School of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada.
Department of Educational Studies, University of South Carolina, Columbia, South Carolina, United States of America.
PLoS One. 2019 Jan 17;14(1):e0210512. doi: 10.1371/journal.pone.0210512. eCollection 2019.
Resilience is a contextual phenomenon where a complex and dynamic interplay exists between individual, environmental, and socio-cultural factors. With growing interest in enhancing resilience in physicians, given their high risk for experiencing prolonged or intense stress, effective strategies are necessary to improve resilience and reduce negative outcomes including burnout. The objective of this review was to identify effective interventions to improve resilience in physicians who have completed training, working in any setting.
We included randomized controlled trials (RCT), and observational studies (including pilot studies) published in English, French, and Spanish that included an intervention to improve resilience in physicians who have completed training. We included studies that implemented interventions to reduce burnout, anxiety, and depression or to improve empathy to ultimately enhance resilience, rather than studies designed solely to reduce stress or trauma-induced stress. We performed a systematic search of Medline, EMBASE, PsychInfo, CINAHL and Cochrane Library with no publication year limit. The last search was conducted on March 29, 2017. We used random effect models to calculate pooled standardized mean differences. Resilience was the primary outcome measure using validated resilience scores. Secondary outcome measures included proxy measures of resilience such as burnout, empathy, anxiety and depression. Our search strategy identified 7,579 records;74 met the criteria for full-text review. Seventeen studies were included in the final review published between 1998 and 2016 of which 9 (4 RCT, 5 observational) had physician data extractable. Interventions varied greatly regarding their approach, duration, and follow-up. Two RCTs measured resilience using validated scales; both found a significant improvement. No meta-analysis for resilience was conducted due to the presence of high clinical and methodological heterogeneity.
Our systematic review demonstrates that there is weak evidence to support one intervention over another to improve resilience in physicians who have completed training. The quality of evidence for the outcomes ranged from very low to low. There is a need for a consensus on the definition of resilience and how it is measured. Longer follow-up is required to ensure any intervention effects are sustained over time.
韧性是一种情境现象，个体、环境和社会文化因素之间存在着复杂而动态的相互作用。鉴于医生经历长期或高强度压力的风险较高，越来越关注增强医生的韧性，因此需要采取有效的策略来提高韧性并减少负面结果，包括 burnout。本综述的目的是确定有效的干预措施，以提高已完成培训的医生的韧性，无论其工作环境如何。
我们纳入了已完成培训的医生的韧性干预措施的随机对照试验 (RCT) 和观察性研究（包括试点研究），这些研究发表于英语、法语和西班牙语。我们纳入了旨在减少 burnout、焦虑和抑郁或提高同理心以最终提高韧性的干预措施的研究，而不是旨在仅减少压力或创伤后应激的研究。我们对 Medline、EMBASE、PsychInfo、CINAHL 和 Cochrane Library 进行了系统检索，没有出版年限限制。最后一次搜索于 2017 年 3 月 29 日进行。我们使用随机效应模型计算了标准化均数差的汇总值。使用经过验证的韧性评分作为主要结果指标来衡量韧性。次要结果指标包括韧性的替代指标，如 burnout、同理心、焦虑和抑郁。我们的搜索策略确定了 7579 条记录；74 条符合全文审查标准。最终综述共纳入了 1998 年至 2016 年间发表的 17 项研究，其中 9 项（4 项 RCT，5 项观察性研究）具有可提取的医生数据。干预措施在方法、持续时间和随访方面差异很大。两项 RCT 使用经过验证的量表测量了韧性；两者都发现了显著的改善。由于存在高度的临床和方法学异质性，因此未对韧性进行荟萃分析。
我们的系统综述表明，目前几乎没有证据支持一种干预措施优于另一种干预措施来提高已完成培训的医生的韧性。各项结局的证据质量从极低到低不等。需要就韧性的定义及其测量方法达成共识。需要进行更长时间的随访，以确保任何干预措施的效果都能持续。
