A national survey of the impact of adverse events on surgeons

Much of what is known already about the impact of adverse events on surgeons comes from studies outside of the UK, or groups surgeons together with other doctors / healthcare professionals (and we think there are some unique or nearly unique aspects of surgical practice), or conflates errors and complications (which are different and are seen as different by surgeons themselves).

Between 2016 and 2019 we conducted a UK national survey of the impact of adverse events on surgeons, initially led by PhD student, Catherine Withers. Our data include details of surgeons’ experience of adverse events, they distinguish between errors and complications, and they include multiple validated psychological measures.

Analysis of this data set is underway and we have published the below article based on this work so far:  

Turner, K., Bolderston, H., Thomas, K., Greville-Harris, M., Withers, C. & McDougall, S (2022). Impact of adverse events on surgeons, British Journal of Surgery, 2022. https://doi.org/10.1093/bjs/znab447

An RCT of resilience training intervention in surgical trainees

We are keen to move beyond describing the extent and nature of the impact of adverse events on surgeons in the UK and to develop evidence based interventions. We have nearly completed the intervention phase of a multi-site Randomised Control Trial (RCT) of a resilience training intervention with surgeons in training in the UK. Based on ACT (Acceptance and Commitment Therapy) our intervention seeks to enhance resilience and other psychological health outcomes. Analysis of our RCT data is currently underway.

So far, we have published an article discussing resilience in surgeons:

Bolderston, H., Greville-Harris, M., Thomas, K., Kane, A., & Turner, K. (2020). Resilience and surgeons: train the individual or change the system?  The Bulletin of the Royal College of Surgeons of England, 102:6, 244-247. https://doi.org/10.1308/rcsbull.2020.170

SAEFAR – Surgical Adverse Events First Aid Response

Surgeons have told us that the immediate aftermath of a significant adverse event is often characterised by confusion and uncertainty around how a surgeon should be supported, how and when they should return to work, the roles and responsibilities of the employing organisation, the Medical Director, the BMA and the medical defence organisations.

Working in collaboration with the Royal College of Surgeons of England, we brought together a working party to develop national guidance to help surgeons and their employers face the immediate aftermath of an adverse event.

In December 2020, the Royal College of Surgeons, England launched a set of Good Practice Guidelines on Improving Surgeon Wellbeing after adverse events. The guidelines were developed in collaboration with the Bournemouth University Surgical Wellbeing Research Team.

A key recommendation in the guidelines was the development of a 'First Responder' system within NHS Trusts in the UK, through which experienced surgeons could provide timely support to their surgical colleagues involved in adverse surgical events.

To this end, in November 2021, two members of the BU team - Professor Kevin Turner, Consultant Urological Surgeon and Dr Helen Bolderston, Clinical Psychologist - delivered a training workshop for a group of consultant surgeons within University Hospitals Dorset NHS Foundations Trust. This development will form the basis of the first UK surgeons' First Responder scheme. 

Future research

We have a number of projects planned including a further national study of Urologists exploring the reasons surrounding the timing of a surgeon’s decision to retire and the factors that influence that decision.