Thielmann Beatrice, Meyer Frank, Böckelmann Irina
Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg mit Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland.
Chirurgie (Heidelb). 2024 Feb;95(2):135-147. doi: 10.1007/s00104-023-01977-9. Epub 2023 Nov 21.
Surgery represents a challenging medical discipline.
This article focuses on psychological stress in surgery and explains resilience as a protective factor against the consequences of psychological stress, based on selected literature references and own relevant clinical experiences. In this context, the sense of coherence, social support and self-efficacy expectation are discussed in more detail as resilience factors.
Narrative review.
RESULTS (CORNER POINTS): Surgery is classified as a challenging medical subspecialty with a high reputation but associated with diverse and varied physical and psychological stress factors. Stress factors differ individually in terms of requirements (can be overdemanding or underdemanding but also stimulating, relevant to learning and meaningful, thus positively or negatively stressful) and resources (potentially beneficial working conditions, experience, or behavior, e.g., social support, scope for action). Fluctuations within surgical specialties and a high dropout rate during residency training are well known and the causes include high psychological stress. In the case of persistent and at the same time insufficient compensation of work stress caused by a lack of or insufficient resources, these can be associated with mental illnesses. Nonetheless, many physicians spend their entire lives working in hospital or private surgical settings and remain healthy, a strong sense of resilience to mental illness may be fundamental to this. Resilience can be present as a personal characteristic or it can be learnt through a process or adapted through positive or negative influences, thus strengthening the personal characteristics. Overall, data on surgeon resilience or interventional studies in resilience research in the surgical setting are limited and provide another research gap. Resilience training (directed at a sense of coherence, social support, strengthening knowledge of coping skills, positive emotions, optimism, hope, self-efficacy expectations, control beliefs or robustness), also clearly indicated in the "robust" medical specialty of surgery, is always individual and should not be generalized. If the surgeon cannot retrieve sufficient resources due to the stressful situation, stress management with its methods is helpful to reduce the psychological stress and to be able to maintain the performance and health of this person.
The consolidation of resilience as a notable aspect of employee management. In collegial interactions, resilience must be based on workplace-based approaches to strengthen coping mechanisms in the face of work stress. Workplace-related stress should also be perceived, addressed and counteracted within the organization, certainly also as an elementary management task.
外科手术是一门具有挑战性的医学学科。
本文基于选定的文献参考资料和自身相关临床经验，重点探讨外科手术中的心理压力，并将恢复力解释为抵御心理压力后果的保护因素。在此背景下，将更详细地讨论连贯感、社会支持和自我效能期望等恢复力因素。
叙述性综述。
结果（要点）：外科手术被归类为一门具有挑战性的医学亚专业，声誉很高，但伴随着各种各样的生理和心理压力因素。压力因素在要求方面（可能要求过高或过低，但也可能具有刺激性、与学习相关且有意义，因此具有正向或负向压力）和资源方面（潜在有益的工作条件、经验或行为，例如社会支持、行动范围）存在个体差异。外科专业内部的波动以及住院医师培训期间的高辍学率是众所周知的，其原因包括高心理压力。如果由于资源缺乏或不足导致工作压力持续且同时得不到充分补偿，这些压力可能与精神疾病有关。尽管如此，许多医生一生都在医院或私人外科环境中工作且保持健康，对精神疾病具有强大的恢复力可能是其根本原因。恢复力可以作为一种个人特质存在，也可以通过一个过程习得或通过正向或负向影响而改变，从而强化个人特质。总体而言，关于外科医生恢复力的数据或外科环境中恢复力研究的干预性研究有限，这是另一个研究空白。恢复力训练（针对连贯感、社会支持、增强应对技能知识、积极情绪、乐观、希望、自我效能期望、控制信念或强健性），在“强健”的外科医学专业中也有明确体现，始终是因人而异的，不应一概而论。如果外科医生由于压力状况无法获取足够资源，压力管理及其方法有助于减轻心理压力，并能够维持其工作表现和健康。
将恢复力巩固为员工管理的一个显著方面。在同事间的互动中，恢复力必须基于以工作场所为基础的方法，以加强面对工作压力时的应对机制。与工作场所相关的压力也应在组织内部被察觉、处理和应对，当然这也是一项基本的管理任务。
