住院医师培训期间的职业倦怠：文献综述
Burnout during residency training: a literature review.
作者信息
Ishak Waguih William, Lederer Sara, Mandili Carla, Nikravesh Rose, Seligman Laurie, Vasa Monisha, Ogunyemi Dotun, Bernstein Carol A
出版信息
J Grad Med Educ. 2009 Dec;1(2):236-42. doi: 10.4300/JGME-D-09-00054.1.
OBJECTIVE
Burnout is a state of mental and physical exhaustion related to work or care giving activities. Burnout during residency training has gained significant attention secondary to concerns regarding job performance and patient care. This article reviews the relevant literature on burnout in order to provide information to educators about its prevalence, features, impact, and potential interventions.
METHODS
Studies were identified through a Medline and PsychInfo search from 1974 to 2009. Fifty-one studies were identified. Definition and description of burnout and measurement methods are presented followed by a thorough review of the studies.
RESULTS
An examination of the burnout literature reveals that it is prevalent in medical students (28%-45%), residents (27%-75%, depending on specialty), as well as practicing physicians. Psychological distress and physical symptoms can impact work performance and patient safety. Distress during medical school can lead to burnout, which in turn can result in negative consequences as a working physician. Burnout also poses significant challenges during early training years in residency. Time demands, lack of control, work planning, work organization, inherently difficult job situations, and interpersonal relationships, are considered factors contributing to residents' burnout. Potential interventions include workplace-driven and individual-driven measures. Workplace interventions include education about burnout, workload modifications, increasing the diversity of work duties, stress management training, mentoring, emotional intelligence training, and wellness workshops. Individual-driven behavioral, social, and physical activities include promoting interpersonal professional relations, meditation, counseling, and exercise.
CONCLUSIONS
Educators need to develop an active awareness of burnout and ought to consider incorporating relevant instruction and interventions during the process of training resident physicians.
目的
职业倦怠是一种与工作或护理活动相关的身心疲惫状态。住院医师培训期间的职业倦怠因对工作表现和患者护理的担忧而受到了极大关注。本文回顾了有关职业倦怠的相关文献，以便向教育工作者提供其患病率、特征、影响及潜在干预措施的信息。
方法
通过对1974年至2009年期间的医学文献数据库（Medline）和心理学文摘数据库（PsychInfo）进行检索来确定研究。共确定了51项研究。先介绍了职业倦怠的定义、描述及测量方法，随后对这些研究进行了全面回顾。
结果
对职业倦怠文献的研究表明，其在医学生（28%-45%）、住院医师（27%-75%，因专业而异）以及执业医师中都很普遍。心理困扰和身体症状会影响工作表现和患者安全。医学院期间的困扰会导致职业倦怠，而这反过来又会给在职医生带来负面后果。职业倦怠在住院医师培训的早期阶段也带来了重大挑战。时间需求、缺乏控制、工作规划、工作组织、本身就困难的工作情况以及人际关系，都被认为是导致住院医师职业倦怠的因素。潜在的干预措施包括工作场所驱动和个人驱动的措施。工作场所干预措施包括关于职业倦怠的教育、工作量调整、增加工作职责的多样性、压力管理培训、指导、情商培训以及健康研讨会。个人驱动的行为、社交和体育活动包括促进人际职业关系、冥想、咨询和锻炼。
结论
教育工作者需要积极认识职业倦怠，并应考虑在培训住院医师的过程中纳入相关指导和干预措施。
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