Mindfulness Applications: Can They Serve as a Stress, Anxiety, and Burnout Reduction Tool in Orthopaedic Surgery Training? A Randomized Control Trial.

Lauren M Boden, Christian Rodriguez, John D Kelly, Amrit S Khalsa, David S Casper
Author Information
  1. Lauren M Boden: Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. ORCID
  2. Christian Rodriguez: Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
  3. John D Kelly: Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  4. Amrit S Khalsa: Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  5. David S Casper: Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. ORCID

Abstract

Stress and burnout are prevalent within the orthopaedic surgery community. Mindfulness techniques have been shown to improve wellness, yet traditional courses are generally time-intensive with low surgeon utilization. We sought to determine whether the introduction of a simple mindfulness-based phone application would help decrease stress, anxiety, and burnout in orthopaedic surgery residents.
Methods: Twenty-four residents participated in this prospective, randomized controlled trial. After simple 1:1 randomization, the treatment group received access to a mindfulness-based phone application for 2 months while the control group did not receive access. All participants completed the Perceived Stress Scale, Generalized Anxiety Disorder-7, and Maslach Burnout Inventory with emotional exhaustion (EE), depersonalization (DP), and personal accomplishment subscores to measure stress, anxiety, and burnout at baseline and after 2 months. Paired tests were used to compare baseline scores and conclusion scores for both groups.
Results: There was no difference in baseline burnout scores between groups, but the treatment group had higher stress and anxiety scores at baseline. On average, the treatment group spent approximately 8 minutes per day, 2 days per week using the mindfulness application. After 2 months, the treatment group had significantly decreased stress (mean = -7.42, p = 0.002), anxiety (mean = -6.16, p = 0.01), EE (mean = -10.83 ± 10.72, p = 0.005), and DP (mean = -5.17 ± 5.51, p = 0.01). The control group did not have any significant differences in stress, anxiety, or burnout subscores.
Conclusions: Use of a mindfulness-based phone app for 2 months led to significant reductions in stress, anxiety, and burnout scores in orthopaedic surgery residents. Our results support the use of a mindfulness-based app to help decrease orthopaedic resident stress, anxiety, and burnout. Benefits were seen with only modest use, suggesting that intensive mindfulness training programs may not be necessary to effect a change in well-being. The higher baseline stress and anxiety in the treatment group may suggest that mindfulness techniques are particularly effective in those who perceive residency to be more stressful.
Level of Evidence: I.

References

  1. Acad Med. 2021 May 1;96(5):751-764 [PMID: 33496433]
  2. JAMA Netw Open. 2020 Jul 1;3(7):e209385 [PMID: 32614425]
  3. BMJ. 2008 Mar 1;336(7642):488-91 [PMID: 18258931]
  4. J Gen Intern Med. 2018 Apr;33(4):429-436 [PMID: 29256091]
  5. J Health Soc Behav. 1983 Dec;24(4):385-96 [PMID: 6668417]
  6. J Grad Med Educ. 2016 May;8(2):256-9 [PMID: 27168899]
  7. J Bone Joint Surg Am. 2022 Jun 1;104(11):959-970 [PMID: 35333812]
  8. J Occup Health Psychol. 2019 Feb;24(1):127-138 [PMID: 29723001]
  9. Ann Surg. 2010 Jun;251(6):995-1000 [PMID: 19934755]
  10. Acad Psychiatry. 2017 Oct;41(5):646-650 [PMID: 28795335]
  11. Annu Rev Clin Psychol. 2019 May 7;15:285-316 [PMID: 30525995]
  12. Med Teach. 2017 Apr;39(4):409-414 [PMID: 28379084]
  13. JAMA. 2009 Sep 23;302(12):1294-300 [PMID: 19773564]
  14. J Biomed Inform. 2009 Apr;42(2):377-81 [PMID: 18929686]
  15. Arch Intern Med. 2006 May 22;166(10):1092-7 [PMID: 16717171]
  16. Mayo Clin Proc. 2019 Sep;94(9):1681-1694 [PMID: 30803733]
  17. Int J Environ Res Public Health. 2020 Jul 27;17(15): [PMID: 32727038]
  18. J Affect Disord. 2020 Mar 15;265:395-401 [PMID: 32090765]
  19. J Intern Med. 2018 Jun;283(6):516-529 [PMID: 29505159]
  20. J Patient Rep Outcomes. 2020 Jun 1;4(1):42 [PMID: 32488344]
  21. J Gen Intern Med. 2009 Dec;24(12):1318-21 [PMID: 19802645]
  22. Arch Surg. 2011 Jan;146(1):54-62 [PMID: 21242446]
  23. Lancet. 2016 Nov 5;388(10057):2272-2281 [PMID: 27692469]
  24. Fam Med. 2020 Jan;52(1):48-52 [PMID: 31914184]
  25. JMIR Mhealth Uhealth. 2020 Apr 1;8(4):e15608 [PMID: 32234708]
  26. Adv Med Educ Pract. 2015 Aug 25;6:525-32 [PMID: 26347361]
  27. JMIR Mhealth Uhealth. 2015 Aug 19;3(3):e82 [PMID: 26290327]
  28. Arch Bone Jt Surg. 2017 Nov;5(6):400-405 [PMID: 29299495]
  29. JAMA Intern Med. 2014 Apr;174(4):527-33 [PMID: 24515493]
  30. Ann Intern Med. 2008 Sep 2;149(5):334-41 [PMID: 18765703]

Word Cloud

Created with Highcharts 10.0.0stressanxiety=burnoutgrouptreatment2baselinescoresorthopaedicmindfulness-basedmonthsmeanp0StresssurgeryphoneapplicationresidentsmindfulnessMindfulnesstechniquessimplehelpdecreaseaccesscontrolAnxietyBurnoutEEDPsubscoresgroupshigherper01±significantappusemayprevalentwithincommunityshownimprovewellnessyettraditionalcoursesgenerallytime-intensivelowsurgeonutilizationsoughtdeterminewhetherintroductionMethods:Twenty-fourparticipatedprospectiverandomizedcontrolledtrial1:1randomizationreceivedreceiveparticipantscompletedPerceivedScaleGeneralizedDisorder-7MaslachInventoryemotionalexhaustiondepersonalizationpersonalaccomplishmentmeasurePairedtestsusedcompareconclusionResults:differenceaveragespentapproximately8minutesdaydaysweekusingsignificantlydecreased-742002-616-10831072005-517551differencesConclusions:UseledreductionsresultssupportresidentBenefitsseenmodestsuggestingintensivetrainingprogramsnecessaryeffectchangewell-beingsuggestparticularlyeffectiveperceiveresidencystressfulLevelEvidence:IApplications:CanServeReductionToolOrthopaedicSurgeryTraining?RandomizedControlTrial

Similar Articles

Cited By