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Invited Commentary|Articles in Press

Abdominal transplant fellowship: Is the current system stretching trainees thin?

  • Srilakshmi Atthota
    Affiliations
    Department of Surgery, Division of Abdominal Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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  • Leigh Anne Dageforde
    Correspondence
    Corresponding author. Massachusetts General Hospital, Harvard Medical School 55 Fruit Street White 511, Boston, MA, 02114, USA.
    Affiliations
    Department of Surgery, Division of Abdominal Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
Published:January 04, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.004
Abdominal transplant fellowship: Is the current system stretching trainees thin?
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      A third of adults in the United States are sleep deprived and a significant number experience stress.
      Centers for Disease Control and Prevention
      Sleep and sleep disorders.
      https://www.cdc.gov/sleep/data-and-statistics/Adults.html
      Date accessed: December 30, 2022
      , 
      Institute of Medicine (US) Committee on Sleep Medicine and Research
      Colten H.R. Altevogt B.M. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US), Washington (DC)2006
      , 
      American Psychological Association
      Stress in AmericaTM Survey.
      2022
      https://www.apa.org/news/press/releases/stress/2022/concerned-future-inflation
      Date accessed: December 30, 2022
      Medical trainees and physicians experience higher rates of stress and burnout compared to the general population.
      • Dyrbye L.N.
      • West C.P.
      • Satele D.
      • et al.
      Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.
      Acad Med. 2014; 89: 443-451https://doi.org/10.1097/ACM.0000000000000134
      In their paper, “Biophysiological Stress and Sleep Deprivation Among Abdominal Transplant Surgery Fellows,” Vaysburg et al. quantify stress and sleep deprivation among abdominal transplant fellows.
      • Vaysburg D.M.
      • Delman A.M.
      • Sisak S.
      • et al.
      Biophysiological stress and sleep deprivation among abdominal transplant surgery fellows: a prospective multi-institutional study using a wearable device.
      Am J Surg. 2022; (Published online November 8)https://doi.org/10.1016/j.amjsurg.2022.11.004
      They performed a cross-sectional observational feasibility study of 17 fellows over 28 days, using biophysical monitoring, surveys and Maslach Burnout Inventory. After analyzing sleep patterns and heart rate variability, they report prevalence of moderate to high levels of stress on majority of days (87.2%), short sleep duration (6.33h), frequent interruptions (8/night) and acute or chronic sleep deprivation (43.9%). Fellows with burnout also had more total sleep duration and more days off, but the study was underpowered to report these differences. Fellows non-compliant with the Transplant Accreditation and Certification Council (TACC) managed time policy (76.5%) experienced more days of stress, but surprisingly had more restorative sleep. Policy compliant fellows reported 2.5 extra days off from work (scheduled vs actual not reported) and experienced an average of 3 fewer days of stress. While the authors conclude that programs should comply with TACC regulations, the data showed no differences in burnout or sleep deprivation based on fellow compliance with TACC regulations.

      Abbreviations:

      TACC (Transplant Accreditation and Certification Council)
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      References

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        Sleep and sleep disorders.
        https://www.cdc.gov/sleep/data-and-statistics/Adults.html
        Date accessed: December 30, 2022
        View in Article
        • Institute of Medicine (US) Committee on Sleep Medicine and Research
        Colten H.R. Altevogt B.M. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US), Washington (DC)2006 (2006)
        View in Article
        • American Psychological Association
        Stress in AmericaTM Survey.
        2022
        https://www.apa.org/news/press/releases/stress/2022/concerned-future-inflation
        Date accessed: December 30, 2022
        View in Article
        • Dyrbye L.N.
        • West C.P.
        • Satele D.
        • et al.
        Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.
        Acad Med. 2014; 89: 443-451https://doi.org/10.1097/ACM.0000000000000134
        View in Article
        • Vaysburg D.M.
        • Delman A.M.
        • Sisak S.
        • et al.
        Biophysiological stress and sleep deprivation among abdominal transplant surgery fellows: a prospective multi-institutional study using a wearable device.
        Am J Surg. 2022; (Published online November 8)https://doi.org/10.1016/j.amjsurg.2022.11.004
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      Article info

      Publication history

      Published online: January 04, 2023
      Accepted: January 3, 2023
      Received: January 3, 2023

      Publication stage

      In Press Journal Pre-Proof

      Identification

      DOI: https://doi.org/10.1016/j.amjsurg.2023.01.004

      Copyright

      © 2023 Elsevier Inc. All rights reserved.

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