Where does it hurt? Identifying the pain points in surgical training

Musculoskeletal (MSK) pain and fatigue is common among surgeons and owes to the high physical demands of surgery. Over the course of a career, the effects of poor ergonomics and inadequate recovery can result in MSK pathology requiring surgical intervention and even early retirement. MSK pain among surgeons starts as early as residency with little insight into contributing factors. The goal of this study was to identify patterns in training that contribute to surgical resident MSK pain and are detrimental to wellness, with the purpose of using results to implement curricular changes and quality improvement initiatives.

An anonymous, voluntary electronic survey was sent out to all general surgery trainees at an academic medical center one month after the start of the academic year. The survey consisted of questions relating to MSK pain, including frequency, location, and contributing factors. Additional questions were asked regarding the use of pain medications.

31 out of 49 (63%) general surgery trainees completed the survey. 100% of the respondents reported pain related to operating with 61% reporting pain during or immediately following half or more of their operative cases. The back and neck were the most frequently identified sites of pain. 75% of interns reported MSK pain “most of the time” when operating. “Duration of cases” was identified as the highest ranked contributing factor to MSK pain, followed by resident “positioning during case” and “total hours spent operating in day” (p < 0.001). PGY level was significantly associated with incidence of reported neck pain and total number of reported MSK pain locations. Only 13% of trainees reported formal training to reduce MSK pain related to surgery. 23% of trainees reported taking pain medications after work at some regular interval.

General surgery trainees experience frequent MSK discomfort related to operating as early as the first month of internship. We have identified several factors that subjectively contribute to trainee pain. While many factors cannot be modified, such as the duration of an operation, future studies should focus on targeted efforts to educate trainees on the importance of surgical ergonomics, test the implementation of surgery specific physical exercises, and explore the use of adaptive devices in the operating room.