OTA 2005 Posters
Scientific Poster #15 Polytrauma/Injury Prevention
Orthopaedic Surgery Residents' Quality of Life during a Trauma Rotation: A Multi-Centered Prospective Study
Purpose: With shortages of orthopaedic surgeons specializing in trauma, the current project is necessary to determine those modifiable factors that predict less than adequate quality of life on trauma rotations. The impact of stressors on health-related quality of life has not been thoroughly evaluated in orthopaedic surgery residents. The objectives of the study were: (1) to determine modifiable predictors of unsatisfactory resident quality of life on orthopaedic trauma rotations, (2) to identify and monitor levels of stressors during orthopaedic trauma rotations, and (3) to quantify the impact of stressors on health-related quality of life among orthopaedic surgery residents.
Methods: Surveys with 15 orthopaedic surgery residents on the trauma service in two separate training programs were completed. The SF-36 validated survey was used to measure health-related quality of life in residents and compared to standardized scores for the general population. Residents were asked to rank level of stress, 15 work-related problems (such as lack of sleep), and 13 individual problems (from Minnesota scale) on a five-point Likert scale. Residents were surveyed before, at 2 months, and 6 months into the trauma rotation. Surveys took 20 minutes to complete. Faculty and staff had no access to the surveys and all results were kept anonymous and confidential.
Results: Residents were mean age 31 years (SD=2.8), from training years 1 through 5. Overall stress ranked by residents as high to excessive increased from 20% at baseline to 33.3% at 6 months. Self-doubt and fear of error decreased among residents at 6 months compared to baseline (P=0.04, P =0.007). Lack of time for spouse, family, and friends decreased as a problem among residents at 2 and 6 months versus baseline (P <0.03). Lack of time for studying decreased as a problem at 2 and 6 months versus baseline (P<0.05). Lack of time for leisure was less of a problem at 2 months versus baseline (P <0.05). More resident social time was spent with medical personnel exclusively at 6 months versus baseline (P <0.02).
Physical functioning and general health scores declined at 2 and 6 months compared with baseline scores (P <0.05, P <0.04). Baseline role physical limitation scores of residents decreased from 95.0±10.35 to 83.04±24.2 at 2 months (P<0.02). Vitality scores decreased at 6 months versus the 2 month scores (P <0.04). Physical function summary scores declined from 57.59±3.51 at baseline to 53.68±6.50 at 2 months (P<0.02), and 53.94±3.52 at 6 months (P<0.01). Social functioning scores decreased at 6 months versus 2 months (P=0.05). Social functioning scores at 6 months decreased from mean population scores for social functioning (P =0.02). Baseline physical function (P <0.05) and physical component summary scores (P<0.01) were above population norms.
Conclusion/Significance: It is evident from our study that as the residents progressed in their rotation and, in turn, increased in their knowledge base and technical experience, many issues that initially were significantly problematic diminished or became nonexistent. This confirms that coping strategies, when placed early in the training program, can be beneficial and thus decrease the level of anxiety and stress among residents early on in their rotation. Mentorship programs whereby residents meet their mentors on a regular basis have been implemented in some programs. Furthermore, stress management training should be implemented and has been shown to be beneficial if frequent training is provided. Therefore, improving the quality of life for orthopaedic residents in a trauma rotation should begin early in their training by means of support programs implemented by residency programs. Trauma rotations impact residents' emotional well-being. Training programs should empower residents with coping strategies to improve quality of life during trauma rotations.