Association for Surgical Education
The stress of residency: recognizing the signs of depression and suicide in you and your fellow residents

Presented at the Meeting of the Association for Surgical Education, March 23, 2012, San Diego, CA.
https://doi.org/10.1016/j.amjsurg.2012.08.003Get rights and content

Abstract

Background

Stress, depression, and suicide are universal but frequently unrecognized issues for women and men in residency training. Stress affects cognitive and psychomotor performance both inside and outside of the operating room. Stress impairs the 2 key components of a surgeon's responsibilities: intellectual judgment and technical skill. We hypothesized that the recognition of depression, substance abuse, failing personal relationships, and potential suicide is poor among surgeons. If residents can recognize the signs of stress, depression, and suicide among colleagues, we believe it will not only improve their quality of life but also may preserve it.

Methods

We first determined baseline resident knowledge of the signs of surgical stress including fatigue; burn out; depression; physician suicide; drug and alcohol abuse; and their effects on family, friends, and relationships. We then developed a curriculum to identify these signs in first, second, third, and fourth year surgical residents were identified as the target learners. The major topics discussed were depression; physician suicide; drug and alcohol abuse; and the effects of stress on family, friends, and our goals. Secondary objectives included identifying major sources of stress, general self-awareness, understanding professional choices, and creating a framework to manage stress. Residents participated in an interactive seminar with a surgical facilitator. Before and after the seminar, a multiple-choice test was administered with questions to assess knowledge of the signs of stress (eg, fatigue, burn out, and depression).

Results

Twenty-one residents participated in this study. Seventeen completed the pretest, and 21 participated in the interactive seminar and completed the post-test. The pretest revealed that surgical residents were correct in 46.8% (standard deviation [SD] = 25.4%) of their responses. The postseminar test showed an improvement to 89.7% (SD = 6.1%, P < .001, paired Student t test = 5.37). The same test administered 4 months later to 17 of the 21 learners revealed 76.9% (SD = 18.7%) correct answers, suggesting that the information had been internalized. Cronbach α was calculated to be .67 for the pretest and .76 for the post-test, suggesting a moderate to high degree of internal consistency.

Conclusions

Stress is a significant and regularly overlooked component of a surgeon's life. Because its effects often go unrecognized, stress frequently remains unresolved. To prevent its associated consequences such as depression, substance abuse, divorce, and suicide, educating house staff about stress is crucial. This study suggests that the symptoms, causes, and treatment of stress among surgeons can be taught effectively to surgical resident learners.

Section snippets

Educational goals and objectives

The goals and objectives of this educational intervention are to increase resident self-awareness of the signs and symptoms of stress, depression, and suicidal ideation and to recognize these signs and symptoms among their colleagues. An interactive seminar using varying educational approaches was designed as the curricular tool.

The major topics discussed were depression; physician suicide; drug and alcohol abuse; and the effects of stress on our family, our friends, and our goals (both

Results

The pretest revealed that the 17 surgical residents were correct in only 46.8% (standard deviation [SD] = 25.4%) of their responses, suggesting a significant lack of understanding of stress and related issues. The immediate postseminar test showed an improvement to 89.7% (SD = 6.1%, P < .001, paired Student t test = 5.37). The same test administered 4 months later (ie, the long-term post-test) to 17 of the 21 learners revealed 76.9% (SD = 18.7%) of correct answers (Fig. 2). The detail of the

Comments

The “early warning system” that a resident may be teetering on the brink of depression or suicide must come from those closest to them—their fellow residents. This study found an alarming lack of resident recognition of the signs and symptoms of stress, family problems, depression, suicide, and even the institutional guidelines aimed at combating these issues. This lack of recognition of a possible impending disaster is surprising given that these are highly selected and highly achieving young

Conclusions

As a group, highly selected and highly trained residents are poor at identifying the signs of depression, stress, and potential suicide among fellow residents. This surprising lack of recognition can and occasionally does have disastrous consequences. Because residents who are experiencing stress, depression, and suicidal ideation rarely self-identify,13, 14 it is incumbent on medical educators to arm residents with the tools to identify emotional and/or psychological impairment among their

Acknowledgments

This article is dedicated to the memory of A. John Erdmann, M.D., 1942–1980.

References (14)

  • J. Firth-Cozens et al.

    Doctors' perceptions of the links between stress and lowered clinical care

    Soc Sci Med

    (1997)
  • H.C. Veldenz et al.

    Impaired residents: identification and intervention

    Curr Surg

    (2003)
  • E. Schemhammer

    Taking their lives: the high rate of physician suicide

    N Engl J Med

    (2005)
  • C.M. Balch et al.

    Stress and burnout among surgeons

    Arch Surg

    (2009)
  • C.P. West et al.

    Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study

    JAMA

    (2006)
  • D. Goebert et al.

    Depressive symptoms in medical students and residents: a multischool study

    Acad Med

    (2009)
  • R.E. Levey

    Sources of stress for residents and recommendations for programs to assist them

    Acad Med

    (2001)
There are more references available in the full text version of this article.

Cited by (52)

  • Lack of Routine Healthcare among Resident Physicians in New England

    2020, Journal of the American College of Surgeons
    Citation Excerpt :

    Approximately 80% of state medical boards ask applicants about mental illness and >30% of licensure board directors believe a diagnosis of mental illness is sufficient grounds for sanctioning a physician.23 As a result, more than one-half of physicians with self-reported mental health diagnoses are concerned about being placed on a restricted medical license24 and 60% of surgeons with suicidal ideation do not seek care due to the possibility that it will affect their licensure.22 To reduce obstacles to treating mental health disorders for physicians, a consensus statement by the American Foundation for Suicide Prevention suggested that disclosures on licensure paperwork be limited to questions on impairment of professional abilities rather than mental health diagnoses, and that hospitals and malpractice insurers encourage physicians to seek help for suicidality and depression.25

  • Psychosocial risks and burnout syndrome of hospital care workers

    2019, Archives des Maladies Professionnelles et de l'Environnement
  • Prevalence of burnout, depression and job satisfaction among French senior and resident radiation oncologists

    2018, Cancer/Radiotherapie
    Citation Excerpt :

    Anxiolytics, antidepressants, alcohol and illegal drugs have significant influences on concentration and vigilance, opening the way to accidents and medical errors [43]. Screening programs, especially aiming at radiation oncology residents, should be implemented [44]. Our study is limited by its response rate (25%), although similar to that reported in other surveys in radiation oncology [17,35,36].

View all citing articles on Scopus

Supported in part by grants from the Josiah Macy, Jr. Foundation; the Arnold P. Gold Foundation; and The Arthur Vining Davis Foundations.

View full text