Evaluación de las estrategias de recuperación del trabajo: una mirada de su efectividad al interior de la residencia de cirugía
DOI:
https://doi.org/10.17533/udea.iatreia.77Palabras clave:
atención plena, desgaste profesional, meditaciónResumen
Introducción: durante el entrenamiento quirúrgico los residentes invierten grandes esfuerzos para alcanzar un desempeño óptimo. Sin embargo, como resultado de las altas demandas y pobres recursos en el trabajo, experimentan variables grados de desgaste profesional, estrés y escaso bienestar. Las estrategias de recuperación del trabajo representan una promisoria área de desarrollo para modificar estos resultados negativos. Nuestro objetivo es sintetizar la evidencia disponible sobre las estrategias de recuperación del trabajo en residentes de cirugía.
Métodos: basados en el marco teórico de la psicología organizacional positiva, en esta revisión narrativa sintetizamos la evidencia proveniente de estudios originales publicados entre 2010-2019, respecto a cuatro estrategias de recuperación: 1. El distanciamiento psicológico del trabajo; 2. La relajación: 3. Control del tiempo libre; y 4. Búsqueda de retos fuera del trabajo.
Resultados: un total de 18 estudios fueron incluidos. La mayoría de las intervenciones se fundamentan en el mindfulness (atención plena) como estrategia de relajación, pero su efectividad en la reducción de los niveles de estrés de los residentes de cirugía es pobre. La literatura es limitada para concluir sobre la efectividad de los otros grupos de estrategias de recuperación.
Conclusión: las estrategias más utilizadas para la recuperación del trabajo en residentes de cirugía, están en fase de desarrollo inicial. Su efectividad es limitada para la reducción del estrés y el desgaste profesional. Estos resultados ofrecen oportunidades de investigación futura.
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(1) Lebares CC, Guvva EV, Ascher NL, Sullivan PSO, Harris HW, Epel ES. Burnout and Stress Among US Surgery Residents: Psychological Distress and Resilience. J Am Coll Surg. 2018 Jan;226(1):80-90. DOI 10.1016/j.jamcollsurg.2017.10.010.
(2) Wild JR, Ferguson HJ, McDermott FD, Hornby ST, Gokani VJ; Council of the Association of Surgeons in Training. Undermining and bullying in surgical training: A review and recommendations by the Association of Surgeons in Training. Int J Surg. 2015;23 Suppl 1:S5-S9. DOI10.1016/j.ijsu.2015.09.017.
(3) Kumar S. Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare (Basel). 2016;4(3):37. DOI 10.3390/healthcare4030037.
(4) Low ZX, Yeo KA, Sharma VK, Leung GK, McIntyre RS, Guerrero A, et al. Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(9):1479. DOI 10.3390/ijerph16091479.
(5) Sinclair P, Fitzgerald JE, Hornby ST, Shalhoub J. Mentorship in surgical training: current status and a needs assessment for future mentoring programs in surgery. World J Surg. 2015;39(2):303-14. DOI 10.1007/s00268-014-2774-x.
(6) Bakker A, Demerouti E, Sanz-Vergel A. Burnout and Work Engagement: The JD–R Approach. Annual Review of Organizational Psychology and Organizational Behavior. 2014;1(1):389-411.
(7) Balch CM, Shanafelt T. Combating stress and burnout in surgical practice: a review. Thorac Surg Clin. 2011;21(3):417-30. DOI 10.1016/j.thorsurg.2011.05.004.
(8) Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. J Am Coll Surg. 2016;223(3):440-51. DOI 10.1016/j.jamcollsurg. 2016.05.014.
(9) Domínguez LD, Sanabria Á, Ramírez A, Vargas F, Pacheco M, Jiménez G. Desgaste profesional en residentes de cirugía colombianos: resultados de un estudio nacional. Rev Colomb Cir. 2017;32:121-7.
(10) Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000. DOI 10.1097/SLA.0b013e3181bfdab3.
(11) Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371-6. DOI10.1001/archsurg.2008.575.
(12) West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516–29. DOI 10.1111/joim.12752.
(13) Williford ML, Scarlet S, Meyers MO, Luckett DJ, Fine JP, Goettler CE, et al. Multiple-institution comparison of resident and faculty perceptions of burnout and depression during surgical training. JAMA Surg. 2018;153(8):705–11. DOI 10.1001/jamasurg.2018.0974.
(14) Van Der Heijden F, Dillingh G, Bakker A, Prins J. Suicidal thoughts among medical residents with burnout. Arch Suicide Res. 2008;12(4):344–6. DOI 10.1080/13811110802325349.
(15) Peets A, Ayas NT. Restricting resident work hours: the good, the bad, and the ugly. Crit Care Med. 2012;40(3):960-6. DOI 10.1097/CCM.0b013e3182413bc5.
(16) Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons. Ann Surg. 2006 Jun;243(6):864–5.
(17) Brandt ML. Sustaining a career in surgery. Am J Surg. 2017;214(4):707-14. DOI 10.1016/j.amjsurg.2017.06.022.
