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- Title
Surgeon and Surgical Trainee Experiences After Adverse Patient Events.
- Authors
Ginzberg, Sara P.; Gasior, Julia A.; Passman, Jesse E.; Stein, Jacob; Keddem, Shimrit; Soegaard Ballester, Jacqueline M.; Finn, Caitlin B.; Myers, Jennifer S.; Kelz, Rachel R.; Shea, Judy A.; Wachtel, Heather
- Abstract
Key Points: Question: How are surgeons and surgical trainees affected by adverse patient events, and what coping mechanisms are used? Findings: This mixed-methods study surveyed 93 surgical trainees and interviewed 23 faculty and found that surgeons and trainees frequently grapple with the personal impact of adverse events. Trainees who identified as female and/or from a minority racial or ethnic background more frequently reported negative psychological consequences, and surgeons described opportunities to reduce stigma and improve support mechanisms. Meaning: These findings suggest that the negative personal impact of adverse events is underrecognized but nearly universal in surgery; more formal structures to restore surgeon and trainee well-being are warranted and may be particularly helpful for underrepresented groups. This mixed-methods study examines how trainees and faculty cope with the impact of adverse patient events. Importance: Adverse patient events are inevitable in surgical practice. Objectives: To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient. Design, Setting, and Participants: In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system. Main Outcomes and Measures: The personal impact of adverse patient events, current coping mechanisms, and desired forms of support. Results: Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing. Conclusions and Relevance: In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.
- Subjects
TREATMENT of psychological stress; WORK; CROSS-sectional method; ACADEMIC medical centers; MEDICAL errors; RESEARCH funding; INTERNSHIP programs; INTERVIEWING; SURGEONS; PSYCHOLOGICAL adaptation; CHI-squared test; DESCRIPTIVE statistics; PSYCHOLOGICAL stress; RESEARCH methodology; ADVERSE health care events; SOCIAL support; DELPHI method; DATA analysis software; PSYCHOSOCIAL factors; EXPERIENTIAL learning
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2414329
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.14329