实习医生在学术医疗中心遭遇破坏性行为的经历。
Interns' experiences of disruptive behavior in an academic medical center.
作者信息
Mullan Charles P, Shapiro Jo, McMahon Graham T
出版信息
J Grad Med Educ. 2013 Mar;5(1):25-30. doi: 10.4300/JGME-D-12-00025.1.
BACKGROUND
The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice.
OBJECTIVE
To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment.
METHOD
All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated.
RESULTS
A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P = .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P < .001), exclusion from decision making (OR, 6.97; P < .001), and berating (OR, 4.84; P = .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P < .001). Attendings reported other physicians as the most frequent source of disruption.
CONCLUSIONS
Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.
背景
毕业后医学教育的第一年是医生职业发展的重要时期。破坏性行为会干扰安全有效的临床实践。
目的
确定教学医院环境中实习医生和主治医生所感知到的破坏性行为的频率和性质。
方法
2010年和2011学年在 Partners HealthCare（马萨诸塞州波士顿）的所有516名实习医生都有资格填写一份匿名问卷。40名主治医生也作为便利非随机样本参与其中。
结果
516名符合条件的实习医生中有394名（76.4%）参与了调查。主治医生和实习医生都表示他们的团队成员总体上行为专业（分别为87.5%和80.4%）。感觉在工作中受到尊重的主治医生比例显著高于实习医生（分别为90.0%和71.5%；P = 0.01）。93%的实习医生经历过破坏性行为；54%的人报告说他们每月经历一次或更多次。实习医生报告的破坏性行为比主治医生频繁得多，包括关于居高临下行为的报告增加（实习医生与主治医生相比的优势比[OR]为5.46；P < 0.001）、被排除在决策之外（OR为6.97；P < 0.001）以及责骂（OR为4.84；P = 0.02）。还报告了不当笑话、辱骂性语言和性别偏见，这些在实习医生中并不比主治医生更频繁。实习医生最常将护士视为干扰源，并且比教员更有可能将护士识别为破坏性行为的来源（OR为10.40；P < 0.001）。主治医生报告其他医生是最常见的干扰源。
结论
尽管实习医生通常感觉在工作中受到尊重，但他们经常经历破坏性行为。与我们机构中作为便利样本的主治医生相比，实习医生描述的破坏性行为更多。
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