Mental toughness in surgeons: Is there room for improvement?

Mental toughness in surgeons: Is there room for improvement?

Can J Surg 2019;62(6):482-487 | PDF | Appendix

Dean B. Percy, MD, MSc; Lucas Streith, MD; Heather Wong, MHS; Chad G. Ball, MD; Sandy Widder, MD; Morad Hameed, MD

Abstract

Background: Mental toughness is crucial to high-level performance in stressful situations. However, there is no formal evaluation or training in mental toughness in surgery. Our objective was to examine differences in mental toughness between staff and resident surgeons, and whether there is an interest in improving this attribute.

Methods: We distributed a survey containing the Mental Toughness Index (domains of self-belief, attention regulation, emotion regulation, success mindset, context knowledge, buoyancy, optimism and adversity capacity) among general surgery residents and staff at 3 Canadian academic institutions. Responses were recorded on a 7-point Likert scale. Participants were also asked about techniques they used to help them perform under pressure and interest in further developing mental toughness.

Results: Eighty-three of 193 surgeons participated: 56/105 (52.8%) residents and 27/87 (31.0%) staff. The average age was 29 (standard deviation 5) years and 42 (standard deviation 8) years, respectively. Residents scored significantly lower than staff in all mental toughness domains. Men scored significantly higher than women in attention regulation and emotion regulation. Age, staff experience and resident postgraduate year were not significantly associated with mental toughness scores. Twenty residents (36%) and 17 staff (63%) reported using specific techniques to deal with stressful situations; 49 (88%) and 15 (56%), respectively, were interested in further developing mental toughness.

Conclusion: Staff surgeons scored significantly higher than residents in all mental toughness domains measured. Both groups expressed a desire to improve mental toughness. There are many techniques to improve mental toughness, and further research is needed to assess their effectiveness in surgical training.

Résumé

Contexte : La force mentale est indispensable à un rendement de haut niveau en situation de stress. Par contre, il n’existe pas de méthode d’évaluation formelle ni de formation pour promouvoir la force mentale en chirurgie. Notre objectif était de comparer la force mentale des chirurgiens en poste à celle des résidents, et de vérifier si l’amélioration de cette compétence suscite l’intérêt.

Méthodes : Nous avons distribué un questionnaire sur les divers domaines qui constituent l’indice de force mentale (confiance en soi, régulation de l’attention et des émotions, attitude gagnante, connaissances du contexte, dynamisme, optimisme et résistance à l’adversité) aux résidents et aux chirurgiens en poste en chirurgie générale dans 3 établissements universitaires canadiens. Les réponses étaient consignées sur une échelle de Likert en 7 points. Les participants ont aussi été interrogés sur les techniques qu’ils utilisent pour mieux composer avec la pression et sur leur intérêt pour l’acquisition d’une plus grande force mentale.

Résultats : Quatre-vingt-trois chirurgiens sur 193 ont participé : 56/105 (52,8 %) résidents et 27/87 (31,0 %) chirurgiens en poste. L’âge moyen était de 29 ans (écarttype 5) et de 42 ans (écart-type 8), respectivement. Les résidents ont obtenu un score significativement moindre que les chirurgiens en poste pour tous les domaines constitutifs de la force mentale. Les hommes ont obtenu des scores significativement plus élevés que les femmes pour la régulation de l’attention et des émotions. L’âge, l’expérience des chirurgiens en poste et l’année de formation postdoctorale des résidents n’ont pas été significativement associés aux scores de force mentale. Vingt résidents (36 %) et 17 chirurgiens en poste (63 %) ont indiqué utiliser des techniques spécifiques pour affronter les situations stressantes; 49 (88 %) et 15 (56 %), respectivement, se sont montrés intéressés à acquérir davantage de force mentale.

Conclusion : Les chirurgiens en poste ont obtenu des scores significativement plus élevés que les résidents pour tous les domaines de la force mentale mesurés. Les 2 groupes ont exprimé un intérêt pour l’amélioration de leur force mentale. Il existe plusieurs techniques à cet effet et il faudra approfondir la recherche pour en évaluer l’efficacité chez les chirurgiens en formation.


This work was presented in part as an e-poster at the Canadian Surgery Forum, Victoria, BC, Sept. 14–16, 2017.

Accepted May 14, 2019

Acknowledgement: The authors thank Peter Crocker of the University of British Columbia Department of Kinesiology for suggesting the use of the Mental Toughness Index to measure mental toughness in this study.

Affiliations: From the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (Percy, Wong, Hameed); the Faculty of Medicine, University of Calgary, Calgary, Alta. (Streith); the Division of General Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Wong); the Interior Health Department of Emergency and Trauma Services, Kelowna, BC (Ball); and the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Widder).

Competing interests: C. Ball is coeditor in chief and S. Widder is an associate editor of CJS. Neither of them was involved in the review of this manuscript or in the decision to accept it for publication. No other competing interests declared.

Contributors: D. Percy, H. Wong, C. Ball and M. Hameed designed the study. D. Percy, L. Streith, H. Wong and S. Widder acquired the data, which D. Percy, C. Ball and M. Hameed analyzed. D. Percy, C. Ball and M. Hameed wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.010818

Correspondence to: D.B. Percy, Department of General Surgery, Faculty of Medicine, University of British Columbia, 950 West 10th Ave, Vancouver BC V5Z 1M9, dean.percy@alumni.ubc.ca