By Lena Trager and Dr. Carter Lebares
January’s AWS Tweetchat is focused around creating an inclusive discussion about health, wellbeing, and work-life balance in surgical training and careers. 2020 drastically changed the lives of many in our country due to major public health crises, ongoing racial injustice, and the COVID-19 pandemic. As we enter 2021, we think it’s valuable to reflect on how to prioritize one’s mental and physical wellbeing by creating burnout prevention plans and engaging in health-promoting activities to combat the cumulative stressors of this past year. To introduce this month’s Tweetchat topic, Lena Trager, a member of the AWS National Medical Student Committee, interviewed Dr. Carter Lebares, an expert in the field of mindfulness-based interventions to address surgeon burnout.
The widely-accepted scientific definition of mindfulness is a form of cognitive training that teaches three key abilities: interoception (or moment-to-moment awareness of one’s thoughts, emotions, and sensations), emotional regulation (or non-reactivity to stimuli), and meta-cognition (or the ability to call on these cognitive skills as needed). Another way of saying this is that mindfulness consists of heightened self-awareness, emotional control, and situational awareness. These are central cognitive mechanisms that don’t just apply to well-being. They also influence our ability to problem solve, develop complex motor skills, and communicate – all key capabilities for surgeons. To Dr. Lebares, mindfulness means not taking things personally, being able to filter out my distractive thoughts, and regularly stepping back from situations (especially stressful situations) so I can see them clearly and respond, not just react.
Mindfulness-Based Cognitive Training and Resilience
Mindfulness-based cognitive training is the process of learning interoception, emotional regulation, and meta-cognition. This kind of learning is experiential, which means you must learn by doing– not by just reading or through lectures. In this way, it’s like body-building; you don’t get a six-pack from reading about sit-ups, you get a six pack from DOING sit-ups.
Dr. Lebares trains this by teaching participants three key skills: The first skill taught is how to recognize our continuous thoughts which often reflect the past or the future, not the reality of the moment. These thoughts can be distracting and not necessarily useful or worth paying attention to, but often still drive our emotions and reactions. This reflexive process is not always in our own best interest. The second skill taught is how to take our awareness of thoughts and link it to the sensations of our bodies. This gives us a ‘red-flag’ for when thoughts and reactions are at work, and gives us the opportunity to build the “six-pack of mindfulness”, which is the ability to pause in our reactions and choose how we want to respond. Third, participants are taught that this awareness and ability is something that, with practice, can be called on whenever needed. It can transform how we experience stress, but also how we problem-solve, how we approach our technical training, and how we sustain long, satisfying careers.
Dr. Lebares shared the following during her interview: “I was interested in mindfulness long before I came to surgery, but its place in surgery really hit me when I was doing my intern rotation on Trauma. That was the first time I saw sudden uncontrolled bleeding in the OR and I felt my body push away from that table and freeze. Then, I watched this amazing attending calmly put a finger on the bleeding and go about fixing it. In the midst of all this mayhem, they were so focused and calm. I was like, “What was THAT?!” and I realized it was emotional regulation in action. This is how mindfulness-based cognitive training relates to resilience, because our repertoire of available thoughts and actions expands so marvelously when we’re not just reacting in old, unconscious ways. This affects our personal relationships, how we learn, our ability to collaborate, and how we approach the work we do.”
The Future of Mindfulness in Surgery
Dr. Lebares described a few of her “cool” on-going projects. One, is looking at changes needed at the level of systems and culture to support and advance wellbeing in surgery. ESRT (Enhanced Stress Resilience Training) is great, but it’s not the whole story. She believes we can figure out what’s needed on these other levels and align them to really maximize what’s possible. Another project is looking at what wellbeing means in the context of race and gender. This part of the story has been left out for too long. The final big project is a true multi-center, randomized trial of ESRT in surgery residents. She believes that data of this caliber will help our field stop arguing about the benefit of systemic, prioritized, and funded wellbeing initiatives and move us on to national implementation.
Her overarching goal is to develop an ‘Internal Curriculum’ in surgery that provides the cognitive skills training to parallel the intellectual and technical training we already do so well. This Internal Curriculum should be longitudinal: starting with ESRT for interns, advancing to things like the evidence-based Mental Skills Training for operative skills in junior residents, and Energy Leadership Training for senior residents on the cusp of independence.
Please join us on Tuesday, January 19th at 8pm Eastern Standard Time for an AWS Tweetchat about wellness and wellbeing in surgery! This chat will focus on exploring the principles of work-life balance/integration and create a forum to share tips and tricks on how to navigate the challenges of being a surgeon. The tweetchat will be moderated by Dr. Jamie Coleman, @JJcolemanMD/ @denverhealthmed, Dr. Jennifer Davids, @jendavidsmd/ @umasscolorectal, and blog author Dr. Carter Lebares, (no Twitter) / @UCSFSurgery. The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtags #AWSchat and #SurgicalWellness. If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more. We will be discussing the following topics during our tweetchat:
Q1:How does your definition of health and well-being influence your personal and professional pursuits?
Q2:What are some changes you’ve made throughout training that have had a significant impact on your health and wellness? Any routines or tips to cultivate daily health/wellbeing practice?
Q3:Are there any specific programs at your home institutions that support wellbeing of trainees and/or faculty? Any advice for training programs to promote resident/fellow health and wellbeing?
Q4:What role does the community and one’s personal support system play in maintaining health and wellness as a surgeon?
Q5:Do you have a burn-out prevention plan? Or a burn-out rescue plan? What do these entail?
Q6: The ongoing COVID-19 pandemic has had a substantial toll on healthcare workers. Do you have any go-to resources that you have used during this time to maintain mental and physical health?
Dr. Carter Lebares is a clinically-active emergency and elective general surgeon at University of California San Francisco (UCSF). She received her medical degree from the University of Minnesota and completed her surgical residency at UCSF. She is a Fellow of the American College of Surgeons. Dr. Lebares is Director of the UCSF Center for Mindfulness in Surgery. She has 20 years of personal practice in mindfulness meditation and scholarly interest in stress, cognition and resilience. She has taken Mindfulness Teacher Training for Physicians through the University of Rochester, is a graduate of the Teaching Scholars Program in Medical Education at UCSF, and is currently pursuing a PhD in Healthcare Education through UCSF and Utrecht University, Netherlands. For more information about her research, please visit: https://www.carterlebares.org, https://mindfulsurgeon.ucsf.edu
Lena is a rising third year medical student at the University of Minnesota. She plans to pursue a career as an academic surgeon scientist. At her medical school, she was the founder and first president of a new AWS chapter. After her second year of medical school she embarked on a 2-Year Sarnoff Research Fellowship, investigating the molecular mechanisms regulating cardiovascular aging, exercise, and heart failure. Last year Lena served as a Midwest Regional Representative and now is the Resource Development Coordinator for the AWS Medical Student Committee. She also enjoys organizing monthly Tweetchats with the AWS Twitter team. You can find her on twitter at @LenaETrager.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.