Tallentire Victoria R, Smith Samantha E, Facey Adam D, Rotstein Laila
University of Edinburgh, Edinburgh, UK.
Alfred Health, Melbourne, Victoria, Australia.
BMJ Open. 2017 Aug 11;7(8):e015890. doi: 10.1136/bmjopen-2017-015890.
Postgraduate year 1 (PGY1) doctors suffer from high levels of psychological distress, yet the contributory factors are poorly understood. This study used an existing model of workplace stress to explore the elements most pertinent to PGY1 doctors. In turn, the data were used to amend and refine the conceptual model to better reflect the unique experiences of PGY1 doctors.
Focus groups were undertaken with PGY1 doctors working at four different health services in Victoria, Australia. Transcripts were coded using Michie's model of workplace stress as the initial coding template. Remaining text was coded inductively and the supplementary codes were used to modify and amplify Michie's framework.
There were 37 participants in total. Key themes included stressors intrinsic to the job, such as work overload and long hours, as well as those related to the context of work such as lack of role clarity and relationships with colleagues. The main modification to Michie's framework was the addition of the theme of uncertainty. This concept related to most of the pre-existing themes in complex ways, culminating in an overall sense of anxiety.
Michie's model of workplace stress can be effectively used to explore the stressors experienced by PGY1 doctors. Pervasive uncertainty may help to explain the high levels of psychological morbidity in this group. While some uncertainty will always remain, the medical education community must seek ways to improve role clarity and promote mutual respect.
一年级住院医师（PGY1）承受着高水平的心理压力，但其促成因素却鲜为人知。本研究采用现有的工作场所压力模型，探究与PGY1医生最相关的因素。进而利用这些数据对概念模型进行修正和完善，以更好地反映PGY1医生的独特经历。
对在澳大利亚维多利亚州四个不同医疗服务机构工作的PGY1医生进行焦点小组访谈。访谈记录以米基的工作场所压力模型作为初始编码模板进行编码。其余文本进行归纳编码，补充编码用于修改和扩充米基的框架。
共有37名参与者。关键主题包括工作本身固有的压力源，如工作负荷过重和工作时间过长，以及与工作环境相关的压力源，如角色不明确和与同事的关系。对米基框架的主要修改是增加了不确定性主题。这一概念以复杂的方式与大多数现有主题相关联，最终导致整体焦虑感。
米基的工作场所压力模型可有效用于探究PGY1医生所经历的压力源。普遍存在的不确定性可能有助于解释该群体中心理疾病的高发率。虽然总会存在一些不确定性，但医学教育界必须寻求方法来提高角色清晰度并促进相互尊重。
