CIRCUMSPECTUS MEDICINAE: TEXT AND CONTEXT Commentary: “Professional Burnout Among Plastic Surgery Residents: Can it be Prevented? Outcomes of a National Survey” To the Editor: or those who mentor residents, it is time we step up. As a faculty surgeon directly involved with plastic surgery residency trainees, I often wonder why residents can at times seem unhappy. Certainly, I remember residency as a time of tremendous challenge, fatigue, and exhilaration. However, I do not recall feeling like I wanted to quit and I believed that many of my coresidents felt the same. I also remember my mentors and teachers as giants that I thrived to emulate, hanging on every word during rounds and every move in the operating room. Over the past decade there have been a number of changes in medicine as well as residency training. Although many of these changes have been designed to improve the lives of our patients and residents, they have created an environment that is profoundly in opposition to the faculty-resident mentoring relationship. This article1 shows that among all of the stresses of residency training, faculty mentoring is highly valued by the trainees and is protective against resident burnout. The article is a straightforward survey of plastic surgery trainees in France seeking to identify sources of professional burnout. Although the training environment in Europe is somewhat different than that within the United States, I believe there are important concepts highlighted in this article that are applicable to all. The survey had only 52 responders (61% response rate). Obviously, a larger study with a higher response rate would be more powerful. Yet, the findings are important. The authors identified weekly ward rounds and regular staff meetings as protective against trainee burnout. I commend them for the study and highlighting this important finding. However, the solution may be harder to achieve than it sounds.
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The Problem In the operating room, as attending surgeons, we fear retribution for less than perfect outcomes and deviations over our allotted operative time. We fear that asking residents' questions or correcting them will generate a complaint that will be detrimental to our career. In research, what was once a resident friendly retrospective chart review is now an exhaustive, Institutional Review Board analyzed multistep process, highly scrutinized by leadership for lack of funding, often rejected from journals for lack of complex modeling or statistics that necessitate a PhD or MPH level of training. In the outpatient setting, we are “in the weeds” with extensive documentation of the Electronic Health Record, overscheduling patients so we can keep the lights on in our extremely expensive hospital-based clinic, all coming at the expense of resident education. We fear that patients' perceptions that residents are involved in their care will cut into our patient satisfaction scores. We are constantly being asked to be more efficient and cost-effective. At nights, we are occupied with hospital committee meetings, society conference calls, webinars, and possibly even family activities. Weekends are essentially off limits, and the available residents are merely a skeleton crew covering a preposterous number of patients through consolidated services. For ward rounds, we often struggle to identify who is “covering” our service due to crafty and complex coverage schemes designed to comply with work hour restrictions. Thus, simply paging the resident for rounds is not so easy. Core knowledge residency training has shifted toward simulators, online lectures, and videos. There is no educational substitution for actual interaction between an attending and their resident, yet we, as mentors, are nowhere to be found. The findings in this study are not surprising. Yet they challenge all of us who serve as mentors to reevaluate our priorities and increase our efforts. Asking someone to work extremely hard in a very stressful environment where they are likely to feel blame for nearly every unfavorable outcome while getting compensation that approaches minimal wage is a
tall order. On top of that, neglecting them and bombarding them with dehumanized education leaves residents feeling unfulfilled. Although time will always be our most precious resource, we must now learn ways to be efficient mentors. We must preemptively schedule time to round with the residents and not simply page them at our whim. We must attend scheduled resident conferences and be engaged, not skip out or sit back and check our phones. Let them show us their knowledge rather than simply tell them the way it is and then leave. We must not be afraid to ask them questions with the intent to further their education. If challenged, our residents will rise to the occasion, just like we did. When we see residents perform well, we must acknowledge them, in public and in private. We must remain cognizant of surgical training and make sure that in each case they are engaged mentally and participate in a novel way, taking on more responsibility as they progress through training. We must focus on developing research programs that are compatible with resident skill sets and time constraints. We must remember what it was like to be a resident, and we must prioritize resident mentoring. The residents of today are our academic leaders of tomorrow and we, as mentors, have an irreplaceable role in shaping their careers. More than joining another subcommittee, or scoring 2 points higher on the patient satisfaction scale, or trimming 5 minutes off a 6-hour surgery, resident training is likely to be one of our most rewarding career endeavors. Scott T. Hollenbeck, MD, FACS Rachel Anolik, MD Division of Plastic and Reconstructive Surgery Duke University Medical Center Durham, NC [email protected]
REFERENCE 1. Chaput B, Bertheuil N, Jacques J, et al. Professional burnout among plastic surgery residents: can it be prevented? Outcomes of a national survey. Ann Plast Surg. 2015;75:2–8.
