Hubris syndrome in neurosurgery

Hubris syndrome

Hubris syndrome (HS) is an acquired psychiatric disorder that affects people who exercise power in any of its forms. It has been reported in many fields, from politics to finance. The physician-patient relationship is also one of power. A lack of humbleness and empathy in this situation can lead to qualities such as self-confidence and self-assurance becoming pride, arrogance and high-handedness, which characterise a doctor suffering from HS.

The diagnostic criteria for HS initially reported in political leaders with government responsibilities are analysed and transferred to the medical field of neurosurgery. Two forms of medical HS are described and ten diagnostic criteria are proposed that are valid for any physician-patient relationship.

HS is an acquired psychiatric disorder that is triggered by power and enhanced by success, and can easily be observed on a daily basis in physicians working in settings that are very close to us. Early identification of these medical behaviours is necessary to be able to mitigate their consequences 1).

1)

Gonzalez-Garcia J. [Hubris syndrome in neurosurgery]. Rev Neurol. 2019 Apr 16;68(8):346-353. doi: 10.33588/rn.6808.2018355. Review. Spanish. PubMed PMID: 30963532.

Millennial

Millennial

Millennials (also known as Generation Y) are the generational demographic cohort following Generation X (born between 1982 and 2004).

Current residency applicants are members of Generation Y and are significantly different from previous generations of trainees as well as the faculty who attract, recruit, and manage them.

Generation Y has been affected by globalizationdiversification, terrorism, and international crisis. They are products of the self-esteem movement in child rearing, education, and extracurricular activities where they were all declared winners. Children’s activities no longer had winners and losers or first, second, and third place; every child received a participation trophy. Even though they were raised to be a team player, their parents always told them they are special. Technology is ingrained into their daily lives, and they expect its use to be effective and efficient. Generation Y-ers desire to impact the world and give back to their communities and demand immediate access to leadership. This generation poses a challenge to residency programs that will need to attract, recruit, and manage them effectively 1).


Millenials are set up for conflict with older generations due to their differing outlook and set of priorities on life, which have been shaped by the unique and formidable events and circumstances that they were exposed to during their upbringing.


Concern has been raised that residents in the millennial era may have more serious professionalism and performance issues (PPIs) during trainingcompared to prior trainees.


Many feel that the generational differences encountered with Millennial trainees are novel; the reality is that prior generations have always bemoaned generational differences. This is not a new problem; some of the same things may even have been said about us during our own training! There are a variety of myths and misconceptions about the Millennial generation. Lourenco et al., in 2017 reviewed some of the differences frequently encountered as we educate and work alongside our Millennial colleagues, dispelling some of the myths and misconceptions. With increased understanding of this talented group of individuals, we hope to be more effective teachers and have more successful professional relationships 2).


Newman et al., retrospectively reviewed a 50-year experience at a single training center. They then prospectively surveyed living graduates of the program to assess variations in practice patterns and job satisfaction over 5 decades.

The PPIs of 141 residents admitted for training at the University of Pittsburgh (subsequently UPMC) Department of Neurological Surgery were reviewed by decade starting in 1971 when the first department chair was appointed. The review was conducted by the senior author, who served from 1975 to 1980 as a resident, as a faculty member since 1980, and as the resident director since 1986. A review of resident PPIs between 1971 and 1974 was performed in consultation with a senior faculty member active at that time. During the last decade, electronic reporting of PPIs was performed by entry into an electronic reporting system. In order to further evaluate whether the frequency of PPIs affected subsequent job satisfaction and practice patterns after completion of training, the authors surveyed living graduates.

There was no statistically significant difference by decade in serious PPIs. Although millennial residents had no significant increase in the reporting of serious PPIs, the increased use of electronic event reporting over the most recent 2 decades coincided with a trend of increased reporting of all levels of suspected PPIs (p < 0.05). Residents surveyed after completion of training showed no difference by decade in types of practice or satisfaction-based metrics (p > 0.05) but reported increasing concerns related to the impact of their profession on their own lifestyle as well as their family’s.

There was no statistically significant difference in the incidence of serious PPIs over 5 decades of training neurosurgery residents at the authors’ institution. During the millennial era, serious PPIs have not been increasing. However, reporting of all levels of PPIs is increasing coincident with the ease of electronic reporting. There was remarkably little variance in satisfaction metrics or type of practice over the 5 decades studied 3).

References

1)

Schlitzkus LL, Schenarts KD, Schenarts PJ. Is your residency program ready for Generation Y? J Surg Educ. 2010 Mar-Apr;67(2):108-11. doi: 10.1016/j.jsurg.2010.03.004. PubMed PMID: 20656608.
2)

Lourenco AP, Cronan JJ. Teaching and Working With Millennial Trainees: Impact on Radiological Education and Work Performance. J Am Coll Radiol. 2017 Jan;14(1):92-95. doi: 10.1016/j.jacr.2016.06.029. Epub 2016 Aug 21. Review. PubMed PMID: 27554062.
3)

Newman WC, Chang YF, Lunsford LD. Professionalism and performance issues during neurosurgical training and job satisfaction after training: a single training center 50-year experience. J Neurosurg. 2018 Aug 1:1-7. doi: 10.3171/2018.3.JNS172347. [Epub ahead of print] PubMed PMID: 30117767.
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