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观点:住院医师的健康:新的希望。

Perspective: Resident physician wellness: a new hope.

机构信息

Department of Emergency Medicine, University of Alberta, Edmonton, Canada.

出版信息

Acad Med. 2012 May;87(5):598-602. doi: 10.1097/ACM.0b013e31824d47ff.

Abstract

Residency training is a challenging period in a physician's career owing to a multitude of stressors perhaps not previously encountered. In some cases, these stressors may culminate in a state of burnout. In response, much has been written about the issues of personal wellness during residency training. Recently, duty hours reform has been the major focus of addressing resident wellness; however, this intervention has established little benefit and has created unintended negative consequences. Alternatively, an emerging solution may be the implementation of resident wellness programs into residency training. Such programs are defined by a combination of active and passive initiatives targeting the various domains of physical, mental, social, and intellectual wellness. In contrast to duty hours reform, resident wellness programs are generally free from controversy and have been shown to improve resident wellness and enhance empathy.This article highlights the salient causes of burnout as it applies to present-day resident physicians and the patient care they provide. Moreover, in the wake of the controversy surrounding duty hours reform, a novel approach to resident wellness involving structured resident wellness programs is discussed. Specifically included are the fundamental components of a wellness program, the advantages held over duty hours reform, methods to evaluate program efficacy, and the current evidence to support these initiatives. Formal wellness curricula, including an evaluative process, should be an integral component of physician training. These programs represent a new hope in the solution to the long-debated issue of burnout and wellness during residency training.

摘要

住院医师培训是医生职业生涯中极具挑战性的时期,因为有许多压力源,而这些压力源可能以前从未遇到过。在某些情况下,这些压力源可能会导致 burnout。为此,人们写了很多关于住院医师培训期间个人健康的问题。最近,工作时间改革一直是解决居民健康问题的主要焦点;然而,这种干预措施收效甚微,并产生了意想不到的负面影响。相反,一种新的解决方案可能是将居民健康计划纳入住院医师培训。这些计划的定义是结合针对身体、心理、社会和智力健康各个领域的积极和被动举措。与工作时间改革不同,居民健康计划通常没有争议,并已被证明可以提高居民的健康水平并增强同理心。本文重点介绍了 burnout 对当前住院医师和他们提供的患者护理的影响。此外,在围绕工作时间改革的争议之后,本文讨论了一种涉及结构化居民健康计划的居民健康的新方法。具体包括健康计划的基本组成部分、优于工作时间改革的优势、评估计划效果的方法以及支持这些举措的现有证据。正式的健康课程,包括评估过程,应成为医生培训的一个组成部分。这些计划代表了解决住院医师培训期间 burnout 和健康问题这一长期争论问题的新希望。

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