Non-Invasive Assessment of Continuous Real-Time Workplace Stress Among Surgeons and Surgical Trainees: A Scoping Review

Clinical Snapshot

Key Findings

• Effect Size: Not applicable (descriptive scoping review)

• Primary Outcome: Identification of physiological stress measurement approaches using wearable devices

• Nnt Or Sensitivity: Most common devices: Polar (21.3%), Holter ECG (11.5%), Medilog (9.8%), WHOOP (9.8%)

Clinical Application

Moderate - requires investment in wearable technology and data management systems Relevant for Australian surgical training programs and workplace wellness initiatives, aligns with RACS wellbeing focus All surgeons and surgical trainees in operating theatre and clinical environments

Abstract

OBJECTIVES: To describe how physiological parameters were used to characterize continuous, real-time workplace stress among surgeons and surgical trainees, and to identify the advantages and disadvantages of using wearable devices. DESIGN: We conducted a scoping review to examine how wearable devices were used to objectively measure surgeons' and trainees' physiological stress in the workplace. Peer-reviewed English articles published up to September 2023 in Medline (Ovid), Cochrane Library (Wiley), Embase (Elsevier), and PsycINFO (Ebsco) databases using wearable devices used to measure continuous, real-time physiological parameters representing workplace stress among surgeons and surgical trainees were included in the review. SETTING: We included studies that assessed physiological stress in the workplace (e.g., operating room and other clinical environments). PARTICIPANTS: Surgeons and surgical trainees. RESULTS: A review of 61 articles that met inclusion criteria revealed that the most commonly used wearable devices were Polar 13 (21.3%), Medilog: 6 (9.8%), Holter ECG device: 7 (11.5%), and WHOOP! : 6 (9.8%). Physiological parameters used to measure continuous, real-time workplace stress were heart rate, heart rate variability, blood pressure, respiratory rate, and electrodermal activity. Physiological parameters indicated that surgeons were more stressed in the operating room than in other clinical environments. Intraoperative surgeons' stress increased with performing critical steps of the operation, teaching a trainee, the number of intraoperative events, e.g., bleeding, and decreased with years of experience. There was a negative relationship between stress and the surgeon's intraoperative performance. The advantages of using wearable devices' physiologic parameters were objectivity, longitudinal measurement, and minimally obtrusive. The disadvantages were short battery life, inadequate data capture, artifacts, and data loss. CONCLUSIONS: Wearable devices can measure a range of physiological parameters that represent workplace stress continuously among surgeons and surgical trainees.

References

1. 1.Abahuje, E., Lin, K. A., Nguyen, M. L. T., Tesorero, K., Wafford, Q. E., Rosu, C., & Stey, A. (2026). Non-invasive assessment of continuous real-time workplace stress among surgeons and surgical trainees: A scoping review. Journal of Surgical Education, 103881. https://doi.org/10.1016/j.jsurg.2026.103881