A Systematic Review of Interventions to Improve Humanism in Surgical Practice

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Abstract

INTRODUCTION: Humanism in surgery is an emerging priority in surgical education. Its emphasis on the patient experience is a key component of the therapeutic relationship between surgeons and their patients. However, the documented high rates of compassion fatigue and burnout among surgical trainees and staff can serve as a barrier in delivering care with empathy and compassion. As such, this systematic review seeks to characterize the outcomes regarding interventions that aim to broadly improve humanism within surgery.

METHODS: A systematic search of 4 electronic databases (EMBASE, MEDLINE, PsycINFO, and Cochrane CENTRAL) was conducted through an independent double selection and extraction process from database inception to March 20, 2020. The inclusion criteria consisted of interventional studies aiming to improve humanism in surgery at all levels of training. A qualitative synthesis and thematic analysis were performed.

RESULTS: A total of 19 studies (1 RCT, 14 prospective cohort, and 4 cross-sectional studies), with 20 intervention arms, were included from the initial 745 studies that were eligible for title screening. Studies included a total of 1763 surgical trainees at varying levels of training. Two major strategies for improving humanism were identified: (1) directly through the development of empathetic communication skills (n=11) and (2) indirectly through programs aimed at reducing levels of compassion fatigue and emotional exhaustion by addressing trainee burnout (n=9). A total of 70% (14/20) of the studied interventions were successful in improving empathy in surgical trainees.

CONCLUSION: Interactive workshops around the principles of empathetic communication with patient simulations and small group learning were effective at improving empathy in surgical trainees. Furthermore, mindfulness-based training and the provision of physical resources to support trainee well-being consistently improved rates of burnout among surgical trainees. Overall, further investigation is necessary to better understand methods of improving empathy in surgery.

Citation

Relevant Evidence Summaries

The evidence was reviewed and included in the following summaries: 

What works to reduce burnout and vicarious trauma among refugee service providers?

There is strong evidence for a variety of strategies to reduce vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout among helping professionals. A strong body of evidence has developed in the past twenty years on reducing stress reactions among a variety of professional helpers in a wide range of settings and professions. Strategies to…

About this study

AGE: Adults

DIRECTION OF EVIDENCE: Positive impact

FULL TEXT AVAILABILITY: Paid

HOST COUNTRY: Multiple countries

HOST COUNTRY INCOME: High

INTERVENTION DURATION: Varies

INTERVENTION: Organizational strategies

INTERVENTION: Self-care

OUTCOME AREA: Reduction of compassion fatigue, burnout, and secondary trauma

STRENGTH OF EVIDENCE: Strong

TYPE OF STUDY: Systematic review

YEAR PUBLISHED: 2020

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