Devens Maria, Hasnain Memoona, Dudkiewicz Brian, Connell Karen J
Department of Family Medicine, University of Illinois at Chicago, USA.
Fam Med. 2012 Apr;44(4):265-8.
Residency presents unique challenges for learners with regard to stress management and working with others to deliver quality patient care. To address resident concerns about stress and teamwork on a family medicine inpatient service, a structured 15-minute intervention was implemented weekly, over a 20-month period. The intervention was conducted by the clinical psychologist and inpatient service medical director. Residents rated their respective stress levels at each session, and facilitators engaged them in problem solving if their stress level was rated 7 or higher on a 0--10 scale. Twenty-six residents experienced the intervention on multiple occasions. The amount of resident participation in the intervention varied based on the resident's level of training during the intervention period.
Residents (n=26) completed a brief questionnaire regarding the effectiveness of the intervention at the end of each 4-week block in which they participated. One hundred of a possible 108 questionnaires were completed (92%).
Questionnaire items were rated on a 7-point Likert scale ranging from 1 (not at all effective) to 7 (very effective). Resident-rated helpfulness of the intervention ranged from a mean of 5.28 (SD=1.30, Resolving Communication Difficulties) to 5.76 (SD=1.06, Facilitating Discussion of Stressful Aspects of Work). Most resident-identified stressors were resolved during the scheduled meetings; only five additional meetings were needed during the 20 months of the project to achieve resolution of resident stressors.
The intervention is time- and cost-efficient, addresses at least two of the Accreditation Council on Graduate Medical Education (ACGME) competencies (professionalism and interpersonal and communication skills) as well as Agency for Healthcare Research and Quality teamwork competencies (leadership, communication, situation monitoring, and mutual support) and can easily be adapted by other specialties.
住院医师培训在压力管理以及与他人协作以提供高质量患者护理方面给学习者带来了独特的挑战。为解决家庭医学住院服务中住院医师对压力和团队合作的担忧，在20个月的时间里，每周实施一次为期15分钟的结构化干预。该干预由临床心理学家和住院服务医疗主任进行。住院医师在每次课程中对各自的压力水平进行评分，如果他们的压力水平在0至10分的量表上被评为7分或更高， facilitators会让他们参与解决问题。26名住院医师多次体验了该干预。住院医师参与干预的程度因干预期间其培训水平而异。
26名住院医师在参与的每4周时间段结束时完成一份关于干预效果的简短问卷。在可能的108份问卷中，有100份完成（92%）。
问卷项目在7分量表上进行评分，范围从1（完全无效）到7（非常有效）。住院医师评定的干预帮助程度从平均5.28（标准差=1.30，解决沟通困难）到5.76（标准差=1.06，促进对工作压力方面的讨论）不等。大多数住院医师确定的压力源在预定会议期间得到解决；在项目的20个月期间，仅额外需要5次会议来解决住院医师的压力源。
该干预具有时间和成本效益，至少满足了研究生医学教育认证委员会（ACGME）的两项能力要求（职业素养以及人际和沟通技能）以及医疗保健研究与质量机构的团队合作能力要求（领导力、沟通、情况监测和相互支持），并且其他专业可以轻松采用。
