title: Stress management training for surgeons-a randomized, controlled, intervention study.
abstract: BACKGROUND
  Stress and coping influence performance. In this study, we evaluate a novel stress management intervention for surgeons.
  
  
  METHODS
  A randomized control group design was used. Sixteen surgeons were allocated to either the intervention or control group. The intervention group received training on coping strategies, mental rehearsal, and relaxation. Performance measures were obtained during simulated operations and included objective-structured assessment of technical skill, observational teamwork assessment for surgery, and end product assessment rated by experts. Stress was assessed using the state-trait-anxiety-inventory, observer rating, coefficient of heart rate variability (C_HRV), and salivary cortisol. The number of applied surgical coping strategies (number of coping strategies [NC]) was assessed using a questionnaire. A t test for paired samples investigated any within-subject changes, and multiple linear regression analysis explored between-subject effects. Interviews explored surgeons' perceptions of the intervention.
  
  
  RESULTS
  The intervention group showed enhanced observational teamwork assessment for surgery performance (t = -2.767, P < 0.05), and increased coping skills (t = -4.690, P < 0.01), and reduced stress reflected inheart rate variability (t = -4.008, P < 0.01). No significant changes were identified in the control group. Linear regression analysis confirmed a significant effect on NC (β = -0.739, P < 0.01). Qualitative data analysis revealed improved technical skills, decision making, and confidence.
  
  
  CONCLUSIONS
  The intervention had beneficial effects on coping, stress, and nontechnical skills during simulated surgery.
authors.affiliation: Department of Surgery and Cancer, Imperial College, UK.
authors.forename: Cordula M
authors.initials: CM
authors.lastname: Wetzel
authors.forename: Akram
authors.initials: A
authors.lastname: George
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Black
authors.forename: Roger L
authors.initials: RL
authors.lastname: Kneebone
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.forename: Maria
authors.initials: M
authors.lastname: Woloshynowych
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002983:Clinical Competence; D016894:Endarterectomy, Carotid / Q000523:psychology; D013502:General Surgery / Q000193:education*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007092:Imagination; D007396:Internship and Residency; D007431:Intraoperative Complications / Q000523:psychology / Q000601:surgery; D008953:Models, Anatomic; D009784:Occupational Diseases / Q000523:psychology / Q000628:therapy*; D010815:Physician Impairment / Q000523:psychology*; D011214:Practice, Psychological; D011594:Psychometrics; D012064:Relaxation Therapy; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone