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[JAMA最新论文]:美国住院医生的临床专科与职业倦怠症状的相关性
2018年09月24日 时讯速递, 进展交流 暂无评论

Original Investigation

September 18, 2018

Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians

Liselotte N. Dyrbye, Sara E. Burke, Rachel R. Hardeman, et al

JAMA. 2018;320(11):1114-1130. doi:10.1001/jama.2018.12615

Abstract

Importance 背景

Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency.

临床医生的职业倦怠非常普遍,且与医疗差错及职业精神缺失相关。尚不清楚住院医生职业倦怠症状与临床专科之间的关系,以及医学院期间的个人因素与住院医生期间职业倦怠和后悔职业选择之间的相关性。

Objective 目的

To explore factors associated with symptoms of burnout and career choice regret during residency.

研究与住院医生期间职业倦怠症状和后悔职业选择的相关因素

Design, Setting, and Participants 设计,场景及研究人群

Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016.

针对4732名美国住院医生的前瞻队列研究。2010年10月至2011年1月期间入选第一年的医学生,并完成基线问卷调查。邀请参研者完成另外2份调查问卷:医学院第4年(2014年1月至3月)及住院医生第2年(2016年春季)。最后随访日期为2016年7月31日。

Exposures 暴露因素

Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school.

临床专科,人口统计学特征,教育贷款,美国执业医师考试第一部分得分,以及在医学院期间焦虑、移情及社会支持情况。

Main Outcomes and Measures 主要预后指标

Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again).

住院医生第2年间报告职业倦怠症状比例(根据2个单项指标测定,根据Maslach工作倦怠量表修订),并根据另外一项指标评估后悔职业选择的情况(定义为,如果能够重新选择职业,住院医师是否还选择成为医生)。

Results 结果

Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.24 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.17 [95% CI, 1.07 to 1.28]; risk difference [RD], 7.2% [95% CI, 3.1% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.11]; RD, 1.8% per 1-point increase [95% CI, 1.6% to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 0.99]; RD, −0.5% per 1-point increase [95% CI, −0.6% to −0.3%]). Reported symptoms of burnout (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret.

在4696名住院医生中,3588名(76.4%)在住院医生第2年完成了调查问卷(2016年年龄中位数,29岁 [四分位区间,28.0-31.0] 岁;1822名 [50.9%] 女性)。3574名住院医生中,1615名 (45.2%; 95% CI, 43.6% to 46.8%) 报告职业倦怠症状。3571名住院医生中,502名(14.1%; 95% CI, 12.9% to 15.2%)后悔职业选择。在多因素分析中,与内科相比,泌尿科、神经内科、急诊科及普通外科培训伴随报告职业倦怠症状相对危险度(RRs)增加(RR范围, 1.24 to 1.48)。与报告职业倦怠症状高风险相关的特征包括女性(RR, 1.17 [95% CI, 1.07 to 1.28];风险差异[RD], 7.2% [95% CI, 3.1% to 11.3%])及医学院期间报告焦虑程度较高(RR, 1.08 每增加1分 [95% CI, 1.06 to 1.11]; RD, 1.8% 每增加1分 [95% CI, 1.6% to 2.0%])。医学院期间报告移情伴随住院医生期间职业倦怠症状风险降低(RR, 0.99 每增加1分 [95% CI, 0.99 to 0.99]; RD, −0.5% 每增加1分 [95% CI, −0.6% to −0.3%])。报告的职业倦怠症状 (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) 与临床专科(RR范围,1.66 to 2.60)均与后悔职业选择显著相关。

Conclusions and Relevance 结论和意义

Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.

在美国住院医生中,职业倦怠症状及后悔职业选择非常普遍,但不同临床专科之间差异显著。需要进一步研究以更好了解并解决上述差异。

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