Are Poor Ergonomics Scaring Residents Away from Surgery Specialties?

Standing in the operating room for long periods of time, often while remaining near static in an awkward position, can be painful. Upwards of 70% of surgeons report musculoskeletal pain while operating. But can it be painful enough to deter medical residents from a career in surgery? The short answer is yes.

More than 36% of medical students who reported an initial interest in surgery but later switched to another medical specialty listed “physical demands of the field” as a deterrent, according to a study published in the Journal of Surgical Research.

The same report found that 75.3% of medical students suffered from musculoskeletal pain during their surgical rotation with the average reported daily pain during surgical rotation higher than all other clinical rotations. Foot and lower back pain from standing in the operating room was cited as the worst pain (81.2%), followed by retracting (59.4%).

A poster study at Yale Medical School showed that more than 80% of Yale surgical residents experienced pain after long operating room cases, but fewer than 20% sought medical treatment for it. The types of pain reported included neck, shoulder, back, upper extremity, hand and lower extremity. The study also reported that junior residents were more likely to experience post-surgical shoulder pain and that female resident were more likely than males to find a variety of surgical instruments uncomfortable.

Extent of Musculoskeletal Pain Among Surgeons

Nearly 70% of surgeons report suffering from musculoskeletal pain during their career. The pain comes from poor posture in the operating room and the main sources of pain include jutting the head forward, flexing the head, bending the spine forward and flexing and rotating the arm towards the body. Longer operations are associated with more significant pain. Six hours into a surgery, 97% of practitioners report pain. Two hours into a surgery, 40% of surgeons report pain, meaning that a large percentage of surgeons will experience pain during most of their cases.

There’s a focus on comfort in the operating room, but that focus has historically been focused on the patient, not the surgeon. Standing on your feet for hours, reaching, twisting, bending, even the operating room setup, can lead to pain. One study showed surgeons reporting pain as a 5 out of 10 following a routine day’s work in the operating room. Most surgeons report musculoskeletal pain during surgery and more than 10% of those report taking a leave of absence, changing medical specialty or retiring early.

Even for those who don’t experience pain, the physical demands of surgery often lead to fatigue, which can affect surgical speed and stamina, as well as concentration, according to a study published in PLOS ONE. Outside of work, surgeons report that work-related musculoskeletal pain can lead to troubles with sleeping, relationships, and quality of life.

Lack of Resources to Improve Ergonomics

The study published in PLOS ONE found that more than 76.1% of surgeons had no prior ergonomics training. In that same study, only 5.2% reported that they had received ergonomics training during medical school, 8.4% received the training in residency, and 1.9% received training from an expert consultation.

Medical students don’t fare much better. A study published in the Journal of the American Society of Plastic Surgeons reported that 97% of residents and attendings said they experienced musculoskeletal pain during surgery and 83% reported a lack of education in posture and ergonomics.

Yet things may be moving in the right direction. While 87% of residents reported pain, once residents participated in ergonomics training that featured targeted exercises and microbreaks, 83% reported less pain, especially in the cervical and lumbar spine, according to a 2020 study published in the Journal of Surgical Education.

Surgical ergonomics may eventually become part of required curriculums, however. In 2017, Duke Surgery introduced an ergonomics program to improve surgeon health. The peer-based program teaches junior residents and medical students about proper positioning in the operating room, including how to avoid awkward surgical postures, choosing ergonomic medical devices and furniture, and the benefits of microbreaks for stretching.