Dahlin Marie, Fjell Jenny, Runeson Bo
Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry St. Goran, SE-112 81 Stockholm, Sweden.
Nord J Psychiatry. 2010 Dec;64(6):402-8. doi: 10.3109/08039481003759219. Epub 2010 Apr 29.
Burnout and stress is frequently reported in young physicians but longitudinal studies are sparse. Exhaustion is a core facet of burnout.
To study individual and environmental medical school predictors and associated working conditions of postgraduate exhaustion, with a reference to gender.
Two cohorts of junior doctors (n=253, 58% women) graduated from Karolinska Institutet were assessed in medical school (2002 and 2005) and in their first postgraduate year (2003 and 2006). Baseline measures were: Performance-based self-esteem (PBSE), study conditions (Higher Education Stress Inventory, HESI) and exhaustion, and at follow-up exhaustion (Oldenburg Burnout Inventory, OLBI) and Learning climate in the clinic. Regression analyses on postgraduate exhaustion (OLBI) were performed in four steps. First PBSE gender and age was entered, second study conditions (HESI), third working conditions (Learning climate in the clinic), and finally we controlled for exhaustion at final year of medical school.
Response rate was 73%. Worries about future endurance/capacity (WFEC; HESI) predicted postgraduate exhaustion, but not PBSE, when baseline exhaustion was controlled for. Women's higher exhaustion scores were explained by their higher WFEC. A positive Learning climate was negatively associated with exhaustion.
High WFEC was a risk factor of exhaustion to which women were more subjected. Students with high doubts of themselves may benefit from specific programmes in medical school, addressing this risk. A positive Learning climate at follow-up seemed protective, although no conclusions on direction of causality can be made. The effect of PBSE needs further study.
年轻医生中倦怠和压力的情况屡有报道，但纵向研究较少。疲惫是倦怠的一个核心方面。
参照性别，研究医学院校中个体和环境因素对研究生疲惫的预测作用以及相关工作条件。
对卡罗林斯卡学院毕业的两批初级医生（n = 253，58%为女性）在医学院校期间（2002年和2005年）及其研究生一年级时（2003年和2006年）进行评估。基线测量指标包括：基于表现的自尊（PBSE）、学习条件（高等教育压力量表，HESI）和疲惫程度，随访时测量疲惫程度（奥尔登堡倦怠量表，OLBI）以及临床学习氛围。对研究生疲惫程度（OLBI）进行回归分析分四个步骤。首先纳入PBSE、性别和年龄，其次纳入学习条件（HESI），再次纳入工作条件（临床学习氛围），最后对医学院校最后一年的疲惫程度进行控制。
应答率为73%。在控制基线疲惫程度后，对未来耐力/能力的担忧（WFEC；HESI）可预测研究生的疲惫程度，但PBSE不能。女性较高的疲惫得分可由其较高的WFEC来解释。积极的学习氛围与疲惫呈负相关。
高WFEC是疲惫的一个风险因素，女性更容易受到影响。对自身高度怀疑的学生可能会从医学院校针对此风险的特定项目中受益。随访时积极的学习氛围似乎具有保护作用，尽管无法得出因果关系方向的结论。PBSE的影响需要进一步研究。