Conflicts of interest and sources of funding: none declared. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/15/7501–0009 DOI: 10.1097/SAP.0000000000000567
Annals of Plastic Surgery • Volume 75, Number 1, July 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.annalsplasticsurgery.com
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The Problem In the operating room, as attending surgeons, we fear retribution for less than perfect outcomes and deviations over our allotted operative time. We fear that asking residents' questions or correcting them will generate a complaint that will be detrimental to our career. In research, what was once a resident friendly retrospective chart review is now an exhaustive, Institutional Review Board analyzed multistep process, highly scrutinized by leadership for lack of funding, often rejected from journals for lack of complex modeling or statistics that necessitate a PhD or MPH level of training. In the outpatient setting, we are “in the weeds” with extensive documentation of the Electronic Health Record, overscheduling patients so we can keep the lights on in our extremely expensive hospital-based clinic, all coming at the expense of resident education. We fear that patients' perceptions that residents are involved in their care will cut into our patient satisfaction scores. We are constantly being asked to be more efficient and cost-effective. At nights, we are occupied with hospital committee meetings, society conference calls, webinars, and possibly even family activities. Weekends are essentially off limits, and the available residents are merely a skeleton crew covering a preposterous number of patients through consolidated services. For ward rounds, we often struggle to identify who is “covering” our service due to crafty and complex coverage schemes designed to comply with work hour restrictions. Thus, simply paging the resident for rounds is not so easy. Core knowledge residency training has shifted toward simulators, online lectures, and videos. There is no educational substitution for actual interaction between an attending and their resident, yet we, as mentors, are nowhere to be found. The findings in this study are not surprising. Yet they challenge all of us who serve as mentors to reevaluate our priorities and increase our efforts. Asking someone to work extremely hard in a very stressful environment where they are likely to feel blame for nearly every unfavorable outcome while getting compensation that approaches minimal wage is a
tall order. On top of that, neglecting them and bombarding them with dehumanized education leaves residents feeling unfulfilled. Although time will always be our most precious resource, we must now learn ways to be efficient mentors. We must preemptively schedule time to round with the residents and not simply page them at our whim. We must attend scheduled resident conferences and be engaged, not skip out or sit back and check our phones. Let them show us their knowledge rather than simply tell them the way it is and then leave. We must not be afraid to ask them questions with the intent to further their education. If challenged, our residents will rise to the occasion, just like we did. When we see residents perform well, we must acknowledge them, in public and in private. We must remain cognizant of surgical training and make sure that in each case they are engaged mentally and participate in a novel way, taking on more responsibility as they progress through training. We must focus on developing research programs that are compatible with resident skill sets and time constraints. We must remember what it was like to be a resident, and we must prioritize resident mentoring. The residents of today are our academic leaders of tomorrow and we, as mentors, have an irreplaceable role in shaping their careers. More than joining another subcommittee, or scoring 2 points higher on the patient satisfaction scale, or trimming 5 minutes off a 6-hour surgery, resident training is likely to be one of our most rewarding career endeavors. Scott T. Hollenbeck, MD, FACS Rachel Anolik, MD Division of Plastic and Reconstructive Surgery Duke University Medical Center Durham, NC [email protected]
REFERENCE 1. Chaput B, Bertheuil N, Jacques J, et al. Professional burnout among plastic surgery residents: can it be prevented? Outcomes of a national survey. Ann Plast Surg. 2015;75:2–8.
Conflicts of interest and sources of funding: none declared. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/15/7501–0009 DOI: 10.1097/SAP.0000000000000567
Annals of Plastic Surgery • Volume 75, Number 1, July 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.annalsplasticsurgery.com
9
