Burnout and Attrition: Looking from the Perspective of Psychological Safety in Surgical Education

Abstract

Objective: Nearly 70% of surgical trainees suffer from burnout, 24-40% have thoughts of attrition, and 20% leave surgery residency. One approach to examine the environment in which burnout and attrition are prevalent is through assessment of a person’s psychological safety (PS). Cumulative stress of an environment with low PS could be hypothesized to contribute to burnout and attrition. The operating room (OR) is an ideal place to study PS given its complex, higher stress environment. Design:We conducted a mixed-methods survey examining 1) how PS in the OR relates to burnout and thoughts of attrition, considering duty hour violations and satisfaction with mentorship, and 2) how OR educator behaviors impact PS. Quantitative measures included validated PS and burnout scales, assessment of mentorship, thoughts of attrition, duty hour violations, and microaggressions. Thematic analysis was performed on open-ended questions about OR educator behaviors either promoting or hindering PS. Setting:Three general surgery programs across a variety of hospital settings. Participants: Categorical general surgery residents at all training levels. 35 responses were included for analysis, 37% response rate.

Results: Increased PS was associated with increased satisfaction with mentorship, decreased duty hour violations, and decreased thoughts of attrition. Increased satisfaction with mentorship was associated with decreased burnout and decreased thoughts of attrition. 71% of residents reported that having positive experiences in the OR have a significant impact on how they view their educational experience. Four behavioral themes were found to be associated with PS: investment in the resident, encouraging a growth mindset, open communication, and creating a collaborative environment.

Conclusions: Psychological safety in the OR appears to be associated with satisfaction with mentorship and thoughts of attrition, supporting our conceptual model describing the relationship between these factors. Understanding behavioral facilitators and decreasing barriers to PS in the OR can help institutions implement interventions for improving burnout and attrition in surgical education.