Investigating influential factors and mechanisms of surgical resident well-being using social network analysis

Ari S Coopersmith; Michael H Berler; Brianna Johnston; Lillian Knutilla; Anya L Edwards; Carter C Lebares; General Surgery Research Collaborative on Resident Wellbeing

doi:10.1016/j.amjsurg.2023.09.004

Investigating influential factors and mechanisms of surgical resident well-being using social network analysis

Am J Surg. 2024 Feb:228:45-51. doi: 10.1016/j.amjsurg.2023.09.004. Epub 2023 Sep 6.

Authors

Ari S Coopersmith¹, Michael H Berler¹, Brianna Johnston¹, Lillian Knutilla¹, Anya L Edwards¹, Carter C Lebares²; General Surgery Research Collaborative on Resident Wellbeing¹

Collaborators

General Surgery Research Collaborative on Resident Wellbeing:
Celia Divino³, Jennifer N Choi⁴, Jennifer E Hrabe⁵, Julia S Shelton⁵, Christopher M Foglia⁶, Varuna Sundaram⁶, Brooke Gurland⁷, David A Spain⁷, Matthew Hanlon⁸, Andreas H Meier⁸, Kelly R Haisley⁹, Alan Harzman⁹, Emily Huang⁹, Jennifer Preston¹⁰, Valentine Nfonsam¹¹, Taylor S Riall¹¹, Barnard J A Palmer¹², Gregory P Victorino¹², Tim R Donahue¹³, Veronica F Sullins¹³, Kenzo Hirose¹⁴, Linda M Reilly¹⁴, Kshama R Jaiswal¹⁵, Mark R Nehler¹⁵, Melissa Brunsvold¹⁶, Daniel E Kendrick¹⁶, M Timothy Nelson¹⁷, Robert B Lim¹⁷, Karen D Horvath¹⁸, Lorrie A Langdale¹⁸, Rebecca Maine¹⁸

Affiliations

¹ UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
² UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA. Electronic address: Carter.Lebares@ucsf.edu.
³ Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Department of Surgery, Indiana University, Indianapolis, IN, USA.
⁵ Department of Surgery, University of Iowa, Iowa City, IA, USA.
⁶ Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA.
⁷ Department of Surgery, Stanford University, Stanford, CA, USA.
⁸ Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.
⁹ Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹⁰ Department of Surgery, University of Arizona, Phoenix, AZ, USA.
¹¹ Department of Surgery, University of Arizona, Tucson, AZ, USA.
¹² Department of Surgery, UCSF-East Bay, Oakland, CA, USA.
¹³ Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
¹⁴ Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
¹⁵ Department of Surgery, University of Colorado, Denver, CO, USA.
¹⁶ Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
¹⁷ Department of Surgery, University of Oklahoma at Tulsa, Tulsa, OK, USA.
¹⁸ Department of Surgery, University of Washington, Seattle, WA, USA.

PMID: 37722938
DOI: 10.1016/j.amjsurg.2023.09.004

Abstract

Background: Burnout and depression in General Surgery residents affect patient care and drive attrition. Few impactful interventions exist, in part because little is known about influential drivers and mechanistic relationships.

Methods: Residents from 16 general surgery programs completed published well-being scales in January 2021. Social network analysis demonstrated influential relationships between factors, and path analysis revealed drivers of burnout and depression.

Results: 300 residents completed the survey (34% response rate). Workplace demand and mindfulness influenced depressive symptoms and emotional exhaustion, mediated by perceived stress. Mindfulness increased personal accomplishment, mediated by psychological well-being (p < 0.05 for all results). All mediated effects were greater than direct effects.

Conclusions: This study yielded a quantitative conceptual model of mechanistic relationships affecting well-being in surgical residency, identifying stress and psychological well-being (measuring sense of purpose) as central mediators, and triangulating workplace demand and mindfulness as potentially high-yield interventional targets for reducing burnout and depression in surgical residency.

Keywords: Burnout; Depression; Mindfulness; Residency; Training; Well-being.

MeSH terms

Burnout, Professional* / prevention & control
Burnout, Professional* / psychology
Humans
Internship and Residency*
Social Network Analysis
Surveys and Questionnaires
Workplace