Arghavan Salles

The relationship between grit and resident well-being

BACKGROUND The well-being of residents in general surgery is an important factor in their success within training programs. Consequently, it is important to identify individuals at risk for burnout and low levels of well-being as early as possible. The aim of this study was to test the hypothesis that resident well-being may be related to grit, a psychological factor defined as perseverance and passion for long-term goals. METHODS One hundred forty-one residents across 9 surgical specialties at 1 academic medical center were surveyed; the response rate was 84%. Perseverance was measured using the Short Grit Scale. Resident well-being was measured with (1) burnout using the Maslach Burnout Inventory and (2) psychological well-being using the Dupuy Psychological General Well-Being Scale. RESULTS Grit was predictive of later psychological well-being both as measured by the Maslach Burnout Inventory (B = -.20, P = .05) and as measured by the Psychological General Well-Being Scale (B = .27, P < .01). CONCLUSIONS Measuring grit may identify those who are at greatest risk for poor psychological well-being in the future. These residents may benefit from counseling to provide support and improve coping skills.

CT of pancreas: minimum intensity projections.

ObjectiveThe purpose of this pictorial essay is to showcase the use of minimum intensity projection in the imaging of low attenuation structures such as the pancreatic duct.ConclusionMinimum intensity projection is a valuable adjunct to other processing techniques for the diagnosis and staging of pancreatic adenocarcinoma and cystic tumors of the pancreas.

Promoting Balance in the Lives of Resident Physicians: A Call to Action

As physicians, we spend a significant amount of time counseling our patients on how to live healthier lives. Ironically, as trainees and practicing physicians, we often do not prioritize our own physical and psychological health. Most residents go to work despite significant physical impairment and severe anxiety.1 Compared with population controls, residents are more likely to experience burnoutandexhibitsymptomsofdepression.2 Theseproblems persist into practice; a recent national survey3 found that 40% of surgeons were burnt out and that 30% had symptoms of depression. Another study4 reported that 6% of surgeons experienced suicidal ideation in the preceding 12 months. Perhaps most startling, there are roughly 300 to 400 physicians who die by suicide per year—the equivalent of 3 medical school graduating classes.5 Against the backdrop of compelling data suggesting the need for interventions to promote wellness, our general surgery training program suffered the tragic suicide of one of our recent graduates in November 2010. After mourning his loss only 5 months after having left Stanford, our residency program took decisive action to create a multifaceted program aimed at enhancing resident wellness. Our goals were to create a program to help residents cope with daily stress, provide tools to manage challenges after completing residency, and reduce the risk of burnout, depression, and suicide. We first formed a committee consisting of residents and faculty. Through several meetings over the course of 4 months, we arrived at the structure of a Balance in Life program, now in its fourth year of implementation. Others, faced with similar challenges, have created educational mental health lectureships.6 Our comprehensive curriculum strives to promote worklife balance despite the inherent stressors of surgical training. As outlined here, the program is divided into 4 domains of well-being: professional, physical, psychological, and social.

A Values Affirmation Intervention to Improve Female Residents' Surgical Performance

BACKGROUND Female residents in surgical training may face stereotype threat. The awareness of negative stereotypes about surgical ability based on gender may heighten stress and thus reduce performance. OBJECTIVE The main objective of this study was to assess the effectiveness of a brief stress-reducing writing exercise, known as a values affirmation, to mitigate the negative effects of stereotype threat on the performance of female surgical residents. METHODS This is a randomized, controlled trial in which 167 residents were invited to participate. A total of 45 resident volunteers, including 18 women, were randomized to the affirmation condition or the no-affirmation condition. We administered a values affirmation intervention and measured clinical evaluations data both prior to and 6 months after the intervention. RESULTS Women benefited from the affirmation. Women who had participated in the affirmation exercise earned higher clinical evaluation scores than those in the control condition (B = 0.34, P < .05). For men, performance did not differ by affirmation condition (B = -0.20, P = .35). CONCLUSIONS Our findings suggest a benefit of values affirmation for women in surgical training, as measured by performance on clinical evaluations. This suggests that a brief psychological intervention may improve on-the-job performance for women in surgery, an underrepresented group.

