Kuhn Gloria, Goldberg Richard, Compton Scott
Department of Emergency Medicine, Wayne State University, Detroit, MI 48201, USA.
Ann Emerg Med. 2009 Jul;54(1):106-113.e6. doi: 10.1016/j.annemergmed.2008.12.019. Epub 2009 Feb 7.
Questions about burnout, career satisfaction, and longevity of emergency physicians have been raised but no studies have examined tolerance for uncertainty as a risk factor for burnout. Primary objectives of this study are to assess the role of uncertainty tolerance in predicting career burnout and to estimate the proportion of emergency physicians who exhibit high levels of career burnout.
A mail survey incorporating validated measures of career satisfaction, tolerance for uncertainty, and burnout was sent to a random sample of members of the American College of Emergency Physicians. Best- and worst-case scenarios of point estimates are provided to assess for the effect of nonresponse bias, and multivariable logistic regression was used to predict evidence of career burnout.
One hundred ninety-three surveys were returned (response rate 43.1%). A high level of career burnout was exhibited in 62 (32.1%; best-worst case 13.8% to 64.1%) respondents. No demographic variables were associated with burnout status. The final model identified that high anxiety caused by concern for bad outcomes (odds ratio=6.35) was the strongest predictor of career burnout, controlling for all other variables.
A large percentage of emergency physicians in this study, 32.1%, exhibited emotional exhaustion, which is the core symptom of burnout. Emotional exhaustion was not related to age or type of practice and was not mitigated by training in emergency medicine. Physicians studied did not feel anxiety because of general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. High anxiety caused by concern for bad outcomes was the strongest predictor of burnout. Despite exhibiting emotional exhaustion, the majority of respondents are satisfied with the career of emergency medicine.
关于急诊医生职业倦怠、职业满意度和职业寿命的问题已经被提出，但尚无研究将对不确定性的耐受性作为职业倦怠的一个风险因素进行考察。本研究的主要目的是评估不确定性耐受性在预测职业倦怠中的作用，并估计表现出高水平职业倦怠的急诊医生的比例。
向美国急诊医师学会会员的一个随机样本发送了一份邮件调查问卷，其中包含经过验证的职业满意度、不确定性耐受性和职业倦怠测量指标。提供了点估计的最佳和最坏情况场景，以评估无应答偏差的影响，并使用多变量逻辑回归来预测职业倦怠的证据。
共返回193份调查问卷（回复率43.1%）。62名（32.1%；最佳 - 最坏情况为13.8%至64.1%）受访者表现出高水平的职业倦怠。没有人口统计学变量与职业倦怠状态相关。最终模型确定，对不良结果的担忧导致的高焦虑（优势比 = 6.35）是职业倦怠的最强预测因素，在控制所有其他变量的情况下。
本研究中很大比例（32.1%）的急诊医生表现出情感耗竭，这是职业倦怠的核心症状。情感耗竭与年龄或执业类型无关，也不会因急诊医学培训而减轻。参与研究的医生不会因为普遍的不确定性、向患者披露不确定性的困难或向其他医生承认错误而感到焦虑。对不良结果的担忧导致的高焦虑是职业倦怠的最强预测因素。尽管表现出情感耗竭，但大多数受访者对急诊医学职业感到满意。
