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“实习医生生活”:对法国全科医生培训期间职业倦怠、同理心及应对策略的纵向研究

'Intern life': a longitudinal study of burnout, empathy, and coping strategies used by French GPs in training.

作者信息

Galam Eric, Vauloup Soupault Camille, Bunge Lucie, Buffel du Vaure Céline, Boujut Emilie, Jaury Philippe

机构信息

GP, Département de Médecine Générale, Faculté de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

GP, Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.

出版信息

BJGP Open. 2017 Jun 14;1(2):bjgpopen17X100773. doi: 10.3399/bjgpopen17X100773.

Abstract

BACKGROUND

More than half of French medical GP trainees (GPTs) suffer from burnout.

AIM

To define and follow the evolution of risk factors, such as empathy and coping strategies, associated with burnout in this population.

DESIGN & SETTING: Prospective longitudinal study involving volunteers of 577 Parisian university GPTs in 2012.

METHOD

Self-reported anonymous online questionnaires were sent three times every 6 months to all participants. Stress was measured using the Intern-Life scale and burnout using the Maslach Inventory, and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic, professional, and personal data, including coping strategies and measures of empathy were also collected.

RESULTS

In total 343 questionnaires were fully completed at baseline (T0): 304 were usable at baseline, 169 were usable at 6 months (T1) and 174 at 1 year (T2). Stress rates decreased sharply between T1 (scores 42.96) and T2 (17.08), while scores for burnout remained relatively stable: more than 13% of GPTs had high scores in all three dimensions of burnout. Depersonalisation increased from 61% (T1) to 66% (T2). One hundred and four paired samples were analysed between T0 and T1, and between T1 and T2. Emotion-centred coping was associated with emotional exhaustion (<0.05), while professional support reduced it. Experiences of aggression increased depersonalisation (<0.05). Social support, problem-centred coping, perspective-taking empathy, and professional support improved the sense of personal accomplishment (<0.05).

CONCLUSION

Tools to help GPTs are available but are underused. More training in doctor-patient relationships and understanding of medical hidden curricula are necessary to decrease burnout among GPTs and improve their wellbeing and patient care.

摘要

背景

超过半数的法国医学全科医生培训学员(GPTs)存在职业倦怠问题。

目的

确定并跟踪该人群中与职业倦怠相关的风险因素(如同理心和应对策略)的演变情况。

设计与背景

2012年对577名巴黎大学GPTs志愿者进行的前瞻性纵向研究。

方法

每6个月向所有参与者发送三次自我报告的匿名在线问卷。使用实习医生生活量表测量压力,使用马氏工作倦怠量表测量职业倦怠,使用医院焦虑抑郁量表(HADS)测量焦虑和抑郁。还收集了社会人口统计学、专业和个人数据,包括应对策略和同理心测量。

结果

共有343份问卷在基线(T0)时完全完成:304份在基线时可用,169份在6个月时(T1)可用,174份在1年时(T2)可用。压力率在T1(得分42.96)和T2(17.08)之间急剧下降,而职业倦怠得分保持相对稳定:超过13%的GPTs在职业倦怠的所有三个维度上得分都很高。去个性化从61%(T1)增加到66%(T2)。在T0和T1之间以及T1和T2之间分析了104对配对样本。以情绪为中心的应对与情感耗竭相关(<0.05),而专业支持则可降低情感耗竭。攻击经历会增加去个性化(<0.05)。社会支持、以问题为中心的应对、换位思考同理心和专业支持可提高个人成就感(<0.05)。

结论

有帮助GPTs的工具,但未得到充分利用。需要更多关于医患关系的培训以及对医学隐性课程的理解,以减少GPTs的职业倦怠,改善他们的幸福感和患者护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c5c/6169958/640fcccfc255/bjgpopen-1-773-g001.jpg

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