Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials.
Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials.
复制标题
增强外科医生的抗压能力训练：2项小型随机试验中的迭代适应和生物心理社会效应。
DOI：
10.1097/sla.0000000000004145
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发表时间：
2021-03-01
影响因子：
9
通讯作者：
Cole SW
中科院分区：
文献类型：
--
作者：
Lebares CC;Coaston TN;Delucchi KL;Guvva EV;Shen WT;Staffaroni AM;Kramer JH;Epel ES;Hecht FM;Ascher NL;Harris HW;Cole SW
确定ESRT（一种迭代适应和定制的MBI）对手术（ESRT-1）和混合专业（ESRT-2）PGY-1志愿者的感知压力、执行认知功能、心理社会健康（即倦怠、正念）和促炎基因表达的影响。量身定制的MBIs已被证明对多个高压力和高绩效人群有益。在外科医生中，定制的MBIs已被证明是可行的和潜在的有益的，但基于正念的认知训练是否可以改善手术和非手术受训者的感知压力，执行功能，幸福感或生理痛苦尚不清楚。在2项小型单机构随机临床试验中，ESRT是一种量身定制的基于正念的认知训练计划，针对第一年的手术（ESRT-1，每周8次，2小时课程，n = 44）和混合专业（ESRT-2，每周6次，90分钟课程，n = 45）住院学员进行了管理和迭代调整。主要和次要结果分别是感知压力和执行功能。其他预先规定的结果是倦怠（通过Maslach倦怠量表评估）、正念（通过认知情感正念量表-修订版评估）和促炎基因表达（通过白细胞转录组谱“对逆境的保守转录反应”评估）。ESRT的两个版本似乎都不会影响感知压力。与对照组相比，ESRT-1组的执行功能和正念评分较高，ESRT-2组的情绪衰竭和人格解体评分较低，干预前/后和/或50周随访（ESRT-1）或32周随访（ESRT-2）。两项试验的汇总分析发现，与对照组相比，ESRT治疗的参与者的促炎RNA表达减少。这项试点工作表明，ESRT可以使PGY-1受训者的执行功能，倦怠和生理困扰受益，并有可能进行定制以优化效果。
To determine the effects of ESRT (an iteratively adapted and tailored MBI) on perceived stress, executive cognitive function, psychosocial well-being (ie, burnout, mindfulness), and pro-inflammatory gene expression in surgical (ESRT-1) and mixed specialty (ESRT-2) PGY-1 volunteers. Tailored MBIs have proven beneficial in multiple high-stress and high-performance populations. in surgeons, tailored MBIs have been shown to be feasible and potentially beneficial, but whether mindfulness-based cognitive training can improve perceived stress, executive function, well-being or physiological distress in surgical and nonsurgical trainees is unknown. In 2 small single-institution randomized clinical trials, ESRT, a tailored mindfulness-based cognitive training program, was administered and iteratively adapted for first-year surgical (ESRT-1, 8 weekly, 2-hour classes, n = 44) and mixed specialty (ESRT-2, 6 weekly, 90-minute classes, n = 45) resident trainees. Primary and secondary outcomes were, respectively, perceived stress and executive function. other prespecified outcomes were burnout (assessed via Maslach Burnout Inventory), mindfulness (assessed via Cognitive Affective Mindfulness Scale - Revised), and pro-inflammatory gene expression (assessed through the leukocyte transcriptome profile “conserved transcriptional response to adversity”). Neither version of ESRT appeared to affect perceived stress. Higher executive function and mindfulness scores were seen in ESRT-1, and lower emotional exhaustion and depersonalization scores in ESRT-2, at pre-/post-intervention and/or 50-week follow-up (ESRT-1) or at 32-week follow-up (ESRT-2), compared to controls. Pooled analysis of both trials found ESRT-treated participants had reduced pro-inflammatory RNA expression compared to controls. This pilot work suggests ESRT can variably benefit executive function, burnout, and physiologic distress in PGY-1 trainees, with potential for tailoring to optimize effects.