(18) West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272-81. DOI 10.1016/S0140-6736(16)31279-X.
(19) Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014;259(6):1041-53. DOI 10.1097/SLA.0000000000000595.
(20) Antiel RM, Reed DA, Van Arendonk KJ, Wightman SC, Hall DE, Porterfield JR, et al. Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns. JAMA Surg. 2013;148(5):448-55. DOI 10.1001/jamasurg.2013.1368.
(21) Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-46. DOI10.1016/j.mayocp.2016.10.004.
(22) Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med. 2016;374(8):713-27. DOI 10.1056/NEJMoa1515724.
(23) Demerouti E, Bakker AB, Geurts SAE, Taris TW. Daily recovery from work-related effort during non-work time. 2009;7:85-123. DOI 10.1108/S1479-3555(2009)0000007006.
(24) Hecht TD, Allen NJ. Environmental standards and labor productivity: Understanding the mechanisms that sustain sustainability. J Organ Behav. 2009;30:839–62.
(25) Shimazu A, Sonnentag S, Kubota K, Kawakami N. Validation of the Japanese Version of the Recovery Experience Questionnaire. J Occup Health. 2012;54(3):196-205. DOI 10.1539/joh.11-0220-oa.
(26) Sonnentag S, Fritz C. The Recovery Experience Questionnaire: Development and Validation of a Measure for Assessing Recuperation and Unwinding From Work. J Occup Health Psychol. 2007;12(3):204–21. DOI 10.1037/1076-8998.12.3.204.
(27) Geurts AE, Sonnentag S. Recovery as an explanatory mechanism in the relation between acute stress reactions and chronic health impairment. Scand J Work Environ Health. 2006 Dec;32(6):482-92. DOI 10.5271/sjweh.1053.
(28) Taco AM, Sciences S, Studies F, Univer- TT, Caldera YM, Studies F, et al. Mindfulness-Based Stress Reduction in Women With Breast Cancer. Families, Systems, & Health. 2004;22(2):193–203. DOI 10.1037/1091-7527.22.2.193.
(29) Germeys L, De Gieter S. Psychological Detachment Mediating the Daily Relationship between Workload and Marital Satisfaction. Front Psychol. 2017 Jan 4;7:2036. DOI 10.3389/fpsyg.2016.02036.eCollection 2016.
(30) Shimazu A, de Jonge J, Kubota K, Kawakami N. Psychological detachment from work during off-job time: predictive role of work and non-work factors in Japanese employees. Ind Health. 2014;52(2):141-6. DOI 10.2486/indhealth.2013-0210.
(31) Shimazu A, Matsudaira K, Jonge JDE, Tosaka N. Psychological detachment from work during non-work time: linear or curvilinear relations with mental health and work engagement ? Ind Health. 2016;282–92. DOI 10.2486/indhealth.2015-0097.
(32) Dissanaike S. How to prevent burnout (maybe). Am J Surg. 2016;212(6):1251–5. DOI 10.1016/j.amjsurg.2016.08.022.
(33) Kabat-zinn J. Mindfulness-Based Interventions in Context: Past, Present, and Future. American Psychological
Association. 2003;10(2):144–56. DOI 10.1093/clipsy/bpg016.
(34) Sancar F. A Cultural Sea Change: Mindfulness for Surgical Residents. JAMA. 2019;322(5):388-9. DOI 10.1001/jama.2019.9999.
(35) Real K, Fields-elswick K, Bernard AC. Understanding Resident Performance, Mindfulness, and Communication in Critical Care. J Surg Educ. 2017;74(3):503-12. DOI 10.1016/j.jsurg.2016.11.010.
(36) Bauer-Wu S. Mindfulness meditation. Oncology (Williston Park). 2010;24(10 Suppl):36-40.
(37) Jha AP, Krompinger J, Baime MJ. Mindfulness training modifies subsystems of attention. Cogn Affect Behav Neurosci. 2007;7(2):109-19. DOI 10.3758/cabn.7.2.109.
(38) Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A metaanalysis. J Psychosom Res. 2004 Jul;57(1):35-43. DOI 10.1016/s0022-3999(03)00573-7.
(39) Lases SS, Irene MJMHL, Onyebuchi AS. Evaluating Mind Fitness Training and Its Potential Effects on Surgical Residents ’ Well-Being : A Mixed Methods Pilot Study. World J Surg. 2016;40(1):29–37. DOI 10.1007/s00268-015-3278-z.
(40) Lebares CC, Hershberger AO, Guvva E V, Desai A, Mitchell J, Shen W, et al. Feasibility of Formal Mindfulness-Based Stress-Resilience Training among Surgery Interns: A Randomized Clinical Trial. JAMA Surg. 2018;153(10):e182734.
