Self-Assessment of Resilience in Advanced Surgery Students

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.