The application of Acceptance and Commitment Therapy-based training to resilience and psychological health in surgical trainees.

Abstract

Trainee surgeons face substantial psychological and occupational demands, with consistently reported elevations in stress, burnout, and emotional distress posing risks to individual wellbeing, workforce sustainability, and patient care. This thesis presents a comprehensive investigation into surgeon wellbeing, integrating an extensive review of the literature with empirical evaluation of an Acceptance and Commitment Therapy (ACT)–informed intervention for UK surgical trainees. Chapter 2 presents a scoping review of the literature examining the psychological impact of a surgical career, identifying key challenges across individual, training-related, and systemic domains. The review highlights recurrent themes of distress, exposure to adverse events, and cultural barriers to help-seeking, as well as limitations in the existing intervention literature. Chapter 3 focuses specifically on resilience, critically examining how resilience has been defined, measured, and applied within surgical and healthcare contexts. This chapter synthesises contemporary resilience theory, identifies conceptual and methodological limitations in existing approaches, and argues for a process-based understanding of resilience that emphasises adaptability and psychological functioning rather than trait-based robustness. Chapter 4 then introduces ACT as a theoretically coherent framework capable of addressing these limitations, positioning psychological flexibility, values-based action, and self-compassion as key mechanisms for fostering resilience and wellbeing in surgeons. Building on this conceptual foundation, the thesis reports findings from an Uncontrolled Preliminary pre–post study, followed by a randomised controlled trial (RCT). In the RCT, 68 trainee surgeons were allocated to either an ACT-based group intervention or an inactive control condition. Outcomes were assessed at baseline, following three ACT sessions, and at three-month follow-up using validated self-report measures of resilience, burnout, psychological distress, and preparedness. Process measures included psychological flexibility, self-compassion, and valued living. Across studies, participation in the ACT intervention was associated with improvements in resilience and reductions in stress and personal burnout, alongside positive changes in key ACT-consistent processes. Exploratory mediation analyses suggested that self-compassion and values-based action may play important roles in these observed changes, consistent with ACT theory. Overall, this thesis advances understanding of resilience and wellbeing in trainee surgeons and provides preliminary evidence supporting ACT-informed, skills-based interventions within surgical training contexts. The findings inform future research directions and offer practical implications for integrating psychologically informed approaches into medical education.