Saint Louis University School of Medicine, St Louis, Missouri 63104, USA.
Med Educ. 2013 Feb;47(2):173-81. doi: 10.1111/medu.12083.
Given the trend among medical students away from primary care medicine and toward specialties that allow for more controllable lifestyles, the identification of factors associated with specialty choice is important. Burnout is one such factor. The purpose of this study was to examine the associations between burnout and residency specialty choice in terms of provision for a less versus more controllable lifestyle (e.g. internal medicine versus dermatology) and a lower versus higher income (e.g. paediatrics versus anaesthesiology).
A survey was sent to 165 Year 4 medical students who had entered the residency matching system. Students answered questions about specialty choice, motivating factors (lifestyle, patient care and prestige) and perceptions of medicine as a profession. They completed the Maslach Burnout Inventory-Human Services (MBI), which defines burnout in relation to emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Burnout and other variables were tested for associations with specialty lifestyle controllability and income.
A response rate of 88% (n = 145) was achieved. Experiences of MBI-EE, MBI-DP and MBI-PA burnout were reported by 42 (29%), 26 (18%) and 30 (21%) students, respectively. Specialties with less controllable lifestyles were chosen by 87 (60%) students and lower-income specialties by 81 (56%). Adjusted odds ratios (ORs) indicated that the choice of a specialty with a more controllable lifestyle was associated with higher MBI-EE burnout (OR = 1.77, 95% confidence interval [CI] 1.06-2.96), as well as stronger lifestyle- and prestige-related motivation, and weaker patient care-related motivation. The choice of a higher-income specialty was associated with lower MBI-PA burnout (OR = 0.56, 95% CI 0.32-0.98), weaker lifestyle- and patient care-related motivation, and stronger prestige-related motivation.
Specialty choices regarding lifestyle controllability and income were associated with the amount and type of medical school burnout, as well as with lifestyle-, prestige- and patient care-related motivation. Given that burnout may influence specialty choice, particularly with regard to the primary care specialties, medical schools may consider the utility of burnout prevention strategies.
鉴于医学生对基层医疗医学的兴趣逐渐减少，转而倾向于选择能够提供更可控生活方式的专业，因此确定与专业选择相关的因素非常重要。职业倦怠就是其中一个因素。本研究的目的是研究职业倦怠与住院医师专业选择之间的关系，具体而言，是研究生活方式的可控性和收入高低方面的专业选择，前者指的是提供更可控的生活方式的专业（例如内科与皮肤科），后者指的是提供更高收入的专业（例如儿科与麻醉科）。
向 165 名进入住院医师匹配系统的四年级医学生发送了一份调查问卷。学生们回答了有关专业选择、动机因素（生活方式、患者护理和声望）以及对医学作为一种职业的看法等问题。他们完成了《Maslach 职业倦怠量表-人力服务》（MBI），该量表将职业倦怠定义为与情绪衰竭（EE）、去人性化（DP）和个人成就感（PA）相关的问题。对职业倦怠和其他变量与专业生活方式可控性和收入之间的关联进行了检验。
回复率为 88%（n=145）。分别有 42 名（29%）、26 名（18%）和 30 名（21%）学生报告经历了 MBI-EE、MBI-DP 和 MBI-PA 职业倦怠。87 名（60%）学生选择了生活方式可控性较低的专业，81 名（56%）学生选择了收入较低的专业。调整后的优势比（OR）表明，选择生活方式更可控的专业与更高的 MBI-EE 职业倦怠有关（OR=1.77，95%置信区间[CI]为 1.06-2.96），同时与更强的生活方式和声望相关的动机以及更弱的患者护理相关动机有关。选择收入更高的专业与较低的 MBI-PA 职业倦怠有关（OR=0.56，95%CI 为 0.32-0.98），同时与更弱的生活方式和患者护理相关的动机以及更强的声望相关的动机有关。
生活方式可控性和收入方面的专业选择与医学院学生的职业倦怠程度和类型有关，也与生活方式、声望和患者护理相关的动机有关。鉴于职业倦怠可能会影响专业选择，尤其是基层医疗专业的选择，医学院可能会考虑采用预防职业倦怠的策略。
