Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Ann Surg. 2018 Aug;268(2):204-211. doi: 10.1097/SLA.0000000000002700.
The aim of the study was to (1) assess differences in how male and female general surgery residents utilize duty-hour regulations and experience aspects of burnout and psychological well-being, and (2) to explore reasons why these differing experiences exist.
There may be differences in how women and men enter, experience, and leave residency programs.
A total of 7395 residents completed a survey (response rate = 99%). Logistic regression models were developed to examine the association between gender and resident outcomes. Semistructured interviews were conducted with 42 faculty and 56 residents. Transcripts were analyzed thematically using a constant comparative approach.
Female residents reported more frequently staying in the hospital >28 hours or working >80 hours in a week (≥3 times in a month, P < 0.001) and more frequently feeling fatigued and burned out from their work (P < 0.001), but less frequently "treating patients as impersonal objects" or "not caring what happens" to them (P < 0.001). Women reported more often having experienced many aspects of poor psychological well-being such as feeling unhappy and depressed or thinking of themselves as worthless (P < 0.01). In adjusted analyses, associations remained significant. Themes identified in the qualitative analysis as possible contributory factors to gender differences include a lack of female mentorship/leadership, dual-role responsibilities, gender blindness, and differing pressures and approaches to patient care.
Female residents report working more, experiencing certain aspects of burnout more frequently, and having poorer psychological well-being. Qualitative themes provide insights into possible cultural and programmatic shifts to address the concerns for female residents.
本研究旨在：(1)评估男性和女性普通外科住院医师在工时规定的使用以及职业倦怠和心理幸福感方面的差异；(2)探讨导致这些差异存在的原因。
女性和男性在进入、经历和离开住院医师培训项目方面可能存在差异。
共有 7395 名住院医师完成了一项调查(应答率=99%)。采用逻辑回归模型来检验性别与住院医师结局之间的关联。对 42 名教员和 56 名住院医师进行了半结构化访谈。使用恒定性比较方法对转录本进行主题分析。
女性住院医师报告更频繁地在医院停留超过 28 小时或每周工作超过 80 小时(≥每月 3 次，P<0.001)，并且更频繁地感到疲劳和职业倦怠(P<0.001)，但较少报告“将患者视为非个人对象”或“对他们漠不关心”(P<0.001)。女性报告经历过许多心理健康不良的方面，如感到不快乐和沮丧或认为自己没有价值(P<0.01)的情况更频繁。在调整后的分析中，关联仍然显著。定性分析中确定的主题被认为是导致性别差异的可能因素，包括缺乏女性导师/领导力、双重角色责任、性别盲视，以及对患者护理的不同压力和方法。
女性住院医师报告工作时间更长，更频繁地经历某些方面的职业倦怠，并且心理健康状况更差。定性主题提供了有关文化和项目计划转变以解决女性住院医师关注问题的见解。
