Department of Anesthesiology, Feinberg School of Medicine, Northwestern Memorial Hospital, 251 E Huron St., F5-704, Chicago, IL 60611, USA.
Anesth Analg. 2013 Jul;117(1):182-93. doi: 10.1213/ANE.0b013e3182917da9. Epub 2013 May 17.
The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care and safety. The primary objective of this study was to determine the prevalence of burnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology.
A cross-sectional survey was sent to 2773 anesthesiology residents in the United States. The questionnaire was divided into 5 parts examining trainees' demographic factors, burnout (Maslach Burnout Inventory), depression (Harvard depression scale), 10 questions designed to evaluate best practice of anesthesiology, and 7 questions evaluating self-reported errors. Best practices and self-reported error rates were compared among subjects with a high risk of burnout only, high risk of depression only, high risk of burnout and depression, and low risk of burnout and depression. Pairwise comparisons were considered significant at P < 0.004 and confidence intervals (CIs) reported at 99.6%.
There were 1508 (54%) resident responds. High burnout risk was found in 41% (575 of 1417) of respondents. Working >70 hours per week, having >5 drinks per week, and female gender were associated with increased burnout risk. Twenty-two percent (298 of 1384) screened positive for depression. Working >70 hours of work per week, smoking, female gender, and having >5 drinks per week were associated with increased depression risk. Two hundred forty (17%) respondents scored at high risk of burnout and depression, 321 (23%) at high risk of burnout, 58 (4%) at high risk of depression only, and 764 (56%) at low risk of burnout or depression. Median best practice scores (maximum = 30) for residents at high risk of burnout (difference -2; 99.6% CI, -1 to -2; P < 0.001) or high risk of burnout and depression (difference -4; 99.6% CI, -3 to -6; P < 0.001) were lower than scores of residents at low risk for burnout or depression. Thirty-three percent of respondents with high burnout and depression risk reported multiple medication errors in the last year compared with 0.7% of the lower-risk responders (P < 0.001).
Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety.
麻醉科住院医师的倦怠和抑郁发生率尚不清楚。麻醉科住院医师的倦怠/抑郁是否会影响患者的护理和安全也不得而知。本研究的主要目的是确定美国麻醉科住院医师的倦怠和抑郁发生率。我们假设处于高倦怠和/或抑郁风险的住院医师报告的医疗错误会更多，并且遵循被认为是麻醉学最佳实践的原则的比例也会更低。
我们向美国的 2773 名麻醉科住院医师发送了一份横断面调查。问卷分为 5 部分，分别调查学员的人口统计学因素、倦怠（Maslach 倦怠量表）、抑郁（哈佛抑郁量表）、10 个旨在评估麻醉学最佳实践的问题以及 7 个自我报告错误的问题。在仅处于高倦怠风险、仅处于高抑郁风险、高倦怠和抑郁风险以及低倦怠和抑郁风险的受试者中，比较最佳实践和自我报告的错误率。只有当 P < 0.004 时，才会考虑到配对比较具有统计学意义，置信区间（CI）为 99.6%。
共有 1508 名（54%）住院医师做出了回应。在 1417 名应答者中，有 41%（575 名）存在高倦怠风险。每周工作超过 70 小时、每周饮酒超过 5 次以及女性性别与倦怠风险增加相关。22%（298 名）筛查出患有抑郁症。每周工作超过 70 小时、吸烟、女性性别和每周饮酒超过 5 次与抑郁风险增加相关。240 名（17%）应答者处于高倦怠和抑郁风险，321 名（23%）处于高倦怠风险，58 名（4%）仅处于高抑郁风险，764 名（56%）处于低倦怠或抑郁风险。高倦怠风险（差值-2；99.6%CI，-1 至-2；P < 0.001）或高倦怠和抑郁风险（差值-4；99.6%CI，-3 至-6；P < 0.001）的住院医师最佳实践得分（最高为 30）中位数低于处于低倦怠或抑郁风险的住院医师。33%的高倦怠和抑郁风险应答者在过去一年中报告了多次用药错误，而风险较低的应答者仅为 0.7%（P < 0.001）。
倦怠、抑郁和自杀意念在麻醉科住院医师中非常普遍。除了对麻醉科住院医师健康的影响外，倦怠和抑郁还可能影响患者的护理和安全。
