Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials.
Carter C Lebares, Troy N Coaston, Kevin L. Delucchi, Ekaterina V. Guvva, Wen T. Shen, Adam M Staffaroni, Joel H. Kramer, Elissa S Epel, Frederick M Hecht, Nancy L. Ascher, Hobart W. Harris, Steven W Cole
Annals of surgery March 1, 2021 DOI: 10.1097/sla.0000000000004145 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 89 |
| Population | PGY-1 resident trainees: surgical (ESRT-1, n=44) and mixed specialty (ESRT-2, n=45) volunteers at a single institution |
| Interventions | ESRT a tailored mindfulness-based cognitive training program |
| Duration | ESRT-1: 8 weekly 2-hour classes with 50-week follow-up; ESRT-2: 6 weekly 90-minute classes with 32-week follow-up |
| Measures | Maslach Burnout Inventory, Cognitive Affective Mindfulness Scale - Revised, conserved transcriptional response to adversity (leukocyte transcriptome profile), perceived stress, executive function |
| Keywords | Humans Pilot projects Burnout, professional Adaptation, physiological Education, medical, graduate Internship and residency Adult Female General surgery Resilience, psychological Surgeons Occupational stress |
| Key findings | Neither ESRT version appeared to affect perceived stress. Higher executive function and mindfulness scores were seen in ESRT-1 and lower emotional exhaustion and depersonalization in ESRT-2 at follow-up compared with controls, and pooled analysis found reduced pro-inflammatory RNA expression in ESRT-treated participants. The authors suggest ESRT can variably benefit executive function, burnout, and physiologic distress in PGY-1 trainees. |
Abstract
Objective: To determine the effects of ESRT (an iteratively adapted and tailored MBI) on perceived stress, executive cognitive function, psychosocial well-being (ie, burnout, mindfulness), and pro-inflammatory gene expression in surgical (ESRT-1) and mixed specialty (ESRT-2) PGY-1 volunteers. Summary of background and data: Tailored MBIs have proven beneficial in multiple high-stress and high-performance populations. In surgeons, tailored MBIs have been shown to be feasible and potentially beneficial, but whether mindfulness-based cognitive training can improve perceived stress, executive function, well-being or physiological distress in surgical and nonsurgical trainees is unknown.
Methods: In 2 small single-institution randomized clinical trials, ESRT, a tailored mindfulness-based cognitive training program, was administered and iteratively adapted for first-year surgical (ESRT-1, 8 weekly, 2-hour classes, n = 44) and mixed specialty (ESRT-2, 6 weekly, 90-minute classes, n = 45) resident trainees. Primary and secondary outcomes were, respectively, perceived stress and executive function. Other prespecified outcomes were burnout (assessed via Maslach Burnout Inventory), mindfulness (assessed via Cognitive Affective Mindfulness Scale - Revised), and pro-inflammatory gene expression (assessed through the leukocyte transcriptome profile "conserved transcriptional response to adversity").
Results: Neither version of ESRT appeared to affect perceived stress. Higher executive function and mindfulness scores were seen in ESRT-1, and lower emotional exhaustion and depersonalization scores in ESRT-2, at pre-/postintervention and/or 50-week follow-up (ESRT-1) or at 32-week follow-up (ESRT-2), compared to controls. Pooled analysis of both trials found ESRT-treated participants had reduced pro-inflammatory RNA expression compared to controls.
Conclusions: This pilot work suggests ESRT can variably benefit executive function, burnout, and physiologic distress in PGY-1 trainees, with potential for tailoring to optimize effects.
Citations in the library
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- Five Practical Video Modules to Reduce Physician Burnout Through Mindfulness and Systematic Review of Evidence Plastic and Reconstructive Surgery, Global Open August 26, 2025
- Implementing mindfulness meditation in hand surgery training: a feasibility study. European journal of plastic surgery 2022
- Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors. Cochrane Database of Systematic Reviews December 10, 2021
- Heal the Healers: A pilot study evaluating the feasibility, acceptability, and exploratory efficacy of a Transcendental Meditation intervention for emergency clinicians during the coronavirus disease 2019 pandemic. Journal of the American College of Emergency Physicians Open December 1, 2021
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and 2 more in the library