Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout - 10/12/20

Doi : 10.1016/j.jamcollsurg.2020.08.762

Ian M. Kratzke, MD ^a,^⁎ , Alana Campbell, PhD ^b, Mae N. Yefimov, BA ^c, Prithima R. Mosaly, PhD, MHA ^b, Karthik Adapa, MBBS, MPP, MPH ^d, Samantha Meltzer-Brody, MD, MPH ^b, Timothy M. Farrell, MD, FACS ^a, Lukasz M. Mazur, PhD ^d
^a Department of Surgery, University of North Carolina, Chapel Hill, NC
^b Department of Psychiatry, University of North Carolina, Chapel Hill, NC
^c Neurocognition and Imaging Research Lab, University of North Carolina, Chapel Hill, NC
^d Division of Healthcare Engineering, University of North Carolina, Chapel Hill, NC

^∗Correspondence address: Ian M Kratzke, MD, 101 Manning Dr, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599-7512.Department of SurgeryUniversity of North Carolina101 Manning DrChapel HillNC27599-7512

Abstract

Background

Burnout is prevalent among surgical residents. Neurofeedback is a technique to train the brain in self-regulation skills. We aimed to assess the impact of neurofeedback on the cognitive workload and personal growth areas of surgery residents with burnout and depression.

Study Design

Fifteen surgical residents with burnout (Maslach Burnout Inventory [MBI] score > 27) and depression (Patient Health Questionnaire–9 Depression Screen [PHQ-9] score >10), from 1 academic institution, were enrolled and participated in this institutional review board-approved prospective study. Ten residents with more severe burnout and depression scores were assigned to receive 8 weeks of neurofeedback treatments, and 5 others with less severe symptoms were treated as controls. Each participant's cognitive workload (or mental effort) was assessed initially, and again after treatment via electroencephalogram (EEG) while the subjects performed n-back working memory tasks. Analysis of variance (ANOVA) tested for significance between the degree of change in the treatment and control groups. Each subject was also asked to rate changes in growth areas, such as sleep and stress.

Results

Both groups showed high cognitive workload in the pre-assessment. After the neurofeedback intervention, the treatment group showed a significant (p < 0.01) improvement in cognitive workload via EEG during the working memory task. These differences were not noted in the control group. There was significant correlation between time (NFB sessions) and average improvement in all growth areas (r = 0.98)

Conclusions

Residents demonstrated high levels of burnout, correlating with EEG patterns indicative of post-traumatic stress disorder. There was a notable change in cognitive workload after the neurofeedback treatment, suggesting a return to a more efficient neural network.

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Visual Abstract

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Abbreviations and Acronyms : EEG, n-back, NFB, PTSD

Plan

	Disclosure Information: Nothing to disclose.
	Support: This study was supported by funding from the University of North Carolina Health Care Wellbeing Program.