Burned Out Trainee Surgeons at High Risk for Alcohol Abuse, Depression, Suicidal Thoughts

UCSF News reports on the results of study led by Carter Lebares, M.D., assistant professor and director the UCSF Center for Mindfulness in Surgery, to assess burnout in general surgery residents. An online survey was distributed in September, 2016, to all ACGME-accredited general surgery programs. Stress, anxiety, depression, resilience, mindfulness, and alcohol use were assessed and analyzed for prevalence. The results, published online in the Journal of the American College of Surgeons on Oct. 26, 2017, were stunning, finding that "7 of 10 trainee surgeons in the survey experienced burnout as a result of emotional exhaustion, “depersonalization” and doubts about their work effectiveness, impacting their performance and potentially patients health.

“Surgical trainees live in a culture where high stress is normative, but excessive stress must be addressed,” said Lebares, noting that 53 percent of residents scored positive for high perceived stress. “While surgical trainees have willingly chosen a high-stress career, the existence of overwhelming stress is evidenced by the strong association between stress and distress symptoms like depression, suicidal thoughts and high anxiety.”

According to Lebares, there is point after stress can overwhelm the resources of a person to handle it  effectively.

“Although stress is initially stimulating, there is a tipping point when demand outstrips resources and stress becomes overwhelming,” Lebares said. “In the absence of adequate coping skills, overwhelming stress that lasts for years has been associated with mood disorders and physiologic deterioration that can lead to disruption of neuro-endocrine regulation and exacerbation of atherosclerosis.”

“Although stress is initially stimulating, there is a tipping point when demand outstrips resources and stress becomes overwhelming,” Lebares said. “In the absence of adequate coping skills, overwhelming stress that lasts for years has been associated with mood disorders and physiologic deterioration that can lead to disruption of neuro-endocrine regulation and exacerbation of atherosclerosis.”

The study also found that mindfulness might present silver lining to stressed residents according the UCSF News.

However, the study revealed two silver linings. Emotional exhaustion, high stress and anxiety, which peaked in the third year of residency, appeared to decline markedly during the later lab years. Secondly, while most of the residents scored high on stress resilience, researchers noted that it was their “dispositional mindfulness” that seemed to serve as a psychological buffer against the rigors of training. Mindfulness was associated with an 85 percent lower probability of scoring high in stress.

“Mindfulness isn’t about thinking nicer thoughts; it’s about recognizing stressors, learning to pause and to assess those stressors in a less reactive and emotional way,” said Lebares, who is also director of the UCSF Center for Mindfulness in Surgery.