Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clin Proc. 2012 Dec;87(12):1138-44. doi: 10.1016/j.mayocp.2012.07.021.
To evaluate the effect of resident physicians' distress on their personal safety.
We conducted a prospective, longitudinal cohort study of internal medicine residents at Mayo Clinic in Rochester, Minnesota. Participants completed surveys quarterly from July 1, 2007, through July 31, 2011, during their training period. Frequency of self-reported blood and body fluid (BBF) exposures and motor vehicle incidents was recorded. Associations of validated measures of quality of life, burnout, symptoms of depression, fatigue, and sleepiness with a subsequently reported BBF exposure or motor vehicle incident were determined using generalized estimating equations for repeated measures.
Data were provided by 340 of 384 eligible residents (88.5%). Of the 301 participants providing BBF exposure data, 23 (7.6%) reported having at least 1 BBF exposure during the study period. Motor vehicle incidents were reported by 168 of 300 respondents (56.0%), including 34 (11.3%) reporting a motor vehicle crash and 130 (43.3%) reporting a near-miss motor vehicle crash. Other than the low personal accomplishment domain of burnout, distress and fatigue at one time point exhibited no statistically significant associations with BBF exposure in the subsequent 3 months. However, diminished quality of life, burnout, positive screening for depression, fatigue, and sleepiness were each associated with statistically significantly increased odds of reporting a motor vehicle incident in the subsequent 3 months.
Exposures to BBF are relatively uncommon among internal medicine residents in current training environments. Motor vehicle incidents, however, remain common. Our results confirm the importance of fatigue and sleepiness to resident safety concerns. In addition, higher levels of distress may be contributory factors to motor vehicle crashes and other related incidents. Interventions designed to address both fatigue and distress may be needed to optimally promote patient and resident safety.
评估住院医师的困扰对其个人安全的影响。
我们对明尼苏达州罗切斯特市梅奥诊所的内科住院医师进行了一项前瞻性、纵向队列研究。参与者在培训期间于 2007 年 7 月 1 日至 2011 年 7 月 31 日期间每季度完成一次调查。记录了自我报告的血液和体液（BBF）暴露和机动车事故的频率。使用广义估计方程对重复测量数据，确定经过验证的生活质量、倦怠、抑郁症状、疲劳和嗜睡指标与随后报告的 BBF 暴露或机动车事故之间的关联。
340 名符合条件的居民中有 340 名（88.5%）提供了数据。在提供 BBF 暴露数据的 301 名参与者中，有 23 名（7.6%）报告在研究期间至少有 1 次 BBF 暴露。300 名受访者中有 168 名（56.0%）报告了机动车事故，其中 34 名（11.3%）报告了机动车事故，130 名（43.3%）报告了机动车事故未遂。除了倦怠的低个人成就感领域外，在一个时间点的困扰和疲劳与随后 3 个月内的 BBF 暴露没有统计学上显著的关联。然而，生活质量下降、倦怠、抑郁筛查阳性、疲劳和嗜睡都与随后 3 个月内报告机动车事故的几率统计学显著增加相关。
在当前的培训环境中，内科住院医师发生 BBF 暴露的情况相对较少。然而，机动车事故仍然很常见。我们的研究结果证实了疲劳和嗜睡对住院医师安全的重要性。此外，较高水平的困扰可能是机动车事故和其他相关事件的促成因素。为了优化促进患者和住院医师的安全，可能需要采取干预措施来解决疲劳和困扰问题。
