Bring your spouse: Brief multifamily group outcome for posttraumatic stress disorder.

OBJECTIVE: There has been little evidence supporting the efficacy of psychoeducation as a stand-alone approach to alleviate posttraumatic stress disorder (PTSD). This study examined the efficacy of a stand-alone psychoeducation PTSD intervention using a group format that incorporated the option of bringing an emotional support person to sessions. METHOD: PTSD 102 is an eight-session, 1-hr, weekly intervention for veterans and their family members. Pre- and posttreatment symptom measurement data were analyzed from 101 veteran men and women seeking outpatient treatment in a PTSD Clinical Team clinic at a Veteran Health care outpatient facility. RESULTS: Paired-samples t tests were performed, which demonstrated a significant difference in the scores for pretreatment PTSD symptoms (M = 55.049, SD = 14.585) and posttreatment scores (M = 45.696, SD = 17.814); t(100) = 8.496, p < .001. The effect size was d = .843. Additionally, there was a significant difference in the scores for pretreatment depressive symptoms (M = 17.000, SD = 6.183) and posttreatment scores (M = 13.608, SD = 6.229); t(89) = 7.106, p < .001. The effect size was d = .749. CONCLUSIONS: Results from this study suggest that integrating emotional support individuals into a psychoeducational PTSD treatment group had a significant impact on mental health symptoms for veteran participants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Barriers to careers identified by women in academic surgery: A grounded theory model.

BACKGROUND: Faculty attrition has been widely acknowledged and poorly understood throughout academic medicine. To date, barriers to career advancement in academic surgery have been identified and described in a limited fashion using only survey data. The authors sought to characterize career barriers for women academic surgeons using grounded theory methodology. METHODS: Authors conducted semi-structured interviews with 15 mid-career and senior female academic surgeons in the United States. Data were drawn together using grounded theory analysis of interview transcripts to develop a conceptual model. RESULTS: Interviewees identified barriers constituting two intersecting categories: (1) obstacles within the system of academic surgery and (2) impediments based in broader culture and its power structures. Interviewees' robust description of the challenges of integrating clinical and non-clinical professional responsibilities is novel. CONCLUSIONS: Career barriers identified by women in academic surgery are complex and include cultural factors from within and outside of the profession. Identifying and dismantling barriers, particularly those that negatively impact perceptions of belonging, is imperative to creating a culture of sustained excellence in academic surgery. SUMMARY: The authors used grounded theory method to develop a conceptual model of barriers to careers in academic surgery as described by successful female academic surgeons. The authors identified intersecting cultural barriers specific to academic surgery and derived from cultural power differentials.

Characteristics of Effective Mentorship for Academic Surgeons: A Grounded Theory Model.

OBJECTIVE: The authors sought to describe characteristics of effective mentoring relationships in academic surgery based upon lived experiences of mid-career and senior female academic surgeons. BACKGROUND: Prior qualitative work describes characteristics of successful mentoring relationships. However, no model exists of effective mentorship that is specific to academic surgery. METHODS: The authors conducted in-depth interviews with mid-career and senior female US academic surgeons about the impact of mentoring on professional development during 2014 and 2015. Purposive selection aimed to maximize institutional, specialty, years in career, and racial diversity. Grounded theory method was used to generate a conceptual model of effective mentoring relationships. Data saturation occurred following 15 interviews. RESULTS: Interviewees described the need for multiple mentors over time with each mentor addressing a unique domain. Interviewees suggested that mentees should seek mentors who will serve as strategic advisors, who will be unselfish, and who engage with diverse mentees. CONCLUSIONS: This study identified a need for multiple mentors across time and disciplines, and identified 3 key characteristics of effective mentoring relationships in academic surgery. Future work in this area should generate an operational definition of mentorship that supports quantitative evaluation of mentor and mentoring panel performance.

Conceptual model of male military sexual trauma.

OBJECTIVE: Male sexual trauma is understudied, leaving much to be known about the unique mental health needs of male survivors. This study examined veteran men's perceptions of the effects of military sexual trauma. METHOD: Military sexual trauma was defined as physically forced, verbally coerced, or substance-incapacitated acts experienced during military service. Interviews were conducted with 21 male veterans who reported experiencing military sexual trauma. Data were drawn together using a grounded theory methodology. RESULTS: Three categories emerged from data analysis, including (a) types of military sexual trauma (being touched in a sexual way against their will [N = 18]; sexual remarks directed at them [N = 15]; being physically forced to have sex [N = 13]); (b) negative life effects (difficulty trusting others [N = 18]; fear of abandonment [N = 17]; substance use [N = 13]; fear of interpersonal violence [N = 12]; conduct and vocational problems [N = 11]; irritability/aggression [N = 8]; insecurity about sexual performance [N = 8]; difficulty managing anger [N = 8]); and (c) posttraumatic growth (N = 15). CONCLUSIONS: Results from this study suggest sexual trauma in the military context may affect systems of self-organization, specifically problems in affective, self-concept, and relational domains, similar to symptoms of those who have experienced prolonged traumatic stressors. This model can be used by clinicians to select treatments that specifically target these symptoms and promote posttraumatic growth. (PsycINFO Database Record

Effects of disruptive surgeon behavior in the operating room.

