Bolanowski Wojciech
Department of Social Medicine, Wrocław Medical University, Wrocław, Poland.
Int J Occup Med Environ Health. 2005;18(4):367-74.
The interest is focused on today's interns who will soon become an essential part of the health care system. Obstacles they perceive at the beginning of the career may encourage them or, inversely, impede their professional development, enhance professional burnout or even lead to change of the profession. International literature, comprising publications on the situation in ten European countries, Canada and the USA, is reviewed. Numerous considerations have encouraged some attempts to measure "anxiety about professional future" (AAF).
Seven factors that induce anxiety about professional future among students and young doctors are listed and briefly discussed: 1) Difficulties in getting a job and growing anxiety for maintaining the job; 2) Low wages; 3) Negative impact of work on private and family life, in particular, a conflict between the professional role and mother's role; 4) Excessive level of organizational stress; 5) Lack of (individual) resources to cope with stress; 6) Institutional and financial limitations for professional development; and 7) Worldwide evolution of the professional role and the status of doctor. A questionnaire was developed by the author and answers were collected from a representative sample of Polish interns (about 1000) and a small sample of French interns. A scale for measuring the anxiety was built with use of factor analysis.
The resulting scale called AAF has proved to have good statistical properties. The mean value of the anxiety indicator proved to be high in Poland. Interns who are familiar with the doctor's daily duties, who feel economically independent and who have good self-valuation of the practical skills are characterized by a lower level of anxiety. AAF values in a sample of French interns was dramatically lower than those characteristic of Polish interns.
The values of AAF for the interns can be related to the intensity of stress-inducing factors in the professional environment. Very high AAF values can stem from an excessive professional stress that may have a negative impact on individual careers and the whole health care system in Poland. Appropriate changes in the curriculum of medical studies (accompanied by legal regulations) might reduce excessive anxiety about future in graduating doctors in Poland. Such changes could include: (a) a greater involvement of students in the examination and treatment of patients and in "daily life" in health care institutions; (b) making more practice (or performing medical procedures) obligatory; (c) creating better opportunities to earn living in the medical professions (by performing procedures or by assisting professionals); and (d) making efforts in the field of practical education more rewarding (e.g., introducing rating for practice and incorporating it into fellowship schemes).
人们的关注点集中在如今的实习生身上，他们很快将成为医疗保健系统的重要组成部分。他们在职业生涯初期所察觉到的障碍可能会激励他们，反之，也可能阻碍他们的职业发展，加剧职业倦怠，甚至导致职业变更。本文回顾了包括有关十个欧洲国家、加拿大和美国情况的出版物在内的国际文献。众多因素促使人们尝试去衡量“对职业未来的焦虑”（AAF）。
列出并简要讨论了导致学生和年轻医生对职业未来感到焦虑的七个因素：1）就业困难以及对保住工作的日益焦虑；2）低工资；3）工作对私人生活和家庭生活的负面影响，尤其是职业角色与母亲角色之间的冲突；4）过高的组织压力水平；5）缺乏应对压力的（个人）资源；6）职业发展的制度和资金限制；7）医生职业角色和地位的全球演变。作者编制了一份问卷，并从波兰实习生的代表性样本（约1000人）和一小部分法国实习生中收集了答案。利用因子分析构建了一个衡量焦虑的量表。
由此产生的名为AAF的量表已被证明具有良好的统计特性。焦虑指标的平均值在波兰被证明较高。熟悉医生日常职责、经济上独立且对实践技能有良好自我评估的实习生焦虑水平较低。法国实习生样本中的AAF值显著低于波兰实习生的特征值。
实习生的AAF值可能与职业环境中压力诱导因素的强度有关。非常高的AAF值可能源于过度的职业压力，这可能对波兰的个人职业生涯和整个医疗保健系统产生负面影响。医学课程（伴随法律法规）的适当变革可能会减少波兰即将毕业的医生对未来的过度焦虑。这些变革可以包括：（a）让学生更多地参与患者的检查和治疗以及医疗机构的“日常生活”；（b）使更多实践（或进行医疗程序）成为强制性要求；（c）创造更好的在医疗行业谋生的机会（通过进行程序或协助专业人员）；（d）在实践教育领域使努力更有回报（例如，引入实践评级并将其纳入奖学金计划）。
