Charles H. Brown

What stress coping strategies are surgeons relying upon during surgery

BACKGROUND The objective of this study was to determine sources of intraoperative stress, impact on surgical outcomes, coping strategies, and surgeon interest in stress management training. METHODS An anonymous survey was electronically distributed to surgeons at a tertiary care hospital. Respondents were asked to rate the perceived impact of 9 stressors on operative performance, identify stress coping strategies, list witnessed stress-related complications, and opine on the perceived need for stress management training. RESULTS Seventy-two responses were received (76% relative risk). Complex or rarely performed cases and poor assistance were associated with the highest stress, while personal life distractions were associated with the least. Importantly, 40% of surgeons indicated that they had witnessed an intraoperative complication directly related to surgeon stress. Respondents (82%) believed that formal stress management training is needed. CONCLUSIONS Several stressors affect surgical performance and contribute to complications. Surgeons use a variety of stress coping strategies. Formal stress management training is needed.

Papilloma of the gallbladder; report of eight cases.

Abstract Eight proved cases of papilloma of the gallbladder occurring in 425,000 new patients and 2,000 cholecystectomies are presented. In three patients the diagnosis was made preoperatively by cholecystography, in one patient a small papilloma of the gallbladder was palpated at the time of a gastric resection and in four the papilloma was an incidental finding by the pathologist. There were associated gallstones in three patients, cholesterosis in one, chronic cholecystitis in two and absence of additional pathologic disorder in two. In no patient could symptoms be attributed to the papillomas. The use of routine postero-anterior and decubitus cholecystographic films are most helpful in the diagnosis of this lesion. Elective cholecystectomy is the recommended treatment because of the high incidence of associated disease in the gallbladder and because of the possibility that papillomas may be the precursors of malignancy.

Minimizing Deterioration of Simulator-Acquired Skills During Transfer to the Operating Room: A Novel Approach

Purpose of ReviewSurgical skill deteriorates due to stress, but mental skills may negate this skill deterioration. We recently developed a mental skills curriculum (MSC) to address this, and present findings of its effectiveness compared to historical controls.Recent FindingsThe MSC was implemented with surgical novices during simulator training, and results were compared to historical controls who had no mental skills training. The groups were comparable at baseline. Compared with the MSC group, historical controls trained longer and achieved higher performance on the simulator but without appreciable differences during the transfer test. Deterioration was less in the MSC group during transfer.SummaryOur review highlights the effectiveness of mental skills training in surgical education in general, and our novel, comprehensive MSC in minimizing performance deterioration during transfer of simulator-acquired skill. Inexperienced surgical trainees who use a comprehensive MSC may be better prepared to handle the stressful OR environment and optimize their performance.