一项全国精神科住院医师培训计划中精神科住院医师的倦怠及其与学习环境和学习者因素的相关性的横断面研究。
A cross-sectional study of burnout and its associations with learning environment and learner factors among psychiatry residents within a National Psychiatry Residency Programme.
机构信息
Research Division, Institute of Mental Health, Singapore, Singapore.
General Psychiatry, Tan Tock Seng Hospital, Singapore, Singapore.
出版信息
BMJ Open. 2019 Aug 30;9(8):e030619. doi: 10.1136/bmjopen-2019-030619.
BACKGROUND
Multiple studies have reported high burnout rates among residents, including psychiatry. There is a paucity of studies examining the relationship between burnout and learning context, stress levels, resilience, stigma in healthcare providers and coping methods concurrently within the same cohort.
OBJECTIVE
We examined the rate of burnout among our psychiatry residents in a cross-sectional study and hypothesised that burnout is associated with poorer perception of learning environment, greater perceived stress, stigma levels, lower resilience and specific coping strategies during training.
METHODS
Ninety-three out of 104 psychiatry residents (89.4%) within our National Psychiatry Residency Programme participated in the study from June 2016 to June 2018. Relevant scales were administered to assess the perception of learning environment, burnout, stress, resilience, stigma levels and coping methods, respectively. We performed comparisons of the above measures between groups (burnout vs no burnout) and within-group correlations for these same measures.
RESULTS
Overall, 54.8% of the sample met criteria for burnout. Residents with burnout had poorer perception of the learning environment, greater stress levels (both p<0.001), were less willing to disclose/seek help and employed greater active-avoidance coping strategies. Within the burnout group, greater perceived stress was correlated with poorer perception of learning environment (r=-0.549) and greater use of active-avoidance coping (r=0.450) versus additional use of problem-focussed coping within the non-burnout group.
CONCLUSIONS
Burnout was related to both environment and learner factors. These findings viewed within the transactional, sequential and imbalance models of burnout suggest the need to address stressors, beef up coping, provide continual support and develop resilience among our learners.
背景
多项研究报告称，住院医师的职业倦怠率很高，包括精神科。目前，研究人员很少同时在同一队列中检查职业倦怠与学习环境、压力水平、适应力、医疗保健提供者的耻辱感和应对方法之间的关系。
目的
我们通过横断面研究调查了我们精神病学住院医师的职业倦怠率，并假设职业倦怠与较差的学习环境感知、更高的感知压力、耻辱感水平、较低的适应力以及培训期间的特定应对策略有关。
方法
2016 年 6 月至 2018 年 6 月期间，我们国家精神病学住院医师计划的 104 名精神病学住院医师中有 93 名（89.4%）参加了这项研究。分别采用相关量表评估学习环境感知、倦怠、压力、适应力、耻辱感水平和应对方法。我们对不同组别（倦怠与无倦怠）之间的上述指标进行了比较，并对同一组内的这些指标进行了相关性分析。
结果
总体而言，样本中有 54.8%的人符合倦怠标准。有倦怠的住院医师对学习环境的感知较差，压力水平较高（均<0.001），不太愿意披露/寻求帮助，并采用更多的主动回避应对策略。在倦怠组内，感知压力越大，与学习环境感知较差（r=-0.549）和更多使用主动回避应对（r=0.450）相关，而与非倦怠组内更多使用问题焦点应对相关（r=0.450）。
结论
倦怠与环境和学习者因素都有关。从职业倦怠的交互、序列和不平衡模型的角度来看，这些发现表明有必要解决压力源，增强应对能力，为学习者提供持续的支持和培养适应力。
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