医学生的韧性：在实习阶段对压力和生活质量的保护作用。
Medical students' resilience: a protective role on stress and quality of life in clerkship.
机构信息
Surgery Department, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China.
Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
出版信息
BMC Med Educ. 2019 Dec 27;19(1):473. doi: 10.1186/s12909-019-1912-4.
BACKGROUND
Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students' resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships.
METHODS
This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students' resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed.
RESULTS
This study verified the negative effects of medical students' perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students' professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R) values of the hierarchical regression building, our study found that medical students' perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction.
CONCLUSIONS
Medical students' resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students' professional quality of life such as burnout and compassion satisfaction warrant additional studies.
背景
韧性是指在应对挑战时灵活适应的能力。在从医学学习过渡到临床实践的实习阶段，医学生面临着各种工作场所的需求，这些需求可能导致负面的学习体验和较差的生活质量。本研究探讨了医学生的韧性是否对工作场所培训期间的压力以及实习期间的职业生活质量起到保护作用。
方法
这是一项为期 1 年的前瞻性基于网络的问卷调查研究，包括一个队列的医学生，他们在台湾的一所医学院接受为期 6 年的医学教育计划，在第五年作为实习医生工作。使用基于网络的、经过验证的、结构化的、自我管理的问卷来测量学生在实习开始时的韧性，以及他们在每个专业轮转时感知到的培训压力（即身体和心理需求）和职业生活质量（即倦怠和同情心满足）。在实习期间，至少三次回复我们专业轮转调查的 93 名医学生被纳入研究，并进行了层次回归分析。
结果
本研究验证了医学生感知到的培训压力对倦怠和同情心满足的负面影响。然而，尽管韧性表现出对身体需求的缓冲（保护）效应（与医学生职业生活质量相关的一个关键风险因素），但在心理需求方面并非如此（另一个关键风险因素）。此外，通过层次回归建立的 R 平方（∆R）值的变化，我们的研究发现，医学生感知到的培训压力在解释他们的倦怠方面起着关键作用，但在解释他们的同情心满足方面则取决于韧性。
结论
医学生的韧性在实习期间身体需求与职业生活质量之间的负性关系中表现出缓冲效应。此外，导致医学生职业生活质量（如倦怠和同情心满足）的不同机制（预测路径）需要进一步研究。
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