Moore Kendra A, O'Brien Bridget C, Thomas Larissa R
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Center for Faculty Educators, University of California, San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2020 Dec;35(12):3443-3448. doi: 10.1007/s11606-020-05803-4. Epub 2020 Mar 30.
Interns are vulnerable to emotional distress and burnout. Little is known about the extent to which interns' well-being can be influenced by peer support provided by their senior residents.
To elucidate contributors to interns' emotional distress and ways that peer support from senior residents may impact intern well-being.
Qualitative study using semi-structured interviews conducted December 2017-March 2018.
Second year residents (n = 11) in internal medicine at a major academic medical center during the data collection period.
Constructivist grounded theory approach in which transcripts were analyzed in an iterative fashion using constant comparison to identify themes and to create a conceptual model.
The investigators identified three themes around emotional distress and two themes around resident peer support. Distress was a pervasive experience among participants, caused by a combination of contextual factors that decreased emotional resilience (e.g., sleep deprivation) and acute triggers (e.g., patient death) that led to an abrupt increase in distress. Participants grappled with identity reconciliation throughout internship. Reaching clinical competency reinforced self-efficacy for participants. With regard to peer support, participants recalled that resident support was ad hoc, primarily involving task support and debriefing traumatic events. Participants reflected that their intern experiences shaped their supervisory support style once they became senior residents; they did not perceive any formalized, systematic approach to supporting interns.
We propose a model illustrating key points at which near-peers can make an impact in reducing interns' distress and suggest strategies they can use. Given the substantial role peer learning plays in intern development, senior residents can impact their interns by normalizing emotions, allowing vulnerability, and highlighting the importance of self-care. A formalized peer support skill-building curriculum for senior residents may empower them to provide more effective support as part of their supervisory efforts.
实习医生容易出现情绪困扰和职业倦怠。对于实习医生的幸福感受上级住院医师提供的同伴支持影响的程度，我们知之甚少。
阐明导致实习医生情绪困扰的因素，以及上级住院医师的同伴支持可能影响实习医生幸福感的方式。
2017年12月至2018年3月进行的定性研究，采用半结构式访谈。
在数据收集期间，一所主要学术医学中心的内科二年级住院医师（n = 11）。
建构主义扎根理论方法，对访谈记录进行反复分析，通过持续比较来确定主题并创建概念模型。
研究人员确定了围绕情绪困扰的三个主题和围绕住院医师同伴支持的两个主题。困扰是参与者中普遍存在的经历，由降低情绪恢复力的背景因素（如睡眠不足）和导致困扰突然增加的急性触发因素（如患者死亡）共同引起。参与者在整个实习期间都在努力进行身份认同的协调。达到临床能力增强了参与者的自我效能感。关于同伴支持，参与者回忆说住院医师的支持是临时的，主要包括任务支持和对创伤性事件的汇报。参与者反映，他们的实习经历塑造了他们成为上级住院医师后的监督支持风格；他们没有察觉到任何支持实习医生的正式、系统的方法。
我们提出了一个模型，阐明了近同伴可以在哪些关键点上对减轻实习医生的困扰产生影响，并提出了他们可以采用的策略。鉴于同伴学习在实习医生发展中发挥的重要作用，上级住院医师可以通过使情绪正常化、允许展现脆弱性以及强调自我护理的重要性来影响他们的实习医生。为上级住院医师制定正式的同伴支持技能培训课程，可能会使他们在监督工作中能够提供更有效的支持。
