The anatomy of enjoyment: the flow experience and cardiac surgery.

PURPOSE OF REVIEW: In a time of record levels of physician burnout coupled with a global pandemic, protecting physician wellness is critical. The experience of cognitive flow has been found to enhance both wellness and performance. Although flow has been vastly explored in other fields including elite sport, it has not been deeply investigated or applied in cardiac surgery. Here we discuss flow and flow-promoting techniques employed in other fields that may be beneficial within cardiac surgery. RECENT FINDINGS: Flow is a prevalent experience among surgeons, amplified during operations. Possible strategies to cultivate flow may be separated into individual skills training, such as mindfulness practice and stress management, institutional changes, such as ensuring adequate resources and protected spaces, and strategies targeting the intersectionality of individuals and systems, such as how workplace culture shapes an individual's experience. These techniques may be applicable within cardiac surgery, especially in training. SUMMARY: Flow has been identified as a key component of a happy and meaningful life, and a potential protector against burnout. Harnessing the benefits of flow may help promote flourishing, particularly in demanding fields, such as cardiac surgery.

Fractured in surgery: Understanding stress as a holistic and subjective surgeon experience.

BACKGROUND: Physician stress impacts patient care and provider wellness. Researchers have largely used reductionist approaches to study stress (e.g. focusing on physiology). This study sought to understand surgeons' subjective experiences of stress in the workplace, using a holistic perspective. METHODS: Using a constructivist grounded theory methodology, semi-structured interviews were conducted with 24 staff surgeons at the University of Toronto, purposively sampled for specialties and experience levels. RESULTS: The stress experience was reconceptualized as a variable and multidimensional state of fracture, comprised of physiologic, cognitive, emotional, sociocultural, and environmental facets. CONCLUSIONS: Reconceptualizing surgeon stress as a multidimensional state of fracture may help surgeons recognize the contributing facets and identify appropriate strategies for promoting wellness and optimizing performance.

Am I Cut Out for This? Transitioning From Surgical Trainee to Attending.

OBJECTIVE: Progressing from trainee to attending surgeon is arguably one of the most significant transitions in a surgeon's career. Despite this, little is known about this critical period. The purpose of this study was to develop a framework for understanding the phenomenon of the transition from trainee to attending surgeon. DESIGN: A constructivist grounded theory methodology was used to explore the experience of new attending surgeons as they transition into practice. A purposeful sampling strategy was used to conduct 13 semistructured interviews with surgeons from various specialties. Data collection and analysis were performed simultaneously as part of the iterative process. Themes were identified and informed the development of the conceptual framework. SETTING: The setting included 4 separate Canadian urban, academic health centers. PARTICIPANTS: A total of 13 surgeons in their first 5 years of practice from 6 separate departments were included. RESULTS: Participants described 4 phases that marked their transition from trainee to attending surgeon. In the initial phase (getting undressed), participants shared vivid moments where they realized they no longer fit their trainee identity, but did not yet belong to the attending group. An intense phase of vulnerability and self-doubt (exposed and vulnerable), which was associated with building a new reputation and identity, followed. In the next phase (suiting up), surgeons began to project the image associated with their new role to others. With the passage of time and accumulation of successful cases, participants began to internalize their new identity in the final phase (tailoring the fit). CONCLUSIONS: The transition from trainee to attending surgeon is a critical time during which new surgeons experience an identity shift. The conceptual framework presented contributes to a deeper understanding of the experience of this transition in order to help new surgeons transition successfully into independent practice.

Where is the patient in models of patient-centred care: a grounded theory study of total joint replacement patients.

BACKGROUND: Patient-centered care ideally considers patient preferences, values and needs. However, it is unclear if policies such as wait time strategies for hip and knee replacement surgery (TJR) are patient-centred as they focus on an isolated episode of care. This paper describes the accounts of people scheduled to undergo TJR, focusing on their experience of (OA) as a chronic disease that has considerable impact on their everyday lives. METHODS: Semi-structured qualitative interviews were conducted with participants scheduled to undergo TJR who were recruited from the practices of two orthopaedic surgeons. We first used maximum variation and then theoretical sampling based on age, sex and joint replaced. 33 participants (age 38-79 years; 17 female) were included in the analysis. 20 were scheduled for hip replacement and 13 for knee replacement. A constructivist approach to grounded theory guided sampling, data collection and analysis. RESULTS: While a specific hip or knee was the target for surgery, individuals experienced multiple-joint symptoms and comorbidities. Management of their health and daily lives was impacted by these combined experiences. Over time, they struggled to manage symptoms with varying degrees of access to and acceptance of pain medication, which was a source of constant concern. This was a multi-faceted issue with physicians reluctant to prescribe and many patients reluctant to take prescription pain medications due to their side effects. CONCLUSIONS: For patients, TJR surgery is an acute intervention in the experience of chronic disease, OA and other comorbidities. While policy has focused on wait time as patient/surgeon decision for surgery to surgery date, the patient's experience does not begin or end with surgery as they struggle to manage their pain. Our findings suggest that further work is needed to align the medical treatment of OA with the current policy emphasis on patient-centeredness. Patient-centred care may require a paradigm shift that is not always evident in current policy and strategies.