of these things in the high stakes world of
      surgeons and anesthesiologists. To address these gaps, researchers have developed Enhanced
      Stress-Resilience Training (ESRT) based on MBSR, but streamlined and tailored for surgeons
      and anesthesiologists.

      Moreover, researchers have refined the scales included in our psychosocial survey of
      well-being in order to sharpen our approach to the complex issue of physician well-being and
      factors influencing physician resilience, within Surgery and Anesthesia, at UCSF.
    

Detailed description: 
      Burnout, which comprises emotional exhaustion, depersonalization and diminished satisfaction
      with one's work, has been documented in medical students, trainees, and practicing physicians
      across specialties, including 69% of surgical residents and 40-60% of practicing physicians.

      Furthermore, a strong correlation between burnout, impaired performance and the development
      of mental and physical illness is coming to light. It has been proposed that chronic and
      overwhelming stress, in the absence of adequate coping skills, promotes burnout and
      associated distress symptoms such as depression, suicidal ideation and anxiety. Among
      physicians, performance deficits from surgical errors to poor professionalism have been
      proposed to result from the effects of stress on cognition. Notably, in other
      high-stress/high-performance groups, mindfulness-based interventions (MBIs) have shown
      promise in reducing distress symptoms, protecting cognition, and enhancing performance. Among
      physicians, limited studies of MBIs have shown improvements in burnout and the sense of
      meaningfulness and satisfaction in work. Nevertheless, in spite of such evidence, MBIs have
      yet to be tested in surgeons and have made little progress being translated to real-world
      settings within healthcare.

      Interestingly, our cross-sectional national survey of general surgery residents found that
      high dispositional mindfulness reduces the risk of emotional exhaustion, depersonalization,
      moderate to severe depression and suicidal ideation, by 75% or more. This suggests that while
      mindfulness may seem out of place among surgeons and operating room culture, it is in fact
      already in use in this setting, albeit unconsciously. More importantly, it appears to be
      beneficial. These findings, in combination with promising preliminary data from our
      longitudinal RCT of mindfulness training in surgical interns, suggested that an appropriate
      MBI could enhance native skills and potentially become a powerful component of stress
      resilience training among surgeons and anesthesiologists. Therefore, through iterative work
      in surgical trainees, researchers have created a streamlined, modular MBI for surgery and
      anesthesia faculty physicians and aim to test it both for pragmatic feasibility and for
      efficacy at enhancing stress resilience and improving wellbeing.

      The significance of this work lies in evaluating a process-centered skill believed to promote
      resilience, defined as the ability to thrive under adversity and predicated on the perception
      of stressors as challenges rather than overwhelming threats. The transformation of how people
      experience stress is a learned skill that can be applied across career stages, practice
      trajectories and life. The potential to protect individuals, while researchers work for
      mandatory institutional and systemic change, is powerful. Moreover, the resultant tendency
      for self-awareness and equipoise has been contagious in other settings, providing fuel for
      the greater culture change that is inarguably necessary and holds great promise for us and
      our patients.

      The innovation of this work is in bringing a mind-body intervention to bear not only on
      well-being but also on the fundamental cognitive processes believed to sub-serve performance
      such as attention, working memory capacity, emotional regulation and self-awareness, which
      may impact behaviors such as medical decision-making, professionalism and team work. The
      potential to improve both the operative environment and surgical or medical errors is
      unprecedented. Moreover, the use of a manualized curriculum specifically crafted for
      physicians could pave the way for translation to larger studies, other specialties and
      outside institutions.
    

Intervention name(s): Enhanced Stress Resilience Training for Faculty Physicians
Intervention type(s): Behavioral
Intervention description(s): Enhanced Stress Resilience Training (ESRT) is derived from Mindfulness-Based Stress Reduction with modifications to language, activities and contextualization to tailor the training to physicians involved in the operating room environment. ESRT consists of 5 weekly 1-hour group classes and 2-4 hour retreat. Classes focus on developing sustained attention and open monitoring in addition to training focused on stress and coping. Increasing duration (3-20 minutes per day) of guided mindfulness exercises are assigned each week. A 2-4 hour intensive retreat occurs at week 4 or 5. The central exercises of the training are the body scan, sitting meditation, qi gong and yoga. The weekly teaching sessions will be offered at various days and times each week in order to accommodate complicated physicians schedules that vary at each site. Participants can attend whichever session is most convenient. Daily practice will occur independently, with the duration reported weekly through text or email.
Other intervention name(s): ESRT
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mindfulness-Bases Stress Reduction, Stress, Resilience, Well-being