BACKGROUND: Surgeons are the physician group most commonly identified as "disruptive physicians." The aim of this study was to develop a conceptual model of the results of disruptive surgeon behavior and to identify the coping strategies used by perioperative staff. METHODS: Perspectives of 19 individuals of diverse occupations in the perioperative setting were drawn together using a grounded theory methodology. RESULTS: Effects of disruptive behavior described by participants included shift in attention from the patient to the surgeon, increased mistakes during procedures, deterrence from careers in surgery, and diminished respect for surgeons. Individual coping strategies employed in the face of intimidation include talking to colleagues, externalizing the behavior, avoidance of perpetrators, and warning others. CONCLUSIONS: Using grounded theory analysis, we were able to elucidate the impact of disruptive surgeon behavior in the perioperative environment. This conceptual model may be used to understand and counter the negative effects of manipulation and intimidation of hospital staff and trainees and to build on current programmatic strengths to improve surgical environments and training.

A model of disruptive surgeon behavior in the perioperative environment.

BACKGROUND: Surgeons are the physicians with the highest rates of documented disruptive behavior. We hypothesized that a unified conceptual model of disruptive surgeon behavior could be developed based on specific individual and system factors in the perioperative environment. STUDY DESIGN: Semi-structured interviews were conducted with 19 operating room staff of diverse occupations at a single institution. Interviews were analyzed using grounded theory methods. RESULTS: Participants described episodes of disruptive surgeon behavior, personality traits of perpetrators, environmental conditions of power, and situations when disruptive behavior was demonstrated. Verbal hostility and throwing or hitting objects were the most commonly described disruptive behaviors. Participants indicated that surgical training attracts and creates individuals with particular personality traits, including a sense of shame. Interviewees stated this behavior is tolerated because surgeons have unchecked power, have strong money-making capabilities for the institution, and tend to direct disruptive behavior toward the least powerful employees. The most frequent situational stressors were when something went wrong during an operation and working with unfamiliar team members. Each factor group (ie, situational stressors, cultural conditions, and personality factors) was viewed as being necessary, but none of them alone were sufficient to catalyze disruptive behavior events. CONCLUSIONS: Disruptive physician behavior has strong implications for the work environment and patient safety. This model can be used by hospitals to better conceptualize conditions that facilitate disruptive surgeon behavior and to establish programs to mitigate conduct that threatens patient safety and employee satisfaction.

Barriers to advancement in academic surgery: views of senior residents and early career faculty.

BACKGROUND: A significant faculty attrition rate exists in academic surgery. The authors hypothesized that senior residents and early-career faculty members have different perceptions of advancement barriers in academic surgery. METHODS: A modified version of the Career Barriers Inventory-Revised was administered electronically to surgical residents and early-career surgical faculty members at 8 academic medical centers. RESULTS: Residents identified a lack of mentorship as a career barrier about half as often as faculty members. Residents were twice as likely as faculty members to view childbearing as a career barrier. CONCLUSIONS: Many early-career faculty members cite a lack of mentors as a limitation to their career development in academic surgery. Childbearing remains a complex perceived influence for female faculty members in particular. Female faculty members commonly perceive differential treatment and barriers on the basis of their sex. Faculty development programs should address both systemic and sex-specific obstacles if academic surgery is to remain a vibrant field.

Perceived gender-based barriers to careers in academic surgery.

BACKGROUND: Women represent roughly 50% of US medical students and one third of US surgery residents. Within academic surgery departments, however, women are disproportionately underrepresented, particularly at senior levels. The aim of this study was to test the hypothesis that female surgeons perceive different barriers to academic careers relative to their male colleagues. METHODS: A modified version of the Career Barriers Inventory-Revised was administered to senior surgical residents and early-career surgical faculty members at 8 academic medical centers using an online survey tool. Likert-type scales were used to measure respondents' agreement with each survey item. Fisher's exact test was used to identify significant differences on the basis of gender. RESULTS: Respondents included 70 women (44 residents, 26 faculty members) and 84 men (41 residents, 43 faculty members). Women anticipated or perceived active discrimination in the form of being treated differently and experiencing negative comments about their sex, findings that differed notably from those for male counterparts. Sex-based negative attitudes inhibited the career aspirations of female surgeons. The presence of overt and implicit bias resulted in a sense that sex is a barrier to female surgeons' career development in academic surgery. No differences were observed between male and female respondents with regard to career preparation or structural barriers. CONCLUSIONS: Female academic surgeons experience challenges that are perceived to differ from their male counterparts. Women who participated in this study reported feeling excluded from the dominant culture in departments of surgery. This study may help guide transformative initiatives within academic surgery departments.