Fundamentals of Laparoscopic Surgery: Not Only for Senior Residents

OBJECTIVE Fundamentals of laparoscopic surgery (FLS) was developed by the Society of American Gastrointestinal and Endoscopic Surgeons to teach the physiology, fundamental knowledge, and technical skills required for basic laparoscopic surgery. We hypothesize that residents are doing more laparoscopic surgery earlier in residency, and therefore would benefit from an earlier assessment of basic laparoscopic skills. Here, we examine FLS test results and ACGME case logs to determine whether it is practical to administer FLS earlier in residency. DESIGN FLS test results were reviewed for the 42 residents completing FLS between July 2011 and July 2016. ACGME case logs for current and former residents were reviewed for laparoscopic cases logged by each postgraduate year. Basic and complex laparoscopic cases were determined by ACGME General Surgery Defined Category and Minimums Report. Descriptive statistics were used for analysis. SETTING Academic general surgery residency, Washington University in St. Louis School of Medicine. PARTICIPANTS Current and former general surgery residents. RESULTS A total of 42 residents took and passed FLS between July 2011 and July 2016. All residents successfully passed the FLS knowledge and skills examinations on the first attempt regardless of their postgraduate year (PGY 3n = 13, PGY 4n = 15, and PGY 5n = 14). Total laparoscopic case volume has increased over time. Residents who graduated in 2012 or 2013 completed 229 laparoscopic cases compared to 267 laparoscopic cases for those who graduated from 2014 to 2016 (p = 0.02). Additionally, current residents completed more laparoscopic cases in the first 2 years of residency than residents who graduated from 2012 to 2016 (median current = 38; former = 22; p < 0.001). Examining laparoscopic case numbers for current residents by PGY demonstrated that the number of total and complex laparoscopic cases increased in each of the first 3 years of residency with the largest increase occurring between the PGY 2 and PGY 3 years. In the PGY 4 and PGY 5 years, most laparoscopic cases were complex. CONCLUSION Increased use of laparoscopic surgery has led to a corresponding increase in laparoscopic case volume among general surgery residents. We would advocate for FLS testing to serve as an early assessment of laparoscopic knowledge and skill and should be performed before a significant increase in complex laparoscopic surgery during training.

Complete resection of a rare intrahepatic variant of a choledochal cyst

The vast majority of choledochal cysts occur as either saccular or diffuse fusiform dilatation of the extrahepatic bile duct. We describe the complete resection of a rare single intrahepatic choledochal cyst communicating with the extrahepatic biliary tree. While previous reports describe partial resection with enteral drainage, we performed a complete resection of this rare choledochal cyst.

Social Belonging as a Predictor of Surgical Resident Well-being and Attrition

OBJECTIVE In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition. DESIGN Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program). SETTING We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017). PARTICIPANTS Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included. RESULTS One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001). CONCLUSIONS Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.

Antidiabetic medication de-escalation following bariatric surgery: 减肥手术之后可以降级使用降糖药物

Approximately 216,000 bariatric surgery (BS) procedures were performed in 2016; an increase from 158,000 in 2011.1 This increase may be attributable to the rising awareness of beneficial effects on health and the improving safety profile of BS. According to the National Institutes of Health consensus criteria, patients qualify for bariatric surgery if they have a body mass index (BMI) ≥35 kg/m2 but <40 kg/m2 along with at least one obesity-related comorbidity or have a BMI ≥40 kg/m2 .

Physician Wellness in Surgical Residency

Purpose of ReviewPhysician wellness has become an increasing focus of attention in recent years as burnout among healthcare professionals appears to be on the rise. Within this review, we attempt to define burnout and describe the ways in which resident well-being is being addressed within surgical residency programs.Recent FindingsBurnout is a psychological construct, defined by emotional exhaustion, depersonalization, and a low sense of personal accomplishment, which has been shown to affect physicians beginning in their medical training. In spite of mounting evidence of the negative effects of burnout on physicians’ personal and professional lives, there is relatively little evidence on how best to address this increasingly pervasive problem. We categorize various ways in which individual surgical residency programs attempt to improve the well-being of their trainees.SummaryLittle consensus exists on how best to improve wellness for surgical trainees. Multiple individual programs have focused on a variety of interventions whose efficacy remains largely unproven. Increased standardization of burnout research with greater collaboration across institutions is needed in order to identify key wellness initiatives.

Assessing gender bias in qualitative evaluations of surgical residents

BACKGROUND There are notable disparities in the training, recruitment, promotion, and evaluation of men and women in surgery. The qualitative assessment of surgical residents may be implicitly gender biased. METHODS We used inductive analysis to identify themes in written evaluations of residents. We also performed a content analysis of words fitting previously defined communal, grindstone, ability, and standout categories. RESULTS Differences in themes that emerged from evaluations of male and female residents were notable regarding overall performance, references to the future, professional competency, job domains, disposition and humanism, and overall tone of evaluations. Comments about men were more positive than those about women, and evaluations of men included more standout words. CONCLUSIONS The more positive evaluations of men may handicap women if they are seen as less likely to perform well based on these evaluations. These differences suggest that implicit bias may play a role in the qualitative evaluation of surgical residents.