工作时间限制对内科住院医师职业倦怠的影响：一项三机构比较研究。

The impact of duty hours restrictions on job burnout in internal medicine residents: a three-institution comparison study.

作者信息

Ripp Jonathan A, Bellini Lisa, Fallar Robert, Bazari Hasan, Katz Joel T, Korenstein Deborah

机构信息

Dr. Ripp is associate professor, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Dr. Bellini is program director, Internal Medicine Residency Training Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Fallar is assistant professor, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York. Dr. Bazari is program director emeritus, Internal Medicine Residency Training Program, Massachusetts General Hospital, Boston, Massachusetts. Dr. Katz is program director, Internal Medicine Residency Training Program, Brigham and Women's Hospital, Boston, Massachusetts. Dr. Korenstein is professor, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

出版信息

Acad Med. 2015 Apr;90(4):494-9. doi: 10.1097/ACM.0000000000000641.

DOI:10.1097/ACM.0000000000000641

PMID:25607940

Abstract

PURPOSE

Internal medicine (IM) residents commonly develop job burnout, which may lead to poor academic performance, depression, and medical errors. The extent to which duty hours restrictions (DHRs) can mitigate job burnout remains uncertain. The July 2011 DHRs created an opportunity to measure the impact of decreased work hours on developing burnout in IM residents.

METHOD

A survey was administered twice to first-year IM residents at three academic medical centers between June 2011 and July 2012. To estimate the impact of the 2011 DHRs, data from this cohort, including demographics, sleepiness, hospital-based patient service characteristics, and burnout measures, were compared with data from 2008-2009 from first-year IM residents at the same institutions.

RESULTS

Of eligible residents, 128/188 (68%) from the 2011-2012 cohort and 111/180 (62%) from the 2008-2009 cohort completed both surveys. Year-end burnout prevalence (92/123 [75%] versus 91/108 [84%], P = .08) and incidence (59/87 [68%] versus 55/68 [81%], P = .07) did not differ significantly between cohorts. There was no difference in year-end prevalence of excessive Epworth sleepiness (72/122 [59%] versus 71/108 [66%], P = .29) between cohorts; however, a greater percentage of residents who developed burnout in the 2011-2012 cohort reported caring for > 8 patients on their service (2011-2012 versus 2008-2009) (29/59 [49%] versus 5/34 [15%], P < .01).

CONCLUSIONS

Job burnout and self-reported sleepiness in IM resident physicians were unchanged after the 2011 DHRs at three academic institutions. Further investigation into the determinants of burnout can inform effective interventions.

摘要

目的

内科住院医师普遍会出现职业倦怠，这可能导致学业成绩不佳、抑郁及医疗差错。工作时长限制（DHRs）能在多大程度上缓解职业倦怠仍不确定。2011年7月的工作时长限制创造了一个机会，可用于衡量工作时长减少对内科住院医师职业倦怠发展的影响。

方法

2011年6月至2012年7月期间，对三个学术医疗中心的一年级内科住院医师进行了两次调查。为评估2011年工作时长限制的影响，将该队列的数据，包括人口统计学、嗜睡情况、基于医院的患者服务特征及职业倦怠测量结果，与同一机构2008 - 2009年一年级内科住院医师的数据进行比较。

结果

符合条件的住院医师中，2011 - 2012队列的128/188（68%）和2008 - 2009队列的111/180（62%）完成了两次调查。两个队列的年终职业倦怠患病率（92/123 [75%] 对 91/108 [84%]，P = 0.08）和发病率（59/87 [68%] 对 55/68 [81%]，P = 0.07）无显著差异。两个队列的年终过度爱泼华嗜睡患病率（72/122 [59%] 对 71/108 [66%]，P = 0.29）无差异；然而，2011 - 2012队列中出现职业倦怠的住院医师中，报告在其服务中照顾超过8名患者的比例更高（2011 - 2012年对2008 - 2009年）（29/59 [49%] 对 5/34 [15%]，P < 0.01）。