Enhanced Stress Resilience Training in Surgeons Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials

ESRT-1 did not significantly reduce perceived stress in surgical PGY-1 residents compared to active controls at post-intervention or 50-week follow-up.

Effect: null; Cohen d = 0.16 (post), Cohen d = 0.07 (50-wk)

ESRT-1 significantly improved executive cognitive function at 50-week follow-up in surgical PGY-1 residents compared to active controls, with a large effect size.

Effect: improvement; Cohen d = 0.89 (50-wk)

ESRT-1 significantly improved mindfulness scores in surgical PGY-1 residents compared to active controls at both post-intervention and 50-week follow-up, with large effect sizes.

Effect: improvement; Cohen d = 1.03 (post), Cohen d = 0.78 (50-wk)

ESRT-2 did not significantly reduce perceived stress in mixed-specialty PGY-1 residents compared to active controls at post-intervention or 32-week follow-up.

Effect: null; Cohen d = 0.38 (post), Cohen d = 0.20 (32-wk)

ESRT-2 significantly reduced emotional exhaustion in mixed-specialty PGY-1 residents compared to active controls at both post-intervention and 32-week follow-up, with medium-to-large effect sizes.

Effect: improvement; Cohen d = 0.67 (post), Cohen d = 0.81 (32-wk)

ESRT-2 significantly reduced depersonalization in mixed-specialty PGY-1 residents compared to active controls at 32-week follow-up, with a medium effect size, though not at post-intervention.

Effect: improvement; Cohen d = 0.69 (32-wk)

Pooled ESRT participants showed a significant 26-37% relative reduction in activity of three stress-stimulated pro-inflammatory signaling pathways (NF-kB, AP-1, CREB) compared to controls, consistent

Effect: improvement; NF-kB: 0.74-fold relative change, p = 0.043; AP-1: 0.73-fold, p = 0.031; CREB: 0.63-fold, p = 0.048; CI: NF-kB: 95% CI (0.56, 0.99); AP-1