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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
      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.
      Institute of Medicine (US) Committee on Sleep Medicine and Research
      American Psychological Association
      Stress in AmericaTM Survey.
      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.
      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.
      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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