Buddeberg-Fischer B, Stamm M, Buddeberg C, Bauer G, Hämmig O, Klaghofer R
Abteilung Psychosoziale Medizin, Universitätsspital Zürich, Haldenbachstr. 18CH-8091 Zürich.
Dtsch Med Wochenschr. 2008 Nov;133(47):2441-7. doi: 10.1055/s-0028-1100936. Epub 2008 Nov 12.
Based on the Effort-Reward-Imbalance Model by Siegrist a study was undertaken to find out (a) in what way young doctors assess effort and reward during their specialist training; (b) whether there are certain job stress patterns over time; and (c) what the correlations are, if any, between perceived job stress, health and satisfaction with life.
Within the framework of a prospective study (2001 - 2007) 370 doctors who had just qualified and were residents in the German-speaking part of Switzerland were assessed four times by means of anonymized questionnaires. Job stress, measured by the Effort-Reward-Imbalance scale, as well as health and satisfaction with life were assessed in these doctors' 2nd (T2), 4th (T3), and 6th (T4) year of specialist training ("residents"). Stress patterns of the participants were evaluated, based on the effort and reward scale values at T2, T3, and T4, by two-step cluster analysis. Gender differences between the clusters were calculated by the 2 test and differences in the continuous variables by analysis of variance with repeated measurements.
During residency the percentage of doctors who experienced an Effort-Reward-Imbalance (ratio between effort and reward ERI > 1) increased from 18% at T2 to 20 % at T3 to 25 % at T4. The cluster analysis revealed two clusters: Type 1 (67%) with effort values below average and reward values above average (ER balance) across the three measurement points, and type 2 (33 %) with effort values above average and reward values below average (ER imbalance). Subjects in cluster 2 showed unfavorable values, when compared with those in cluster 1, in overcommitment, in workload and in the health variables (anxiety, depression, physical and psychological well-being), as well as in their assessed satisfaction with life at all three measurement points.
One third of the doctors experienced stress at work, caused by an effort-reward imbalance. This had a negative impact on their health and satisfaction with life. Regular supervision and goal-oriented career counselling provided by senior physicians could contribute to young doctors not feeling so much stressed at work, feeling well and being more content with their work.
基于西格里斯特的努力-回报失衡模型，开展了一项研究，以查明：（a）年轻医生在专科培训期间如何评估努力与回报；（b）随着时间推移是否存在特定的工作压力模式；以及（c）感知到的工作压力、健康与生活满意度之间是否存在相关性（若有）。
在一项前瞻性研究（2001 - 2007年）的框架内，通过匿名问卷对370名刚获得资格且在瑞士德语区担任住院医师的医生进行了四次评估。在这些医生专科培训的第2年（T2）、第4年（T3）和第6年（T4）（“住院医师”阶段），使用努力-回报失衡量表测量工作压力，并评估健康状况和生活满意度。基于T2、T3和T4时的努力和回报量表值，通过两步聚类分析评估参与者的压力模式。通过卡方检验计算各聚类之间的性别差异，通过重复测量方差分析计算连续变量的差异。
在住院医师培训期间，经历努力-回报失衡（努力与回报之比ERI > 1）的医生比例从T2时的18%增至T3时的20%，再到T4时的25%。聚类分析揭示了两个聚类：第1类（67%）在三个测量点的努力值低于平均水平且回报值高于平均水平（努力-回报平衡），第2类（33%）的努力值高于平均水平且回报值低于平均水平（努力-回报失衡）。与第1类聚类中的受试者相比，第2类聚类中的受试者在过度投入、工作量以及健康变量（焦虑、抑郁、身心健康）方面表现出不利值，并且在所有三个测量点的生活满意度评估中也是如此。
三分之一的医生因努力-回报失衡而经历工作压力。这对他们的健康和生活满意度产生了负面影响。资深医生提供的定期监督和目标导向的职业咨询有助于年轻医生在工作中不感到那么大的压力，感觉良好并对工作更满意。
