Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Psychology, Syracuse University, Syracuse, New York.
JAMA. 2018 Sep 18;320(11):1114-1130. doi: 10.1001/jama.2018.12615.
Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency.
To explore factors associated with symptoms of burnout and career choice regret during residency.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016.
Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school.
Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again).
Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.24 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.17 [95% CI, 1.07 to 1.28]; risk difference [RD], 7.2% [95% CI, 3.1% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.11]; RD, 1.8% per 1-point increase [95% CI, 1.6% to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 0.99]; RD, -0.5% per 1-point increase [95% CI, -0.6% to -0.3%]). Reported symptoms of burnout (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret.
Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.
重要性：医生职业倦怠很常见，且与医疗失误和职业操守缺失有关。目前尚不清楚住院医师的职业倦怠症状发生率是否因临床专业而异，以及医学生时期测量的个体因素是否与住院医师期间的职业倦怠和职业选择后悔风险相关。
目的：探讨与住院医师期间职业倦怠和职业选择后悔相关的因素。
设计、地点和参与者：这是一项针对 4732 名美国住院医师的前瞻性队列研究。第一年初等医学生于 2010 年 10 月至 2011 年 1 月期间入组，并完成基线问卷。邀请参与者回答 2 份问卷；一份在医学生涯的第 4 年（2014 年 1 月至 3 月），另一份在住院医师生涯的第二年（2016 年春季）。最后一次随访是在 2016 年 7 月 31 日。
暴露因素：临床专业、人口统计学特征、教育债务、美国医师执照考试第 1 步成绩，以及在校期间报告的焦虑、同理心和社会支持水平。
主要结果和措施：在住院医师生涯第二年报告的职业倦怠症状的流行率，使用 2 个单项测量（改编自马斯拉赫职业倦怠量表）和一个额外的评估职业选择后悔的项目进行评估（定义为如果能够重新选择职业，住院医师是否会再次选择成为医生）。
结果：在 4696 名住院医师中，有 3588 名（76.4%）在住院医师生涯第二年完成了问卷（中位数年龄为 29 岁[四分位距，28.0-31.0]岁，2016 年；1822 名[50.9%]为女性）。3574 名住院医师中有 1615 名（45.2%）报告有职业倦怠症状。3571 名住院医师中有 502 名（14.1%）报告有职业选择后悔。在多变量分析中，泌尿科、神经病学、急诊医学和普通外科的培训与报告的职业倦怠症状的相对风险（RR）较高（范围为 1.24 至 1.48），而内科培训的 RR 较低。与报告的职业倦怠症状风险较高相关的特征包括女性（RR，1.17 [95%CI，1.07 至 1.28]；风险差异 [RD]，7.2% [95%CI，3.1% 至 11.3%]）和在校期间报告的焦虑水平较高（RR，每增加 1 分增加 1.08 [95%CI，1.06 至 1.11]；RD，每增加 1 分增加 1.8% [95%CI，1.6% 至 2.0%]）。在校期间报告的同理心水平较高与住院医师期间报告的职业倦怠症状风险较低相关（RR，每增加 1 分降低 0.99 [95%CI，0.99 至 0.99]；RD，每增加 1 分降低 0.5% [95%CI，0.6% 至 0.3%]）。报告的职业倦怠症状（RR，3.20 [95%CI，2.58 至 3.82]；RD，15.0% [95%CI，12.8% 至 17.3%]）和临床专业（RR 范围为 1.66 至 2.60）均与职业选择后悔显著相关。
结论和相关性：在美国住院医师中，职业倦怠和职业选择后悔的症状很常见，但因临床专业而异。需要进一步研究以更好地了解这些差异并解决这些问题。
