Transforming mental health in anesthesia education
Anesthesia residents have been reported to be at a very high risk for developing mental health problems. There is a need to address mental health concerns in anesthesia residents.
The literature on mental health of physicians has noted that over 20% of physicians had felt unable to experience joy or had felt depressed.1 Another survey noted that 26% of physicians felt their mental health made it difficult to work at certain points over the previous year.2 When specifically looking at medical residents, studies have reported that approximately 20-30% self-reported their mental health to be fair to poor or they have acutely suffered moderate to severe depression.3,4 In general, factors contribute to resident mental health issues include the lack of control of one’s schedule, intense work demands, work-life imbalance, and fear of constant assessment/failure.5 Anesthesia residents specifically, are in a unique situation where they work long continuous hours, in a rapid, high intensity environment with a single faculty supervisor on a one-to-one daily basis. Additionally, anesthesia residents lack the peer support as they are less likely to every work with their resident peers on a daily basis compared to other specialties. This could add to the stress of being constantly evaluated and judged by their faculty supervisors in addition to the stressors mentioned above. Lastly, but most important, recent work has shown that the root of such problems can be due the perfectionist nature of trainees. They have trouble mentally and emotionally looking past small shortcomings in their daily work activity leading to stress, anxiety and depression6. However, very limited studies have looked at this concept in resident well-being of anesthesia residents nor created novel approaches to tackle the issue. Anesthesia residents do not have the time or motivation for frequent visits to a psychiatrist or to take part in long perfectionist alleviating therapies.
The lack of resident mental well-being has been associated with adverse patient outcomes both in the short and long term.7,8 Furthermore this is an issue that needs to be addressed locally in Toronto as it is the largest anesthesia residency programs in Canada. Being a large program results in learners being isolated as they are spread out over the city without peer support. However, mental health is an issue that can also be extrapolated to training programs across North America.
Unfortunately, health care regulatory bodies are organized in a way that those with mental health concerns are dealt with in more of a punitive manner than one to help address the root of the problem.9 Similarly, screening questions on insurance questionnaires or physician license renewal applications are more likely treat mental illness as a disorder that will interfere with patient care.9,10 As most literature on mental health is based on physician surveys, the aforementioned factors can serve as a barrier for physicians reporting a problem or even seeking help. Moreover, the literature has also alluded to the fact that physicians may not recognize that they are having mental health issues5. This too is a barrier to clarifying and treating mental health concerns in anesthesia residents.
Capstone Advisory Committee:
TRP Faculty Lead:
Dr. Joseph Ferenbok