Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Surg Res. 2024 Mar;295:9-18. doi: 10.1016/j.jss.2023.09.052. Epub 2023 Nov 11.
There is a well-established positive correlation between improved physician wellness and patient care outcomes. Mental fitness is a component of wellness that is understudied in academic medicine. We piloted a structured mental fitness Positive Intelligence (PQ) training program for academic surgeons, hypothesizing this would be associated with improvements in PQ scores, wellness, sleep, and trainee evaluations.
This is a single-institution, prospective, mixed-methods pilot study. All active Burn/Trauma/Acute & Critical Care Surgical faculty and fellows in our division were offered the PQ program and the option to participate in this research study. The 6-wk program consists of daily exercises on a smartphone application, weekly readings, and small-group meetings with a trained mindfulness coach. Study outcomes included changes in pretraining versus post-training PQ scores, sleep hygiene, wellness, and teaching scores. A Net Promoter Score was calculated to measure user overall experience (range -100 to 100; positive scores being supportive). For secondary analysis, participants were stratified into high versus low user groups by "muscle" scores, which were calculated by program use over time. A postintervention focus group was also held to evaluate perceptions of wellness and experience with the PQ program.
Data were analyzed for 15 participants who provided consent. The participants were primarily White (73.3%), Assistant Professors (66.7%) with Surgical Critical Care fellowship training (86.7%), and a slight female predominance (53.3%). Comparison of scores pretraining versus post-training demonstrated statistically significant increases in PQ (59 versus 65, P = 0.004), but no significant differences for sleep (24.0 versus 29.0, P = 0.33) or well-being (89.0 versus 94.0, P = 0.10). Additionally, there was no significant difference in teaching evaluations for both residents (9.1 versus 9.3, P = 0.33) and medical students (8.3 versus 8.5, P = 0.77). High versus low user groups were defined by the median muscle score (166 [Interquartile range 95.5-298.5]). High users demonstrated a statistically higher proportion of ongoing usage (75% versus 14%, P < 0.05). The final Net Promoter Score score was 25, which demonstrates program support within this group. Focus group content analysis established eight major categories: current approaches to wellness, preknowledge, reasons for participation, expected gains, program strengths, suggestions for improvement, recommendations for approaches, and sustainability.
Our pilot study highlighted certain benefits of a structured mental fitness program for academic acute care surgeons. Our mixed-methods data demonstrate significant improvement in PQ scores, ongoing usage in high user participants, as well as interpersonal benefits such as improved connectedness and creation of a shared language within participants. Future work should evaluate this program on a higher-powered scale, with a focus on intentionality in wellness efforts, increased exposure to mental fitness, and recruitment of trainees and other health-care providers, as well as identifying the potential implications for patient outcomes.
改善医生的健康状况和患者的护理结果之间存在着良好的正相关关系。精神健康是健康的一个组成部分，在学术医学中研究得还不够。我们为学术外科医生试点了一个结构化的精神健康积极智能（PQ）培训计划，假设这将与 PQ 分数、健康、睡眠和学员评估的改善有关。
这是一项单机构、前瞻性、混合方法的试点研究。我们部门的所有现役烧伤/创伤/急性和重症监护外科医生和研究员都被提供了 PQ 计划，并可以选择参加这项研究。为期 6 周的计划包括在智能手机应用程序上进行日常锻炼、每周阅读以及与经过培训的正念教练进行小组会议。研究结果包括培训前后 PQ 分数、睡眠卫生、健康和教学评分的变化。计算了净推荐值来衡量用户的整体体验（范围为-100 到 100；正数表示支持）。为了进行二次分析，根据“肌肉”评分将参与者分为高用户和低用户组，该评分是根据程序随时间的使用情况计算得出的。还进行了一次干预后焦点小组，以评估对健康的看法和对 PQ 计划的体验。
对同意参与的 15 名参与者的数据进行了分析。参与者主要是白人（73.3%）、助理教授（66.7%），具有外科重症监护 fellowship培训（86.7%），女性略占优势（53.3%）。与培训前相比，培训后 PQ 显著增加（59 对 65，P=0.004），但睡眠（24.0 对 29.0，P=0.33）或健康（89.0 对 94.0，P=0.10）无显著差异。此外，居民（9.1 对 9.3，P=0.33）和医学生（8.3 对 8.5，P=0.77）的教学评估也没有显著差异。高用户和低用户组是通过中位数肌肉评分（166 [四分位距 95.5-298.5]）定义的。高用户表现出更高比例的持续使用（75%对 14%，P<0.05）。最终的净推荐值为 25，这表明该组对该计划的支持。焦点小组的内容分析确定了八个主要类别：当前的健康方法、先验知识、参与的原因、预期收益、计划优势、改进建议、方法建议和可持续性。
我们的试点研究强调了结构化精神健康计划对学术急性护理外科医生的某些益处。我们的混合方法数据表明 PQ 分数显著提高，高用户参与者持续使用，以及参与者之间的人际效益，如改善联系和在参与者中创造共同语言。未来的工作应该在更高功率的基础上评估该计划，重点关注健康工作的意图、更多地接触心理健康以及招募学员和其他医疗保健提供者，并确定对患者结果的潜在影响。
