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.
then Dr. Lebares recently shared with me several concepts her group has been
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
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
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
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.
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.
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
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