Augustin Ian D, Long Timothy R, Rose Steven H, Wass C Thomas
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Clin Anesth. 2014 Mar;26(2):91-105. doi: 10.1016/j.jclinane.2013.01.020. Epub 2014 Mar 20.
To re-evaluate factors responsible for selecting a career in anesthesiology and for selecting an anesthesiology training program. The perceptions of anesthesiology residents about employment opportunities and future job security were also re-examined. Novel data on the impact of duty hour restrictions on residency training were obtained.
Survey instrument.
Academic medical center.
63 residents enrolled in the anesthesiology residency at Mayo Clinic in Rochester, MN (clinical base year and clinical anesthesia years 1-3) during the 2010-11 academic year. All responses were anonymous.
Current study data were compared to data from two similar studies published by the authors (1995-96 and 2000-01) using an f-exact test. A P-value ≤ 0.05 was considered significant.
55 of 63 (87%) residents responded to the survey. The most frequently cited reasons for selecting a career in anesthesiology were: anesthesiology is a "hands-on" specialty (49%), critical care medicine is included in the scope of training/practice (33%), anesthesiology provides opportunities to perform invasive procedures (31%), and the work is immediately gratifying (31%). When current data were compared with data from the 1995-96 survey, respondents reported significant decreases in interest in physiology/pharmacology (42% vs 21%; P = 0.03), opportunities to conduct research (13% vs 2%; P = 0.05) and opportunities to train in pain medicine (13% vs 0%; P = 0.01) as reasons for selecting anesthesiology. When current data were compared with data from the 2000-2001 survey, respondents reported a significant increase in critical care medicine (7% vs 33%, P = 0.01), significant decreases in time off (36% vs 11%; P = 0.01) and work time mostly devoted to patient care (20% vs 2%; P = 0.01) as factors in selecting anesthesiology as a career. Nearly all (94%) respondents reported a high level of satisfaction with their specialty choice and would choose anesthesiology again if currently graduating medical school. When current data were compared with those from the 2000-2001 survey, a significant increase in respondents who anticipated difficulty securing employment (0% vs 14%; P = 0.01) was noted. However, anticipation of difficulty in securing employment remained significantly lower than what was reported on the 1995-96 survey (54% vs 14%; P = 0.01). Thirty-eight percent of residents reported that implementation of duty hour restrictions had a positive impact on resident education, and 43% of residents reported that duty hour restrictions improved their quality of life. However, most respondents (69%) did not support further duty hour restrictions, and many (43%) expected to work longer hours after graduation.
Residents in this study remain highly satisfied with anesthesiology as a career choice and with their training program. However, a resurgence of concern about employment after program completion and about future job security is apparent. The impact of critical care medicine training has significantly increased as a factor in selecting anesthesiology as a career, and the impact of training in pain medicine has significantly decreased. Although work hour restrictions were viewed as having a positive impact on training and well-being by 48% of residents, a majority of respondents in this study (76%) disagreed with further duty hour restrictions.
重新评估影响选择麻醉学职业以及选择麻醉学培训项目的因素。同时重新审视麻醉学住院医师对就业机会和未来工作保障的看法。获取了关于值班时间限制对住院医师培训影响的新数据。
调查工具。
学术医疗中心。
2010 - 2011学年在明尼苏达州罗切斯特市梅奥诊所参加麻醉学住院医师培训的63名住院医师（临床基础年及临床麻醉第1 - 3年）。所有回答均为匿名。
使用f精确检验将当前研究数据与作者发表的两项类似研究（1995 - 1996年和2000 - 2001年）的数据进行比较。P值≤0.05被认为具有统计学意义。
63名住院医师中有55名（87%）回复了调查。选择麻醉学职业最常被提及的原因是：麻醉学是一门“动手操作”的专业（49%），重症医学包含在培训/实践范围内（33%），麻醉学提供了进行侵入性操作的机会（31%），以及工作能立即带来满足感（31%）。将当前数据与1995 - 1996年调查数据相比，受访者表示对生理学/药理学的兴趣显著下降（42%对21%；P = 0.03），进行研究的机会（13%对2%；P = 0.05）以及疼痛医学培训机会（13%对0%；P = 0.01）作为选择麻醉学的原因有所减少。将当前数据与2000 - 2001年调查数据相比，受访者表示重症医学作为选择麻醉学职业的因素显著增加（7%对33%，P = 0.01），休假时间显著减少（36%对11%；P = 0.01），以及主要用于患者护理的工作时间（20%对2%；P = 0.01）有所减少。几乎所有（94%）受访者表示对自己的专业选择高度满意，如果现在从医学院毕业，会再次选择麻醉学。将当前数据与2000 - 2001年调查数据相比，预计就业困难的受访者显著增加（0%对14%；P = 0.01）。然而，预计就业困难的比例仍显著低于1995 - 1996年调查中所报告的比例（54%对14%；P = 0.01）。38%的住院医师表示实施值班时间限制对住院医师教育有积极影响，43%的住院医师表示值班时间限制改善了他们的生活质量。然而，大多数受访者（69%）不支持进一步限制值班时间，许多人（43%）预计毕业后会工作更长时间。
本研究中的住院医师对选择麻醉学作为职业以及他们的培训项目仍高度满意。然而，对培训结束后就业以及未来工作保障的担忧明显再次出现。重症医学培训作为选择麻醉学职业的一个因素，其影响显著增加，而疼痛医学培训的影响显著下降。尽管48%的住院医师认为工作时间限制对培训和幸福感有积极影响，但本研究中的大多数受访者（76%）不同意进一步限制值班时间。
