Mougalian Sarah Schellhorn, Lessen David S, Levine Randy L, Panagopoulos Georgia, Von Roenn Jamie H, Arnold Robert M, Block Susan D, Buss Mary K
M. D. Anderson Cancer Center, Houston, Texas 77030-4000, USA.
J Support Oncol. 2013 Jun;11(2):95-102.
Burnout among physicians can lead to decreased career satisfaction, physical and emotional exhaustion, and increased medical errors. In oncologists, high exposure to fatal illness is associated with burnout.
The Maslach Burnout Inventory, measuring Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was administered to second-year US oncology fellows. Bivariate and multivariate analyses explored associations between burnout and fellow demographics, attitudes, and educational experiences.
A total of 254 fellows out of 402 eligible US fellows responded (63.2%) and 24.2% reported high EE, 30.0% reported high DP, and 26.8% reported low PA. Over half of the fellows reported burnout in at least one domain. Lower EE scores were associated with the fellows' perceptions of having received better teaching, explicit teaching about certain end-of-life topics, and receipt of direct observation of goals-of-care discussions. Fellows who reported better overall teaching quality and more frequent observation of their skills had less depersonalization. Fellows who felt a responsibility to help patients at the end of life to prepare for death had higher PA.
This survey relies on the fellows' self-reported perceptions without an objective measure for validation. Factors associated with burnout may not be causal. The number of analyses performed raises the concern for Type I errors; therefore, a stringent P value (0.01) was used.
Burnout is prevalent during oncology training. Higher-quality teaching is associated with less burnout among fellows. Fellowship programs should recognize the prevalence of burnout among oncology fellows as well as components of training that may protect against burnout.
医生职业倦怠会导致职业满意度下降、身心疲惫，并增加医疗差错。肿瘤学家因频繁接触致命疾病，更容易出现职业倦怠。
对美国肿瘤学专业二年级住院医师进行了Maslach职业倦怠量表调查，该量表用于测量情感耗竭（EE）、去人格化（DP）和个人成就感（PA）。采用双变量和多变量分析方法，探讨职业倦怠与住院医师人口统计学特征、态度及教育经历之间的关联。
402名符合条件的美国住院医师中，共有254人做出回应（回应率63.2%）。其中，24.2%的人情感耗竭程度较高，30.0%的人去人格化程度较高，26.8%的人个人成就感较低。超过半数的住院医师在至少一个维度上存在职业倦怠。情感耗竭得分较低与住院医师认为接受了更好的教学、接受了关于某些临终话题的明确教学以及接受了护理目标讨论的直接观察有关。报告整体教学质量更好且技能观察更频繁的住院医师去人格化程度较低。认为有责任帮助临终患者为死亡做准备的住院医师个人成就感较高。
本调查依赖于住院医师的自我报告认知，缺乏客观测量方法进行验证。与职业倦怠相关的因素可能并非因果关系。所进行的分析数量较多，引发了对I类错误的担忧；因此，采用了严格的P值（0.01）。
职业倦怠在肿瘤学培训期间普遍存在。高质量的教学与住院医师较低的职业倦怠相关。住院医师培训项目应认识到肿瘤学住院医师职业倦怠的普遍性以及可能预防职业倦怠的培训内容。
