INTEGRATION OF RESILIENCE / MINDFULNESS TRAINING INTO A DEPARTMENT OF SURGERY: Interview with Carter LeBares, MD Director UCSF Aging, Metabolism and Emotion research Center.
Historically, surgeons deemed themselves highly resilient and resistant to the effects of stress. Over the past decade, it has steadily been recognized that surgeons are very susceptible to the effects of fatigue including burnout. Fortunately, I have had the pleasure of discussing this concern with several surgeons who are experts in the field of burnout, resiliency and mindfulness.
Following our collaborative efforts during the 2017 ACS panel, Crisis Management in the Operating Room, Dr. Sharmila Dissanaike, MD* (Chair Dept Surgery at TTUHSC), met with me to discuss her work in mindfulness training and its importance in developing resilience to burnout. She explained to me that she had positive experiences with teaching mindfulness and helping trainees develop more secure emotional intelligence.
After a Duke University Feagin Leadership Conference, I met with LTG (Ret) Eric B. Schoomaker, MD** (Surgeon General of the US Army 2007 to 2011) to discuss his thoughts about resiliency and the benefits of mindfulness training during his tenure in his Army leadership positions. During that moment he revealed that he developed the skills of mindfulness towards the conclusion of his US Military leadership role. He said, in retrospect he felt that if he had mastered this early on, he would potentially have felt less stress during the many challenges he faced.
Previously, Risk and resilience factors associated with resident burnout, that 33% of first year residents experience burnout and of that group, they exhibited lower levels of mindfulness and coping skills and higher levels of depression symptoms, fatigue, worry, and stress.***
Since then Dr. Lebares recently shared with me several concepts her group has been working on. One interesting area is the use of Enhanced Stress-Resilience Training to reduce generalized anxiety among surgery trainees to reduce burnout, depression and potential for suicide.
WHILE LISTENING TO HER RECENT PRESENTATIONS DURING THE AMERICAN COLLEGE OF SURGEONS VIRTUAL CLINICAL CONGRESS (Oct 2020), SEVERAL QUESTIONS CAME TO MIND THAT I ASKED TO DISCUSS WITH HER ON NOVEMBER 2nd 2020:
ENHANCED STRESS RESILIENCE TRAINING (ESRT) is a formal mindfulness-based stress resilience training. The theory is that this can modify the hypothalamic pituitary adrenal axis.
We are currently working with Lorrie Langdale at the University of Washington and Pierre F. Saldinger, MD – New York-Presbyterian Hospital
· Activation of ventrolateral prefrontal cortex (which includes the inferior frontal gyrus) is associated with reinterpretation of the affective stimuli to alter emotional impact. Our study proves that these images are provocative regardless who the person is. Provocation was seen in both intervention and control.
· Activation of the Dorsolateral prefrontal cortex (which includes the middle and superior frontal gurus) is associated with the functioning of the executive control hub of higher order cognition. This is the area of filtering and responding to stimuli.
· The precuneus (which is within the posterior Cingular’s cortex) is associated with mental imagery/ Interoception, Visio spatial motor skills/ bimanual skills and self-awareness/self-reference. It is the seat in the brain for our inner awareness. It allows you to comprehend “how might I solve this problem”.
Both areas are activated during mindfulness stress reduction.
* Dr. Sharmila Dissanaike is the Professor and the Peter C. Canizaro Chair of Surgery at TTUHSC. She is the former Medical Director of the John A. Griswold Level 1 Trauma Center and the Assistant Director of the Timothy J. Harnar Burn Center at UMC. She is active in clinical surgery, with a focus on critical care, trauma and burns.
**LTG (Ret) Eric B. Schoomaker Surgeon General of The United States Army 2007 to 2011 (prior to that he was the Commander of the N. Atlantic Regional Medical Command and Walter Reed Army MC). https://crisislead.blogspot.com/2016/06/lessons-on-resiliency-in-leadership-by_7.html
***Chaukos D, Chad-Friedman E, Mehta DH, et al. Risk and resilience factors associated with resident burnout. Acad Psy- chiatry 2017;41:189-194.
****Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11:412–420.
*****Carter Lebares- Assistant Professor of Surgery Division of General Surgery Director, UCSF Center for Mindfulness in Surgery
Lebares CC, Guvva EV, Ascher NL, O’Sullivan PS, Harris HW, Epel ES. Burnout and Stress Among US Surgery Residents: Psychological Distress and Resilience. J Am Coll Surg 2018;226:80-90.
The effect of mindfulness-based cognitive skills training on anxiety among general surgery residents during covid-19 Caitlin R Collins MD, MPH, Micaela L Rosser MD, Anya L Greenberg MBA, Carter C Lebares MD, University of California, San Francisco
A Feasibility trial of formal mindfulness based stress resilience training among surgery interns JAMA 2018/sur/08292018
Key factors for implementing mindfulness based burnout interventions in surgery Am J Surg 2019 in Press
Enhanced stress resilience training in surgeons: iterative adaptation and biopsychosocial effects in 2 small randomized trials. Annals Surgery In press 2020
Efficacy of mindfulness based cognitive training in surgery: additional analysis of the mindful surgeon pilot randomized clinical trial. JAMA 2019/05 24 2019.
Annals of surgery
Lebares CC, Coaston TN, Delucchi KL, Guvva EV, Shen WT, Staffaroni AM, Kramer JH, Epel ES, Hecht FM, Ascher NL, Harris HW, Cole SW
American journal of surgery
Lebares CC, Guvva EV, Desai A, Herschberger A, Ascher NL, Harris HW, O'Sullivan P
JAMA network open
Lebares CC, Guvva EV, Olaru M, Sugrue LP, Staffaroni AM, Delucchi KL, Kramer JH, Ascher NL, Harris HW
Lebares CC, Hershberger AO, Guvva EV, Desai A, Mitchell J, Shen W, Reilly LM, Delucchi KL, O'Sullivan PS, Ascher NL, Harris HW
American journal of surgery
Lebares CC, Braun HJ, Guvva EV, Epel ES, Hecht FM
Journal of the American College of Surgeons
Lebares CC, Guvva EV, Ascher NL, O'Sullivan PS, Harris HW, Epel ES