Anand Ananya, Jensen Rachel, Korndorffer James R
Department of Surgery, Stanford University, Stanford, California.
Department of Surgery, Stanford University, Stanford, California.
J Surg Educ. 2023 Nov;80(11):1618-1640. doi: 10.1016/j.jsurg.2023.07.009. Epub 2023 Aug 3.
Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation.
A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score.
A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8).
Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.
职业倦怠、抑郁和疲劳在外科住院医师中很常见。大多数已发表的外科领域健康研究仅关注培训中围绕健康的态度和认知的横断面视图。虽然这些文献大多呼吁采取干预措施并提出改善住院医师幸福感的策略，但已发表的健康倡议很少，进行项目评估的更少。
一项范围综述旨在解决以下问题：（1）外科住院医师培训项目中采用了哪些健康倡议？（2）这些项目涉及哪些健康领域？（3）项目结果如何评估？使用PubMed、Embase和Scopus数据库进行正式文献检索，以识别在美国进行的描述针对外科住院医师的以健康为重点的倡议的英文研究。两位作者独立筛选所有摘要和全文以确定是否纳入。提取的数据包括健康领域和结果评估方法以及相关的柯克帕特里克级别（1-反应，2-学习，3-行为，4-结果）。使用医学教育研究研究质量指数（MERSQI）评分检查研究质量。
共筛选了2237篇摘要，审查了115篇全文的合格性。最终分析纳入了51项研究，代表39个不同的健康项目。涉及的最常见健康领域是情绪（19/39，48.7%）、职业（17/39，43.6%）和身体（16/39，41.0%）。在审查的51项研究中，8项（15.7%）未进行任何项目评估，27项（52.9%）评估了1级，30项（58.8%）评估了2级，3项（5.9%）评估了3级，没有评估4级结果。平均MERSQI评分为9.16（标准差1.8）。
健康是外科培训中一个既定的问题。本综述揭示了少数已发表的健康干预措施，而在行为和结果变化层面纳入项目评估的更少。有效的改变将需要严谨且深思熟虑的规划，涉及多个领域和评估层面。
