Self-Assessment of Resilience in Advanced Surgery Students Alexandra Berger, Colleen Gillespie, Sandra Yingling, Umut Sarpel, Mark Hochberg and Jennifer Ogilvie New York University School of Medicine Introduction • Resilience is the ability to anticipate, recognize and adjust to changes in a continuously changing and stressful environment. • Surgeons with strong characteristics of resilience may experience less burnout and commit fewer medical errors. • We examined resilience and coping strategies among 4th year medical students in an Advanced Surgery Clerkship to assess: – Change in resilience scores before and after the clerkship – Student self assessment of resilience compared to assessment by faculty – Which coping strategies correlated with resilience Methods • 17 4th year medical students (10 men, 7 women) enrolled in an Advanced Surgery Clerkship, JulyDecember 2011 • All students completed two questionnaires before and after the 4-week clerkship – Resilience: 17-item questionnaire of factors associated with resilience – Coping Strategies: 7-item questionnaire of strategies used when facing new challenges • Surgical faculty mentors chose which resilience factors they thought students needed to improve at the end of the clerkship Please complete the following 17 items.* Resilience Score 16 I adapt quickly. I am good at bouncing back from difficulties. I am optimistic, I see difficulties as temporary, I expect to overcome them and have things turn out well. In a crisis I calm myself and focus on taking useful actions. I am good at solving problems logically. I can think up creative solutions to challenges. I trust intuition. I am playful, find the humor, laugh at myself, chuckle. I am curious, ask questions. I want to know how things work. I experiment. I constantly learn from experience and from the experiences of others. I am very flexible. I feel comfortable with my inner complexity and contradictions. I anticipate problems to avoid them and expect the unexpected. I am able to tolerate ambiguity and uncertainty about situations. I feel self-confident, enjoy healthy self-esteem, and have an attitude of professionalism about work. I am a good listener and have good empathy skills. I “read" people well. I can adapt to various personality styles. I am non-judgmental, even with difficult people. I am able to recover emotionally from losses and setbacks. I can express feelings to others, let go of anger, overcome discouragement, and ask for help. I am very durable, I keep on going during tough times. I have an independent spirit. I have been made stronger and better by difficult experiences. 17 I convert misfortune into good fortune. I discover the unexpected benefit. 1 2 • 17-item questionnaire • 6-point Likert scale: 0 (“not true”) to 5 (“very true”) • Resilience score calculated as the sum of 17 items (max score=85) • Cronbach’s alpha=.85 3 4 5 6 7 8 9 10 11 12 13 14 15 *“Personal Resilience Assessment Tool.” Career Diagnostics. 2008. http://www.careerdiagnostics.com/surveys/resilience.htm Histogram of Resiliency Scores Histogram: Resilience Score Frequencies 7 Frequency of Score 6 5 4 3 2 1 0 50 55 60 65 70 75 80 Resilience Score Pre Resilience Scores Post Resilience Scores 85 90 Results: Resilience Score Resilience Score Changes Pre- to Post-Course Change in Resilience Score 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 -5 -10 Students • Resilience scores increased in 11/17 (65%) students by the end of the clerkship (avg. 2.41, range -5 to 16, P=.11) Coping Strategies • 7-item questionnaire • 5-point Likert scale: 1 (rarely use) to 5 (consistently use) • Cronbach’s Alpha=-.218 When you are faced with a new situation in your medical training, how often do you use each of these methods? 1 Research on my own (on-line journals, search engines, textbooks) 2 Reflect on my own and give myself time to think through options 3 Trust my instinct and move ahead 4 Consult with a colleague (fellow medical student) 5 Consult with a superior (direct supervisory faculty) 6 Consult with a superior (without direct supervisory responsibility) 7 Seek support from my family or friends Results: Coping Questionnaire Coping: Average Score Per Question 5 4 3 2 1 0 Research on Reflect on my my own own Trust my instincts Pre Consult with Consult with Consult with colleague direct superior indirect superior Family & Friends Post • “Research on my own” & “Reflect on my own” were the most frequently used strategies Pearson Correlation Research Reflect on on my own my own Trust my instincts Consult colleague Consult direct superior Consult indirect superior Family & Friends Resilience Pre-Course 0.28 p=0.279 0.690** p=.002 -0.388 p=.124 -0.328 p=0.199 0.23 p=0.379 -0.053 p=.840 -0.094 p=.719 Resilience Post-Course -0.025 p=.923 0.579* p=.015 .613** p=.009 -0.508* p=.038 0.696** p=.002 0.077 p=.770 0.076 p=.773 *Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed) • “Reflect on my own” strongly correlated with Resilience Score • “Trust my instincts” strongly correlated • Most coping strategies emphasizing self-reliant strategies were positively correlated with Resilience Score • “Consult with a direct superior” strongly correlated post-course • “Consult with a colleague” strongly negatively correlated postcourse Conclusions • Overall self-assessed resilience scores were high, and increased during the clerkship. • No significant agreement between students and faculty on which resilience factors students needed to improve. • More internally focused or independent coping strategies correlated positively with overall Resilience Scores.