Acceptance and commitment therapy- based intervention to improve psychological skills and resilience in surgical trainees: a randomised waitlist-controlled trial.

Abstract

Background: High levels of burnout, psychological distress and suicidal ideation are well documented in surgeons. The need for supporting wellbeing of surgical trainees and preparing them for the inevitable occupational stress have also been identified in the literature. ACT-based interventions have been successfully utilised in other populations to help develop psychological skills and improve wellbeing. However, there has been no research focusing on such interventions for surgical trainees. Therefore, this randomised controlled trial (RCT) examined the impact of an Acceptance and Commitment Therapy (ACT) based intervention on key psychological skills and wellbeing outcomes in surgical trainees. Methods: Surgical trainees (n = 68) were randomised to a three-session ACT-based intervention or waitlist control group. Validated scales were used to measure change in psychological skills (values consistency, psychological flexibility) and wellbeing outcomes (resilience, self-compassion and emotional distress) pre, during and post intervention, and at 3-month follow-up. Results: Two-factor mixed analyses of variance (ANOVAs) with post hoc pairwise comparisons indicated significant improvements in values consistency (p <.001), resilience (p <.001) and self-compassion (p <.001) for the ACT-based intervention compared with controls from baseline to follow-up. No such improvements were observed for psychological flexibility or emotional distress. Conclusions: This RCT suggests that a short ACT-based intervention is useful for surgical trainees, showing promise in facilitating improvements in values consistency, resilience and self-compassion. Future research is needed to explore the scalability of such interventions, as well as the potential need for more tailored mindfulness training within such trainings, to specifically target psychological flexibility and reduce emotional distress. Trial registration: Preregistered with CLINICALTRIALS.gov Protocol Registration and Results System, NCT03759795, first posted 30^th November 2018.