Emotional support attending
UND’s Department of Surgery initiates a new Surgical Resident Wellness Program.
“I entered medical school and surgery residency with some idea of what I was getting into, but even that couldn’t have prepared me,” says Dr. Alessandra Spagnolia, who grew up the daughter of two surgeons and was initially skeptical of a career in medicine because of the work hours her parents kept. “Surgery residency requires long hours and an efficiency that I still haven’t fully mastered. It keeps you away from friends, family, and special life events sometimes.”
Even so, says Spagnolia, it was these very factors—the challenge of surgery—that eventually drew the third-year surgical resident to the field.
But the job is still stressful.
“Burnout in the medical community, and in surgery specifically, is very real,” Spagnolia continues, referencing statistics like those from a 2018 study in the Journal of the American College of Surgery that reported “burnout” among surgery residents at an astounding 69%. “I have seen it in two forms: a transient ebb and flow that is somewhat normal, and a more chronic form that causes a person to drop out of residency, switch specialties, or worse. Regardless of the type, burnout has the potential for significant harm to our providers and patients.”
All of this is why Spagnolia is encouraged by the UND General Surgery Residency’s newly established Surgical Resident Wellness Program.
One of North Dakota’s oldest post-graduate medical residencies, the residency is a five-year program that accepts five new physicians each year—plus four preliminary residents—for a total of 29 residents. This makes the program also the largest single residency in the state, family medicine aside. As such, the program bears an outsized responsibility for resident wellness in a time when both burnout among and a shortage of physicians is getting major institutional and scholarly attention.
“Surgical residencies have always been stressful and difficult,” says UND Department of Surgery Chair Dr. Cornelius “Mac” Dyke, who helped get the new program off the ground and is critically aware of the shortage of surgeons nationally. “One reason work hour limits came into being was to address resident wellness and quality of care, and we’re paying more attention to [wellness]. By caring about things that are not just about achievements in the O.R.—looking outside the operating room—we’re hoping we can help people do better inside the operating room and throughout their career. We want people to succeed after they leave us, and taking care of them is a big part of that.”
As Dyke puts it, the program will help residents by better emphasizing things like team-building, counseling for residents needing assistance, and checking in on each other.
“We’re also going to improve our counseling on the profession itself, career development,” he says, “and need to address things like childbirth policy for female residents and time-off and leave for mothers—reducing the negative stigma of having a child during residency.”
On this last, Dyke’s colleague Dr. Kristin Korderas recalls an anecdote from her own residency.
“During my [surgical] training, I was in New Jersey and my Chief Resident’s water broke on rounds,” says Korderas, an acute care surgeon at Altru Health System in Grand Forks who also serves as co-director of resident wellness for UND’s surgery residency. “She was working hard up to that moment. She pushed it to the end and only took two weeks off so she could graduate on time. That’s not normal. Or healthy. We need to focus on creating better human beings, not just robot surgeons.”
Korderas’s co-director and colleague Dr. Daniel Tuvin agrees.
“Burnout is real. It’s not a sign of weakness, but of being a human,” insists the Sanford Health surgeon and assistant professor of surgery at UND. “We’re not machines. We have to have lives too. And it’s possible to have kids during surgical residency, but possible is not enough. We need to support residents and show and say that we want to create well-adjusted people, who also have excellent surgical skills. But we need to work on the human being part of it. We are better than we used to be, but we can do even better and let people have personal lives while in training.”
So it is, says Tuvin, that the UND residency hopes to help shape those humans through both wellness policy and programming.
“We’re planning to develop more extracurricular activities related to well-being for sure,” he says. “We want to make surgical education and surgery as a profession more accessible and produce surgeons that are part of society, so to speak, out in the community.”
The Old Culture
All three faculty—Dyke, Korderas, and Tuvin—suggest that part of what made such accessibility more difficult in the past was the often “macho” (that is to say, predominantly male) Twentieth Century surgery culture that likely prevented some potentially very good physicians from either completing a surgery residency or choosing surgery as a specialization in the first place.
“The traditional way of learning surgery was unhealthy—you’re supposed to be able to work 120 hours a week and not complain and not get burned out,” says Korderas, adding that it’s her hope that the cultural shift will change medical students’ attitudes toward what can be a very rewarding profession. “That old culture, we’re realizing now, doesn’t promote happy, good surgeons. The old way tends to promote burnout. And burned out surgeons aren’t good surgeons, so we really need to listen to what residents are saying and be advocates for them as people and be people they can come to for help.”
By helping change the culture, then, this “emotional support attending [physician],” as Korderas says some of her residents call her, has managed to turn four medical students toward surgery. And now she has a real, formal job title to go with the work she was already doing anyway.
“It’s good to be not just one-size-fits-all,” says Tuvin, admitting that greater diversity in the profession—whether race, sex, or national origin—is good for institutions and patients. “[Diversity is] not just a nice concept—it makes us better and is good for camaraderie.”
Such admissions give Spagnolia, who calls resident wellness programs much-needed, hope that the residency culture is opening up.
“This will allow our residents to focus on something else, even just for a bit, while in the company of friends and colleagues,” she concludes. “I know of other programs that focus on wellness more regularly and those residents seem to really enjoy it. I’m looking forward to many great things from UND’s resident wellness program.”