Adverse events may be associated with negative personal impact on surgeons, trainees
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Key takeaways:
- Surgical faculty and trainees report a negative psychological impact associated with adverse events in their patients.
- Trainees from historically underrepresented groups were most frequently affected.
Surgical faculty and trainees report having a negative psychological impact associated with adverse events in their patients, according to results from a mixed-methods study and survey.
Researchers surveyed 93 surgical trainees and interviewed 23 surgical faculty members from seven programs within a single health system. According to the study, programs included cardiothoracic surgery, general surgery, orthopedic surgery, otorhinolaryngology, plastic surgery, urology and vascular surgery.
Overall, 82.8% of trainees (n = 77) reported being involved in at least one recent adverse event, with 22.6% of trainees (n = 21) reporting involvement in at least five adverse events. Among trainees, 84.8% reported embarrassment; 82.1% reported rumination; 65.4% reported fear of attempting future procedures and 35.9% considered quitting. In addition, 97.4% of trainees reported the most desired form of support was the opportunity to discuss the incident with an attending physician.
Researchers noted female trainees and trainees from historically underrepresented groups more frequently reported negative psychological consequences from adverse events compared with male and white trainees.
Among surgical faculty members, 100% reported involvement in at least one adverse event that led to negative psychological consequences. Faculty members reported adverse events with a negative psychological impact were commonly unexpected, had a lack of clear explanation and caused significant harm to the patient.
According to the study, faculty members reported the utility of confiding in peers and senior colleagues after an adverse event; however, some faculty members reported an unwillingness to reach out for support. Researchers also noted most faculty members were unfamiliar or skeptical of institutional support resources.
“Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups,” the researchers wrote in the study.
Perspective
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Jeffrey M. Smith, MD, FAAOS, FACS, PCC
The authors highlight that significant distress, negative thoughts and emotions arise in surgeons after patient adverse events. Surgical trainees may be particularly vulnerable to these catastrophic moral injuries due to their inexperience, especially if inadequately trained in healthy coping strategies. I can personally attest to the damage it can even do to the psyche of an experienced surgeon.
The article further reinforces that a dedicated program for surgeons delivered by surgeons with buy-in from surgeons is necessary to support the humanity and recovery of those recovering from an event with harm to the patient (whether real or perceived). While counseling, web-based mental health resources, internal advocates, trained supportive peers and even app-based programs can help destigmatize the “dings in our shields” or actual scars to our souls, nothing will replace the effectiveness of a third-party surgeon well-trained in specific coaching skills after an adverse event.
We must help surgeons prepare for these events through education, standard immediate and follow-up outreach, and voluntary response options. Ultimately, this will support the career development and well-being of trainees, surgeons and patients.
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