abstract: 'IMPORTANCE Physician well-being is a critical component of sustainable

  health care. There are few data on the effects of multilevel well-being

  programs nor a clear understanding of where and how to target resources.

  OBJECTIVE To inform the design of future well-being interventions by

  exploring individual and workplace factors associated with surgical

  trainees'' well-being, differences by gender identity, and end-user

  perceptions of these initiatives.

  DESIGN, SETTING, AND PARTICIPANTS This mixed-methods study among

  surgical trainees within a single US academic surgical department

  included a questionnaire in January 2019 (98 participants, including

  general surgery residents and clinical fellows) and a focus group (9

  participants, all clinical residents who recently completed their third

  postgraduate year {[}PGY 3]) in July 2019. Participants self-reported

  gender (man, woman, nonbinary).

  EXPOSURES Individual and organizational-level initiatives, including

  mindfulness-based affective regulation training (via Enhanced Stress

  Resilience Training), advanced scheduling of time off, wellness

  half-days, and the creation of a resident-driven well-being committee.

  MAIN OUTCOMES AND MEASURES Well-being was explored using validated

  measures of psychosocial risk (emotional exhaustion, depersonalization,

  perceived stress, depressive symptoms, alcohol use, languishing,

  anxiety, high psychological demand) and resilience (mindfulness, social

  support, flourishing) factors. End-user perceptions were assessed

  through open-ended responses and a formal focus group.

  RESULTS Of 98 participants surveyed, 64 responded (response rate, 65\%),

  of whom 35 (55\%) were women. Women vs men trainees were significantly

  more likely to report high depersonalization (odds ratio {[}OR], 5.50;

  95\% CI, 1.38-21.85) and less likely to report high mindfulness

  tendencies (OR, 0.17; 95\% CI, 0.05-0.53). Open-ended responses

  highlighted time and priorities as the greatest barriers to using

  well-being resources. Focus group findings reflected Job Demand-Resource

  theory tenets, revealing the value of individual-level interventions to

  provide coping skills, the benefit of advance scheduling of time off for

  maintaining personal support resources, the importance of work quality

  rather than quantity, and the demoralizing effect of inefficient or

  nonresponsive systems.

  CONCLUSIONS AND RELEVANCE In this study, surgical trainees indicated

  that multilevel well-being programs would benefit them, but tailoring

  these initiatives to individual needs and specific workplace elements is

  critical to maximizing intervention effects.'
affiliation: 'Lebares, CC (Corresponding Author), Univ Calif San Francisco, Dept Surg,
  513 Parnassus Ave,HSW 1601, San Francisco, CA 94143 USA.

  Lebares, Carter C.; Greenberg, Anya L.; Ascher, Nancy L.; Reilly, Linda M.; O''Sullivan,
  Patricia, Univ Calif San Francisco, Dept Surg, 513 Parnassus Ave,HSW 1601, San Francisco,
  CA 94143 USA.

  Delucchi, Kevin L., Univ Calif San Francisco, Dept Psychiat, San Francisco, CA USA.

  Van der Schaaf, Marieke, Univ Med Ctr Utrecht, Ctr Res \& Dev Hlth Profess Educ,
  Utrecht, Netherlands.

  Baathe, Fredrik, Univ Gothenburg, Inst Care \& Hlth Serv, Gothenburg, Sweden.

  Baathe, Fredrik, Inst Stress Med, Gothenburg, Sweden.

  Baathe, Fredrik; Isaksson Ro, Karin, Univ Oslo, Inst Studies Med Profess, Oslo,
  Norway.'
article-number: e2032676
author: Lebares, Carter C. and Greenberg, Anya L. and Ascher, Nancy L. and Delucchi,
  Kevin L. and Reilly, Linda M. and Van der Schaaf, Marieke and Baathe, Fredrik and
  O'Sullivan, Patricia and Isaksson Ro, Karin
author-email: carter.lebares@ucsf.edu
author_list:
- family: Lebares
  given: Carter C.
- family: Greenberg
  given: Anya L.
- family: Ascher
  given: Nancy L.
- family: Delucchi
  given: Kevin L.
- family: Reilly
  given: Linda M.
- family: Van der Schaaf
  given: Marieke
- family: Baathe
  given: Fredrik
- family: O'Sullivan
  given: Patricia
- family: Isaksson Ro
  given: Karin
da: '2023-09-28'
doi: 10.1001/jamanetworkopen.2020.32676
files: []
issn: 2574-3805
journal: JAMA NETWORK OPEN
keywords-plus: 'TRAIT ANXIETY; JOB DEMANDS; BURNOUT; DEPRESSION; MINDFULNESS;

  RESILIENCE; STRESS; MODEL; ENGAGEMENT; RESOURCES'
language: English
month: JAN 6
number: '1'
number-of-cited-references: '53'
orcid-numbers: 'Edwards, Anya/0000-0002-6174-5976

  Baathe, Fredrik/0000-0002-3799-1077'
papis_id: 235977e4a3b7bede4318dfd7da346a12
ref: Lebares2021explorationindividua
times-cited: '15'
title: Exploration of Individual and System-Level Well-being Initiatives at an Academic
  Surgical Residency Program A Mixed-Methods Study
type: Article
unique-id: WOS:000610371200007
usage-count-last-180-days: '1'
usage-count-since-2013: '13'
volume: '4'
web-of-science-categories: Medicine, General \& Internal
year: '2021'