Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials
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Objective: 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. Summary of Background and Data: 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. Methods: 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”). Results: 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-/postintervention 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. Conclusions: 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.
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These barriers are consistent with reports from medical students and trainees facing similar pressures.
“These barriers are consistent with reports from medical students and trainees facing similar pressures [20, 30, 33].”
From Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation (2025) · cites this paper as [33]
The Results (Attendance, Attrition, and Adherence; page not provided) report that two resident trainees withdrew after feeling overloaded by additional obligations. The Discussion also describes surgery residents’ extreme workload as leaving little discretionary time. These passages support similar pressures and barriers among trainees, but the paper does not report barriers among medical students. (LLM, conf=0.85)
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Enhanced stress-resilience training for surgical trainees
Luton, O. W., James, O. P., Mellor, K., Eley, C., Hopkins, L., Robinson, D. B. T., Lebares, C. C., Powell, A. G. M. T., Lewis, W. G., & Egan, R. J. (2021) · BJS Open · doi:10.1093/bjsopen/zrab054 · Cited by 44 · see citing works
“…training has improved wellbeing, stress, cognition and performance, yet only a modest number of studies have hypothesized the ability of such training to mitigate stress and burnout across medical specialties, or to effect improvements in the cognition 18 and performance 19 of physicians.”
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Enhanced Stress Resilience Training for UK Surgical Trainees; Effect and Evolution Evaluated
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- Authors
- Lebares, C. C., Coaston, T. N., Delucchi, K. L., Guvva, E. V., Shen, W. T., Staffaroni, A. M., Kramer, J. H., Epel, E. S., Hecht, F. M., Ascher, N. L., Harris, H. W., & Cole, S. W.
- Affiliations
- University of California, San Francisco (US)
- Department of Psychiatry & Biobehavioral Sciences, and Department of Medicine, University of California, Los Angeles.
- Corresponding author
- Lebares, Carter C.
- Coaston, Troy N.
- Guvva, Ekaterina V.
- Shen, Wen T.
- Ascher, Nancy L.
- Harris, Hobart W.
- ORCID
- Venue
- Annals of Surgery
- Published
- 2020-07-08
- Volume
- 273
- Issue
- 3
- Pages
- 424-432
- ISSN
- 0003-4932 (ISSN-L)
- 1528-1140
- PMC
- PMC7863698
- OpenAlex
- W3048934680
- Cited by
- 81
- References
- 46
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 13 · 2023: 14 · 2022: 17 · 2021: 14
- FWCI
- 4.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (P30AG062422)
- National Center for Complementary and Integrative Health (K24AT007827)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- mindfulness-based interventions, surgeons, surgical residents, perceived stress, executive function, burnout, mindfulness, pro-inflammatory gene expression, leukocyte transcriptome, emotional exhaustion, depersonalization, psychosocial well-being, personalized interventions
- MeSH terms
- Occupational Stress, Adaptation, Physiological, Adult, Burnout, Professional, Education, Medical, Graduate, Female, Humans, Internship and Residency, Male, Pilot Projects, General Surgery, Resilience, Psychological, Surgeons
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