J Grad Med Educ. 2020 Jun;12(3):284-290. doi: 10.4300/JGME-D-19-00645.1.
Studies examining mitigating factors associated with residents' experience of burnout have found mixed results; thus the most effective approaches for programs to prevent resident burnout are unclear.
We used mixed methods to explore the association of 4 psychological constructs thought to be important protective factors for burnout-grit, resiliency, social support, and psychological flexibility-across a wide variety of residency programs at 1 institution.
The explanatory sequential study design included an online survey of previously published scales measuring burnout, grit, resiliency, social support, and psychological flexibility. The survey was sent to 20 residency programs in a single institution during the 2017-2018 academic year. Data were analyzed using descriptive statistics and ordinal logistic regressions to determine the association of protective factors and demographic variables. Interviews with 13 residents were conducted and analyzed deductively and inductively to identify when and how residents employed the protective factors.
Among the 268 responders (51% response rate), grit, resiliency, social support, and psychological flexibility were individually inversely associated with burnout level. However, resiliency and relationship status were no longer associated with burnout when all 4 factors were included in the model. Interviews revealed that grit both protects from and contributes to burnout, residents prefer peer support, and they cognitively "step back" when stress is high.
Although many programs and institutions focus on resiliency in wellness programs, there may be other factors to consider, such as grit and equipping students with tools to disengage psychologically when feeling stressed or overwhelmed.
研究考察了与居民 burnout 体验相关的缓解因素，结果喜忧参半；因此，预防居民 burnout 的项目最有效的方法尚不清楚。
我们使用混合方法探讨了 4 种心理结构的关联，这些结构被认为是 burnout 的重要保护因素——坚毅、韧性、社会支持和心理灵活性——在一个机构的各种住院医师培训计划中。
解释性顺序研究设计包括对先前发表的衡量 burnout、坚毅、韧性、社会支持和心理灵活性的量表进行在线调查。在 2017-2018 学年期间，该调查发送到一个机构的 20 个住院医师培训计划。使用描述性统计和有序逻辑回归来确定保护因素和人口统计学变量的关联，对数据进行分析。对 13 名居民进行了访谈，并进行了演绎和归纳分析，以确定居民何时以及如何运用保护因素。
在 268 名应答者中（51%的应答率），坚毅、韧性、社会支持和心理灵活性与 burnout 水平呈反比。然而，当所有 4 个因素都包含在模型中时，韧性和关系状况与 burnout 不再相关。访谈显示，坚毅既能保护又能导致 burnout，居民更喜欢同伴支持，当压力高时，他们会在认知上“退后一步”。
尽管许多项目和机构在健康计划中关注韧性，但可能还有其他因素需要考虑，例如坚毅和为学生提供在感到压力或不知所措时心理脱离的工具。
