Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts.
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Surg Educ. 2023 Aug;80(8):1129-1138. doi: 10.1016/j.jsurg.2023.05.020. Epub 2023 Jun 17.
Leadership skills of team leaders can impact the functioning of their teams. It is unknown whether attending surgeons' leadership skills impact residents' physiological stress. This study sought to (1) assess the relationship between attending surgeons' leadership skills and residents' physiological stress and (2) to characterize lifestyle behaviors associated with resident physiological stress. We hypothesized that strong attending leadership skills would be associated with low resident physiological stress.
This prospective observational cohort study was conducted at a single urban, academic medical center in the US, over 12 months. Residents were enrolled during their rotation of 1 to 2 months on the Trauma and ICU services. The primary predictor was the attending surgeons' leadership skills that were measured using a weekly survey filled out by residents, using the Surgeons' Leadership Inventory (SLI). The SLI uses a 4-point Likert scale to measure surgeons' leadership skills across eight domains. The primary outcome was residents' physiological stress, which was measured by their Heart Rate Variability (HRV). We recorded the residents' HRV with a WHOOP strap that was continuously worn on the wrist or the bicep. We used multivariate repeated measures gamma regression to assess the relationship between attending leadership skills and residents' physiological stress, adjusting for hours of sleep, age, and service.
Sixteen residents were enrolled over 12 months. The median attending surgeons' leadership score was 3.8 (IQR: 3.2-4.0). The median residents' percent of maximal HRV was 70.8% (IQR: 56.7-83.7). Repeated measure gamma regression model demonstrated a minimal nonsignificant increase of 1.6 % (95% CI: -5.6, 8.9; p-value = 0.65) in the percent of maximal HRV (less resident physiological stress) for every unit increase in leadership score. There was an increase of 2.9% (95% CI= 1.6, 4.2; p-value < 0.001) in the percent of maximal HRV per hour increase in sleep and a significant decrease of 10.9% (95% CI= -16.8, -5.2; < 0.001) in the percent of HRV when working in the ICU compared to the Trauma service.
This study revealed that more residents' sleep was associated with lower physiological stress. Attending surgeons' leadership skills were not associated with residents' physiological stress.
团队领导的领导技能会影响团队的运作。目前尚不清楚主治医生的领导技能是否会对住院医生的生理压力产生影响。本研究旨在：(1)评估主治医生的领导技能与住院医生的生理压力之间的关系；(2)描述与住院医生生理压力相关的生活方式行为。我们假设，主治医生的领导技能越强，住院医生的生理压力就越低。
本前瞻性观察队列研究在美国的一家城市学术医疗中心进行，共持续 12 个月。住院医生在创伤和 ICU 服务科室轮转 1 至 2 个月期间被纳入研究。主要预测因素是主治医生的领导技能，由住院医生每周使用外科医生领导清单(SLI)进行评估。SLI 使用 4 分李克特量表来衡量外科医生在八个领域的领导技能。主要结局是住院医生的生理压力，通过心率变异性(HRV)来衡量。我们使用 WHOOP 腕带连续记录住院医生的 HRV，该腕带佩戴在手腕或二头肌上。我们使用多元重复测量伽马回归来评估主治医生的领导技能与住院医生的生理压力之间的关系，同时调整睡眠时间、年龄和科室。
在 12 个月期间共纳入了 16 名住院医生。主治医生的领导技能评分中位数为 3.8(四分位距：3.2-4.0)。住院医生最大 HRV 的中位数百分比为 70.8%(四分位距：56.7-83.7)。重复测量伽马回归模型显示，领导技能评分每增加 1 个单位，最大 HRV 的百分比(住院医生生理压力降低)仅增加 1.6%(95%CI：-5.6，8.9；p 值=0.65)，无统计学意义。睡眠时间每增加 1 小时，最大 HRV 的百分比增加 2.9%(95%CI=1.6，4.2；p 值<0.001)，与创伤科室相比，在 ICU 工作时，最大 HRV 的百分比下降 10.9%(95%CI=-16.8，-5.2；p 值<0.001)。
本研究表明，更多的睡眠时间与较低的生理压力相关。主治医生的领导技能与住院医生的生理压力无关。
