Billings Martha E, Lazarus Michael E, Wenrich Marjorie, Curtis J Randall, Engelberg Ruth A
J Grad Med Educ. 2011 Dec;3(4):503-10. doi: 10.4300/JGME-D-11-00044.1.
Residents learn and participate in care within hospital cultures that 5 tolerate unprofessional conduct and cynical attitudes, labeled the "hidden curriculum." We hypothesized that this hidden curriculum 5 have deleterious effects on residents' professional development and investigated whether witnessing unprofessional behavior during residency was associated with burnout and cynicism.
We surveyed internal medicine residents at 2 academic centers for 3 years (2008-2010). Hidden curriculum items assessed exposure to unprofessional conduct. We used regression analyses to examine if hidden curriculum scores were associated with cynicism and the Maslach Burnout Inventory depersonalization and emotional exhaustion domain scores.
The response rate was 48% (337 of 708). In the 284 surveys analyzed, 45% of respondents met burnout criteria and had significantly higher hidden curriculum scores (26 versus 19, P < .001) than those not meeting criteria. In cross-sectional analyses, the hidden curriculum score was significantly associated with residents' depersonalization, emotional exhaustion, and cynicism scores. Cynicism scores were also associated with burnout.
Exposure to unprofessional conduct was associated with higher burnout and cynicism scores among internal medicine residents. We also found that cynicism and burnout were significantly associated and 5 be measures of similar but not necessarily identical responses to the challenges posed by residency. Measuring the hidden curriculum and cynicism 5 provide direction for educators attempting to reform hospital culture and improve resident well-being.
住院医师在容忍不专业行为和愤世嫉俗态度的医院文化中学习并参与医疗工作，这种现象被称为“隐性课程”。我们假设这种隐性课程会对住院医师的职业发展产生有害影响，并调查住院期间目睹不专业行为是否与职业倦怠和愤世嫉俗有关。
我们在两个学术中心对内科住院医师进行了为期三年（2008 - 2010年）的调查。隐性课程项目评估了接触不专业行为的情况。我们使用回归分析来检验隐性课程得分是否与愤世嫉俗、马氏职业倦怠量表中的去个性化和情感耗竭领域得分相关。
回复率为48%（708人中337人回复）。在分析的284份调查问卷中，45%的受访者符合职业倦怠标准，其隐性课程得分（26分对19分，P <.001）显著高于未达标准者。在横断面分析中，隐性课程得分与住院医师的去个性化、情感耗竭和愤世嫉俗得分显著相关。愤世嫉俗得分也与职业倦怠相关。
内科住院医师接触不专业行为与更高的职业倦怠和愤世嫉俗得分相关。我们还发现愤世嫉俗和职业倦怠显著相关，并且可能是对住院医师培训所带来挑战的类似但不一定相同反应的衡量指标。衡量隐性课程和愤世嫉俗可为试图改革医院文化和改善住院医师福祉的教育工作者提供指导。
