Turning stress into strength: Resilience training for surgeons

Jennifer E. Rosen, MD, FACS
Jennifer E. Rosen, MD, FACS

Many surgeons encounter challenging situations both clinically and within their work and home environments, and a morning panel session Tuesday, October 6—Resilience Training for Surgeons: How to Confront Adversity—outlined strategies for managing extreme incidents of stress.

“Resilience thrives in an environment [such as residency] when you have the opportunity to fail, where you have the opportunity to succeed, and where you can learn that not every cut kills and you can try to be your best self every day,” said Jennifer E. Rosen, MD, FACS, regional chief of endocrine surgery, Medstar Washington Hospital Center and Georgetown University Medical Center, Washington, DC. “Resilience is a muscle. It is intentional. You have to grow and nurture it,” she said, noting that a key component of resilience is the ability to adapt when your goals change.

The session will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.

Margo C. Shoup, MD, MBA, FACS
Margo C. Shoup, MD, MBA, FACS

Margo C. Shoup, MD, MBA, FACS, senior vice-president and chair, Cancer Institute Nuvance Health, CT, described two personal situations—her breast cancer diagnosis and her college-aged daughter’s leukemia—that compelled her family to readjust their life goals in order to cope with the stress brought on by these devasting events.

“The way we delt with [my daughter’s diagnosis] was somewhat similar to how we delt with my diagnosis, although, we took a step back and thought about how do we change our goals…what we really want for our kids is to be healthy and happy,” she said. “By being happy, you will be successful.”

Surgeons are resilient, she asserts. “We made it through four years of medical school and five to 10 years of residency and fellowship training, facing adversity all along the way, but resilience in life is a little less straightforward,” said Dr. Shoup, noting that surgeons who take the time to engage in daily activities they find personally rewarding will bolster their resilience both at work and at home.

Carter K. Lebares, assistant professor of surgery and director, University of California-San Francisco Center for Mindfulness in Surgery, summarized the benefits of Enhanced Stress Resilience Training (ESRT), which she described as a “basic skills lab for the mind that teaches three core skills: awareness, emotional regulation, and meta-cognition (awareness of one’s own cognitive processes).”

“We know that stress is a heterogeneous entity, meaning stress is not all bad…there is good stress, the kind that feels challenging and that stimulates adaptation and mastery,” Dr. Lebares said. “It’s our minds that prevent us from reacting to all stressors in the same way. This is the result of feedback between the body and mind specifically the hypothalamic-pituitary-adrenal (HPA) axis and the prefrontal cortex, a process that can be intervened upon,” she said.

Dr. Lebares also noted that the ability to respond and not react is a skill that can be taught, and mindfulness training in particular, enhances an individual’s ability to do this. With the cost of burnout across specialties totaling $4.6 billion annually, evidence-based, individual interventions are not only feasible they are essential, she said.