2023 Military Poster Presentations

Beau Prey, MD1; Hannah Palmerton, MD1; Mike Weykamp, MD2; Paul Gonzales3; Ari Coopersmith3; Carter Lebares, MD, FACS3; 1Madigan Army Medical Center; 2University of Washington Medical Center; 3Department of Surgery, UCSF

Objectives: Up to 40% of General Surgery trainees experience burnout. Growing data suggests mindfulness-based interventions (MBIs) benefit burnout, stress, and performance in surgeons, yet uptake of MBIs remains low. We identified US Special Operations (SO) surgeons as a unique population with the ability to perform exceptionally well under immense stress, and hypothesized their techniques for stress mastery may map to skills provided by MBIs.

Methods: A survey was administered to all current, active duty surgeons in SO military units (n = 20), and results were compiled and analyzed. Semi-structured interviews were conducted until concept saturation was reached. Survey and interview questions pertained to career and combat experience, burnout, stress coping techniques, team management, and mindfulness. Interviews were coded and analyzed using an inductive thematic approach to identify recurring themes of discrete stress-mitigation techniques and mindfulness principles or skills.

Results: Based on a survey response rate of 65% (13/20), surgeons with less operating experience and fewer deployments more frequently reported burnout as compared to more experienced surgeons. Those with fewer years of experience, fewer deployments, and fewer deployed cases more frequently reported a benefit to mindfulness training, compared to their more experienced colleagues. Of all participants, 23% had received formal mindfulness training, of which 100% felt it would be beneficial for surgical trainees. Analysis of interview transcripts through the lens of critical stress management skills consciously or unconsciously utilized in SO training, revealed repeated emphasis on mindfulness concepts such as resilience, perspective-taking, emotional regulation, presence, and practice (of mental skills). Emergent themes included applications unique to the SO setting such as practicing emotional regulation and present awareness in proactive ways, imagining future combat scenarios in which these skills along with technical rehearsal were essential. Additionally, team-based scenario generation with rehearsal of mental and technical skills was emphasized as opposed to traditional individual mindfulness practice.

Conclusion: This study suggests that SO surgeons with more experience have less burnout and less familiarity with MBIs, yet apply MBI skills in both traditional and novel ways as a deliberate part of performance preparedness. Using both familiar and unique terminology, SO surgeons advocated for mindfulness skills as critical to their success. Two key differences were the application of mindfulness skills and practice to entire teams not just individuals, and proactive practice on future scenarios not just immediately-arising experiences.  Future work exploring adaptation and application of mindfulness training to operative teams is warranted.