(41) Lebares CC, Guvva EV, Olaru M, Sugrue LP, Staffaroni AM, Delucchi KL, et al. Efficacy of Mindfulness-Based Cognitive Training in Surgery Additional Analysis of the Mindful Surgeon Pilot Randomized Clinical Trial. JAMA Network Open. 2019;2(5):e194108. DOI 10.1001/jamanetworkopen. 2019.4108.
(42) Maher Z, Milner R, Cripe J, Gaughan J, Fish J, Goldberg AJ. Stress training for the surgical resident. Am J Surg. 2013;205(2):169–74.
(43) Verweij H, van Ravesteijn H, van Hooff MLM, Lagro-Janssen ALM, Speckens AEM. Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial. J Gen Intern Med. 2018;33(4):429-36. DOI 10.1007/s11606-017-4249-x.
(44) Aggarwal R, Deutsch JK, Medina J, Kothari N. Resident Wellness: An Intervention to Decrease Burnout and Increase Resiliency and Happiness. MedEdPORTAL. 2017;13:10651. DOI 10.15766/mep_2374-8265.10651.
(45) Söderström M, Jeding K. Insufficient Sleep Predicts Clinical Burnout J Occup Health Psychol. 2012 Apr;17(2):175-83. DOI 10.1037/a0027518.
(46) Mendelsohn D, Despot I, Gooderham PA, Singhal A, Redekop GJ, Toyota BD. Impact of work hours and sleep on well-being and burnout for physicians-in-training: The Resident Activity Tracker Evaluation Study. Med Educ. 2019;53(3):306–15. DOI 10.1111/medu.13757.
(47) Baldwin DC, Daugherty SR, Ryan PM, Yaghmour NA. What Do Residents Do When Not Working or Sleeping? A Multispecialty Survey of 36 Residency Programs. 2012;87(4):395–402.
(48) Shanafelt TD, Oreskovich MR, Dyrbye LN, Satele D V, Hanks JB, Sloan JA, et al. Avoiding burnout: The personal health habits and wellness practices of US surgeons. Ann Surg. 2012;255(4):625–33.
(49) Perrin DL, Cordingley DM, Leiter JR, MacDonald PB. Physical fitness of medical residents: Is the health of surgical residents at risk? Can J Surg. 2018 Oct 1;61(5):345-49. DOI 10.1503/cjs.012617.
(50) De Bloom J, Geurts SA, Sonnentag S, Taris T, de Weerth C, Kompier MA. How does a vacation from work affect employee health and well-being? Psychol Health. 2011;26(12):1606-22. DOI 10.1080/08870446.2010.546860.
(51) Welk B, Winick-Ng J, McClure A, Dubois L, Nagpal D. Cardiac Surgeons after Vacation: Refreshed or Rusty? Thorac Cardiovasc Surg. 2017;65(7):524-7.
(52) Rui M, Lee JE, Vauthey JN, Conrad C. Enhancing surgical performance by adopting expert musicians’ practice and performance strategies. Surgery. 2018;163(4):894-900.
(53) Sonnentag S. Psychological Detachment From Work During Leisure Time : The Benefits of Mentally Disengaging From Work. Curr Dir Psychol Sci. 2012;21(2):114-8. DOI 10.1177/0963721411434979.
(54) Sonnentag S, Kühnel J. Coming back to work in the morning: Psychological detachment and reattachment as predictors of work engagement. J Occup Health Psychol. 2016;21(4):379-90. DOI 10.1037/ocp0000020.
(55) Simon CR, Durand-Bush N. Differences in psychological and affective well-being between physicians and resident physicians: Does high and low self-regulation capacity matter? Psychol Well Being. 2014;4(1):1–19.
(56) Regehr C, Glancy D, Pitts A, LeBlanc VR. Interventions to reduce the consequences of stress in physicians: a review and meta-analysis. J Nerv Ment Dis. 2014;202(5):353-9. DOI 10.1097/NMD.0000000000000130.
(57) Civil I. Practical Non-Clinical Skills for Surgeons. ANZ J Surg. 2013 Jan;83(1-2):3.
(58) Spinelli C, Wisener M, Khoury B. Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials. J Psychosom Res. 2019;120:29-38.
(59) Verweij H, van Ravesteijn H, van Hooff MLM, Lagro-Janssen ALM, Speckens AEM. Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial. J Gen Intern Med. 2018;33(4):429-36. DOI 10.1007/s11606-017-4249-x.
(60) Jennings ML, Slavin SJ. Resident Wellness Matters: Optimizing Resident Education and Wellness Through the Learning Environment. Acad Med. 2015;90(9):1246-50. DOI 10.1097/ACM.0000000000000842.
(61) Goldhagen BE, Kingsolver K, Stinnett SS, Rosdahl JA. Stress and burnout in residents: impact of mindfulnessbased resilience training. Adv Med Educ Pract. 2015;6:525-32. DOI 10.2147/AMEP.S88580.
(62) Ames SE, Cowan JB, Kenter K, Emery S, Halsey D. Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues. J Bone Joint Surg Am. 2017;99(14):e78. DOI 10.2106/JBJS.16.01215.
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