Wong Matthew L, Peters Gregory, Joseph Joshua W, Chung Arlene, Sanchez Leon D
Departments of Emergency Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA.
Department of Emergency Medicine Maimonides Medical Center Brooklyn NY.
AEM Educ Train. 2019 May 20;4(1):30-35. doi: 10.1002/aet2.10353. eCollection 2020 Jan.
Stress is a common experience in the emergency department (ED) and is a balance of personal capabilities versus demands. Residency training is meant to improve individuals' capabilities and therefore may attenuate an individual's stress response. Grit is a personality trait that may attenuate stress in individuals. In this study we explore the relationship between time of year, postshift salivary cortisol concentrations, and the influence of grit among attendings and residents in an academic ED.
Thirty-nine residents and 17 attendings were enrolled and followed for two academic years at an urban academic medical center. Postwork salivary cortisol samples were collected quarterly, and Duckworth 12-point Grit Scales were administered annually. Data from the relative quarters of the first and second years were combined, and the results were analyzed using descriptive statistics and generalized estimating equations.
We analyzed 216 cortisol samples and 87 grit scores over 2 academic years. Between the first and fourth quarters of the academic year, the percentage of subjects with a detectable postshift cortisol sample decreased from 47.6% (30 of 62) to 18.4% (9 of 49). In the fourth academic quarter compared to the first, the odds that an individual had a detectable cortisol were significantly lower overall (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.10 to 0.59, p = 0.01), including the subset of only trainees (OR = 0.26, 95% CI = 0.07 to 0.88, p = 0.01), and adjusting for grit did not meaningfully change the ORs.
Over the course of the academic year, the odds that an individual's postshift salivary cortisol concentration will be above detectable concentration significantly decrease over time, and this relationship is not confounded by grit.
压力是急诊科常见的体验，是个人能力与需求之间的平衡。住院医师培训旨在提高个人能力，因此可能会减弱个人的应激反应。毅力是一种人格特质，可能会减轻个体的压力。在本研究中，我们探讨了一年中的时间、轮班后唾液皮质醇浓度以及毅力对一所学术性急诊科的主治医师和住院医师的影响之间的关系。
在一家城市学术医疗中心，招募了39名住院医师和17名主治医师，并对他们进行了两个学年的跟踪。每季度收集轮班后的唾液皮质醇样本，每年进行达克沃思12点毅力量表测试。将第一年和第二年相对季度的数据合并，并使用描述性统计和广义估计方程对结果进行分析。
我们在两个学年中分析了216个皮质醇样本和87个毅力得分。在学年的第一季度和第四季度之间，轮班后可检测到皮质醇样本的受试者百分比从47.6%（62人中的30人）降至18.4%（49人中的9人）。与第一季度相比，在第四学术季度，个体可检测到皮质醇的几率总体上显著更低（优势比[OR]=0.25，95%置信区间[CI]=0.10至0.59，p=0.01），包括仅实习生的子集（OR=0.26，95%CI=0.07至0.88，p=0.01），并且调整毅力后并没有有意义地改变优势比。
在学年过程中，个体轮班后唾液皮质醇浓度高于可检测浓度的几率会随着时间显著降低，并且这种关系不受毅力的影响。
