Zaré S Mahmood, Galanko Joseph, Behrns Kevin E, Koruda Mark J, Boyle Lisa M, Farley David R, Evans Stephen R T, Meyer Anthony A, Sheldon George F, Farrell Timothy M
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7081, USA.
J Am Coll Surg. 2004 Apr;198(4):633-40. doi: 10.1016/j.jamcollsurg.2003.10.006.
Accreditation Council on Graduate Medical Education work-hour restrictions are aimed at improving patient safety and resident well-being. Although surgical trainees will be dramatically affected by these changes, no comprehensive assessment of their well-being has been recently attempted.
A multicenter study of psychological well-being of surgical residents (n = 108) across four US training programs before implementation of the 80-hour work week was performed using two validated surveys (Symptom Checklist-90-R [SCL-90-R] and Perceived Stress Scale [PSS]) during academic year 2002-03. Societal normative populations served as controls. Primary outcomes measures were psychologic distress (SCL-90-R) and perceived stress (PSS). Secondary outcomes measures (SCL-90-R) were somatization, depression, anxiety, interpersonal sensitivity, hostility, obsessive-compulsive behavior, phobic anxiety, paranoid ideation, and psychoticism. The impact of personal variables (age, gender, marital status) and programmatic variables (level of training, laboratory experience, institution) was assessed.
Mean psychologic distress was significantly higher in general surgery residents than in the normative population (p < 0.0001), with 38% scoring above the 90th percentile and 72% above the 50th percentile. Mean perceived stress among surgery residents was higher than historic controls (p < 0.0001), with 21% scoring above the 90th percentile and 68% above the 50th percentile. Among secondary outcomes, eight of nine symptom dimensions were significantly higher in surgical residents than in societal controls. In subgroup analyses, male gender was associated with phobic anxiety (p < 0.001) and anxiety (p < 0.05), and junior level of training (PGY 1 to 3) with anxiety (p < 0.05), obsessive-compulsive behavior (p < 0.05), and interpersonal sensitivity (p < 0.05).
More than one-third of general surgery residents meet criteria for clinical psychologic distress. Surgery residents perceive significantly more stress than societal controls. Both personal and programmatic variables likely affect resident well-being and should be considered in assessing the full impact of Accreditation Council on Graduate Medical Education directives and in guiding future restructuring efforts.
研究生医学教育认证委员会的工作时间限制旨在提高患者安全和住院医师的健康水平。尽管外科住院医师将受到这些变化的显著影响，但最近尚未尝试对他们的健康状况进行全面评估。
在2002 - 2003学年，使用两项经过验证的调查问卷（症状自评量表90修订版[SCL - 90 - R]和感知压力量表[PSS]），对美国四个培训项目中的108名外科住院医师的心理健康状况进行了多中心研究。以社会标准人群作为对照。主要结局指标为心理困扰（SCL - 90 - R）和感知压力（PSS）。次要结局指标（SCL - 90 - R）包括躯体化、抑郁、焦虑、人际敏感、敌对、强迫行为、恐惧焦虑、偏执观念和精神病性。评估了个人变量（年龄、性别、婚姻状况）和项目变量（培训水平、实验室经验、机构）的影响。
普通外科住院医师的平均心理困扰显著高于标准人群（p < 0.0001），38%的人得分高于第90百分位数，72%的人得分高于第50百分位数。外科住院医师的平均感知压力高于历史对照（p < 0.0001），21%的人得分高于第90百分位数，68%的人得分高于第50百分位数。在次要结局中，九个症状维度中的八个在外科住院医师中显著高于社会对照。在亚组分析中，男性与恐惧焦虑（p < 0.001）和焦虑（p < 0.05）相关，初级培训水平（住院医师第1年至第3年）与焦虑（p < 0.05）、强迫行为（p < 0.05）和人际敏感（p < 0.05）相关。
超过三分之一的普通外科住院医师符合临床心理困扰的标准。外科住院医师感知到的压力明显高于社会对照。个人和项目变量都可能影响住院医师的健康状况，在评估研究生医学教育认证委员会指令的全面影响以及指导未来的重组工作时应予以考虑。
