Winkel Abigail Ford, Feldman Nathalie, Moss Haley, Jakalow Holli, Simon Julia, Blank Stephanie
Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York; the Department of Obstetrics, Gynecology and Reproductive Medicine, University of Vermont Medical Center, Burlington, Vermont; and the Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, Illinois.
Obstet Gynecol. 2016 Oct;128 Suppl 1:27S-33S. doi: 10.1097/AOG.0000000000001619.
To determine whether a workshop Narrative Medicine curriculum can improve burnout among obstetrics and gynecology residents.
A Narrative Medicine curriculum was conducted at three obstetrics and gynecology training programs. An explanatory research design examined correlation between Narrative Medicine attendance and changes in survey responses. Residents completed a pretest and 1-year posttest survey that included validated measures of burnout and empathy. A within-participants design used baseline pretest scores as an internal control and measured changes in individual scores. The primary outcome of the study was change in burnout rates. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the data.
A total of 66 residents at three institutions participated in the Narrative Medicine curriculum. Of those, 54 (81%) enrolled in the study by completing any part of the surveys, and 43 (80%) of those enrolled had complete data for analysis. Burnout was high on all Maslach Burnout Inventory subscales and increased over 1 year. Participants with high Narrative Medicine attendance had decreased burnout on the Emotional Exhaustion subscale (-4.1 [±8.1]) points compared with an increase of 0.5 (±6.0) for low-attendance participants (U=134, P=.02, d=0.65). Lower self-care ratings were associated with improved Personal Accomplishment (+0.5 [±5.0]) compared with +2.0 (±2.7), U=84, P=.01]. Other characteristics did not significantly correlate with burnout or empathy.
Burnout was high and worsened over time among obstetrics and gynecology residents in these three programs. Higher attendance at Narrative Medicine workshops was associated with improved Emotional Exhaustion.
确定叙事医学课程工作坊能否改善妇产科住院医师的职业倦怠状况。
在三个妇产科培训项目中开展了叙事医学课程。采用解释性研究设计，考察叙事医学课程的参与情况与调查反馈变化之间的相关性。住院医师完成了一项预测试和一项为期1年的后测试调查，其中包括经过验证的职业倦怠和同理心测量指标。采用参与者内部设计，将预测试基线分数作为内部对照，并测量个体分数的变化。该研究的主要结果是职业倦怠率的变化。使用曼-惠特尼U检验和克鲁斯卡尔-沃利斯检验来分析数据。
三个机构的66名住院医师参加了叙事医学课程。其中，54名（81%）通过完成调查的任何部分参与了该研究，参与研究的人员中有43名（80%）拥有完整的分析数据。所有马氏职业倦怠量表子量表上的职业倦怠程度都很高，且在1年中有所增加。叙事医学课程参与度高的参与者在情感耗竭子量表上的职业倦怠有所降低（-4.1[±8.1]分），而参与度低的参与者则增加了0.5（±6.0）分（U=134，P=0.02，d=0.65）。自我护理评分较低与个人成就感提高（+0.5[±5.0]）相关，而个人成就感提高为+2.0（±2.7），U=84，P=0.01]。其他特征与职业倦怠或同理心无显著相关性。
这三个项目中的妇产科住院医师职业倦怠程度较高，且随时间推移而恶化。参加叙事医学工作坊的频率较高与情感耗竭状况的改善相关。
