Feedback and Mental Well-being in Anesthesiology

A recent report by the Royal College of Anaesthetists (UK) reveals that one in four qualified anesthetists is considering leaving the NHS in the next five years, resulting in over one million procedures being postponed yearly. This is a public health issue. Among the main reasons cited by these anesthetists is the negative impact they attribute to their profession on their mental health. Regarding trainee anesthetists, another report by the Royal College of Anaesthetists highlights burn-out symptoms in 85% of interns. Meanwhile, a survey of members of the European Society of Anaesthesiology and Intensive Care highlighted this year the fact that over 50% of anesthetists suffer from "imposter syndrome", first described in 1978 as the inability to internalize success and the tendency to attribute success to external causes such as luck, error or knowing the right people. This "syndrome" is more common among physicians than in the general population. It is statistically associated with burnout, anxiety, and depression.

The survey revealed that women and young anesthetists are particularly at-risk sub-groups who may preferentially benefit from targeted interventions aimed at improving their well-being. Further research is needed to explore the nature and effectiveness of such interventions.

As part of their anesthesia training, future anesthetists receive teacher feedback. This feedback, defined as communication consisting of an opportunity to comment on actions to obtain a modification or reinforcement of those actions, is not delivered in the same way by all anesthesia teachers due to a lack of training on the part of the latter, but also to a lack of standardization of practices. Yet these conversations constitute complex interpersonal exchanges in which the teacher's lack of training and the absence of a shared model between teacher and learner can be deleterious, particularly to the psychological well-being of the various parties involved.

The literature reports that trainees can sometimes perceive that the institutional culture within universities prevents honest, two-way feedback, negatively impacting the specialty's working environment and learning objectives. How relationships with faculty might influence the quality and impact of feedback delivered in future anesthetists' training is yet to be fully explored.

A learning conversation model based on the advocacy-inquiry method has been described to foster productive conversation. This methodology is adopted in the sphere of medical simulation as part of debriefing with good judgment, an approach designed to encourage open dialogue, reflection, and accurate assessment of the learner's thought process.

The determinants of this type of feedback are based on several elements. Firstly, the conversation must be non-confrontational to avoid triggering defensiveness. Secondly, the conversation must be direct and concise to maintain the participants' focus and attention, especially as these conversations occur in busy clinical environments. Thirdly, the supervisor must accurately identify trainees' knowledge gaps and teach them, avoiding appearing condescending or paternalistic by sharing concepts already known. The proper conversation will create a sense of shared ownership of a patient, emphasizing the function of both individuals as team members with a collective responsibility.

This type of feedback enables supervisors to deeply interrogate the reasons behind trainees' actions to understand their thought processes better, thus providing leverage for more in-depth teaching. This technique is not about "talking nicely" but involves the instructor increasing cooperation by making themselves vulnerable to learning and opening their opinions to questioning. Moreover, by combining this feedback with genuine curiosity, the instructor encourages exchange by respecting the trainees enough to appreciate their point of view, enhancing learning.

Psychological safety - defined as "the shared belief that the team is safe for interpersonal risk-taking, with a sense of confidence that the team will not embarrass, reject or punish someone for speaking out" - is particularly important in high-functioning clinical teams. Notably, the objective and frank nature of "advocacy-inquiry" feedback foster a culture of psychological safety by encouraging strategies associated with safe learning environments, including normalizing the discussion of mistakes, stimulating curiosity, seeking new perspectives, and recognizing the valuable contributions of all team members.

The investigators hypothesize that developing this type of conversation between teachers and trainees could promote the psychological well-being of all stakeholders involved.

The first aim of this study is to assess the mental health of trainees and anesthesia teachers working in our hospital using the Clance Impostor Phenomenon Scale (CIPS) and Maslach Burnout Inventory (MBI) scores.

The second objective is to observe whether - and to what extent - the introduction of a debriefing session in the form of a daily two-way feedback session conducted according to the principles of the "learning conversation" between teachers and trainees, over a full quarter, can influence participants' mental well-being.

The third objective is to identify any personal and/or institutional factors hindering the implementation of this learning-centered conversation method and its successful running within an academic hospital.

Data will be collected through questionnaires, which participants will complete via the secure LiveSurvey platform :

• Clance Impostor Phenomenon Scale (CIPS)
• Maslach Burnout Inventory (MBI)
• Debriefing questionnaire (Timmis \& Speirs)