LeBlanc Vicki R, Bandiera Glen W
Wilson Centre for Research in Education; Division of Emergency Medicine, Department of Medicine, University of Toronto and ORNGE Transport Medicine, Toronto, Ontario, Canada.
Med Educ. 2007 Jun;41(6):556-64. doi: 10.1111/j.1365-2923.2007.02765.x.
Despite the finding that residents are exposed to significant stressors during their training, little is known about the impact of these stressors on performance. The objectives of this project were to measure the subjective anxiety felt by emergency medicine (EM) residents during in-training examinations, and to determine the effect of this anxiety on their ability to diagnose visual stimuli such as X-rays, photographs and electrocardiographs.
Two examinations, matched for difficulty and length, were constructed based on the performance of 23 residents in 2 Royal College of Physicians and Surgeons of Canada (RCPSC) EM residency programmes. These examinations were then administered at 2-week intervals to another 24 residents in 2 additional RCPSC EM programmes. One examination was administered under high-stress conditions (in-training examination) and the other under low-stress (control) conditions. Perceived anxiety was measured using the state scale of the State-Trait Anxiety Inventory before and after each iteration of the examination.
Residents reported higher levels of anxiety in the high-stress condition (41.5 versus 35.9, P < 0.05). Examination scores were higher in the high-stress condition (70.4 versus 64.4, P < 0.01). The scores of junior residents improved in the high-stress condition, whereas those of intermediate and senior residents did not change.
Emergency medicine residents report higher anxiety during in-training examinations compared with control conditions. Residents at all levels exhibited similar perceptions of anxiety. Junior residents performed better under stress, achieving higher scores during the in-training examination than during the control condition. The performance of more experienced residents was not affected by the stress condition.
尽管已发现住院医师在培训期间面临重大压力源，但对于这些压力源对其表现的影响却知之甚少。本项目的目标是测量急诊医学（EM）住院医师在培训期间考试中的主观焦虑程度，并确定这种焦虑对他们诊断X射线、照片和心电图等视觉刺激的能力的影响。
根据23名住院医师在加拿大皇家内科医师与外科医师学会（RCPSC）的2个EM住院医师培训项目中的表现，构建了两场难度和长度相当的考试。然后，每隔两周对另外2个RCPSC EM项目中的24名住院医师进行这两场考试。一场考试在高压力条件下（培训期间考试）进行，另一场在低压力（对照）条件下进行。在每次考试前后，使用状态-特质焦虑量表的状态量表来测量感知到的焦虑。
住院医师报告在高压力条件下的焦虑水平更高（41.5对35.9，P<0.05）。高压力条件下的考试成绩更高（70.4对64.4，P<0.01）。低年资住院医师在高压力条件下的成绩有所提高，而中年资和高年资住院医师的成绩没有变化。
与对照条件相比，急诊医学住院医师在培训期间考试时报告的焦虑程度更高。各级住院医师表现出相似的焦虑感。低年资住院医师在压力下表现更好，在培训期间考试中的成绩高于对照条件下的成绩。经验更丰富的住院医师的表现不受压力条件的影响。
