Kruper Abbey, Domeyer-Klenske Amy, Treat Robert, Pilarski Alicia, Kaljo Kristina
Medical College of Wisconsin, Milwaukee, Wisconsin.
Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Educ. 2021 May-Jun;78(3):1024-1034. doi: 10.1016/j.jsurg.2020.08.038. Epub 2020 Sep 15.
This study aims to evaluate the incidence of secondary traumatic stress in Obstetrics and Gynecology physicians including symptoms, impact, and programmatic needs for support.
This study used a mixed-methods approach comprised of an anonymous online survey and individual interviews/focus groups. IBM SPSS 24.0 generated statistical analysis: descriptive statistics, Fisher's exact test to compare nominal survey data and across groups, phi correlations (ϕ) and interitem reliability (Cronbach alpha). Constant comparative qualitative analysis determined cross-cutting themes. Research was approved by institutional IRB.
This study was conducted at the Medical College of Wisconsin, Milwaukee, Wisconsin, a large academic medical institution.
Participants were recruited from the Department of Obstetrics & Gynecology via email. Faculty, fellows, and residents participated in an anonymous online survey and were invited to complete individual interviews or focus groups. The online survey was distributed to 67 clinical faculty, residents, and fellows with a total of 27 individuals completing the reliable (alpha = 0.71) anonymous survey (40% response rate). Ten faculty participated in individual interviews or focus groups.
Respondents to the quantitative survey identified involvement in adverse medical events (95%) and symptoms of traumatic stress (75%). Anxiety (81%), guilt (62%), and disrupted sleep (58%) were most frequently reported symptoms (mean number of symptoms = (3.4(±2.1)). Individuals reporting anxiety were more likely to seek support from colleagues (ϕ = 0.5, p < 0.006); those reporting guilt would go to friends (ϕ = 0.5, p < 0.007). Disrupted sleep more commonly led to seeking mental health services (ϕ = 0.5, p < 0.007). Desire for support varied. Those reporting anxiety were interested in peer-to-peer responders (ϕ = 0.6, p < 0.001); those reporting guilt would use debriefing sessions (ϕ = 0.4, p < 0.023). Qualitative data from individual interviews and focus groups yielded descriptions of physical and cognitive symptoms associated with second victim experiences included responsibility, guilt/shame, self-doubt, anxiety/rumination and sleep disturbance. Identified resources for coping: just culture, collegial support, peer-to-peer responders, and structured case conferences for emotional debriefing.
Obstetrics and Gynecology providers are likely to experience symptoms of secondary traumatic stress following adverse patient events similar to other medical specialties. Comprehensive programs to address emotional well-being of physicians are important to promote collegiality and reduce symptoms of secondary traumatic stress. Safety and transparency with opportunities for group processing are identified as essentials for positive institutional culture, as well as peer support programs.
本研究旨在评估妇产科医生继发性创伤应激的发生率，包括症状、影响以及支持项目需求。
本研究采用混合方法，包括匿名在线调查和个人访谈/焦点小组。IBM SPSS 24.0进行统计分析：描述性统计、用于比较名义调查数据和跨组数据的Fisher精确检验、phi相关性（ϕ）和项目间信度（Cronbach阿尔法系数）。持续比较定性分析确定贯穿各领域的主题。研究获得机构审查委员会批准。
本研究在威斯康星州密尔沃基市的威斯康星医学院进行，这是一家大型学术医疗机构。
通过电子邮件从妇产科招募参与者。教职员工、研究员和住院医师参与匿名在线调查，并被邀请完成个人访谈或焦点小组。在线调查分发给67名临床教职员工、住院医师和研究员，共有27人完成了可靠的（阿尔法系数=0.71）匿名调查（回复率40%）。10名教职员工参与了个人访谈或焦点小组。
定量调查的受访者表示经历过不良医疗事件（95%）和创伤应激症状（75%）。焦虑（81%）、内疚（62%）和睡眠障碍（58%）是最常报告的症状（症状平均数=3.4（±2.1））。报告焦虑的个体更有可能向同事寻求支持（ϕ=0.5，p<0.006）；报告内疚的个体则会向朋友寻求支持（ϕ=0.5，p<0.007）。睡眠障碍更常导致寻求心理健康服务（ϕ=0.5，p<0.007）。对支持的需求各不相同。报告焦虑的个体对同伴回应者感兴趣（ϕ=0.6，p<0.001）；报告内疚的个体将使用汇报会（ϕ=0.4，p<0.023）。个人访谈和焦点小组的定性数据得出了与“二次受害者”经历相关的身体和认知症状描述，包括责任感、内疚/羞耻感、自我怀疑、焦虑/反复思考和睡眠障碍。确定的应对资源：公正文化、同事支持、同伴回应者以及用于情绪汇报的结构化病例讨论会。
妇产科医护人员在患者出现不良事件后，可能会像其他医学专业一样经历继发性创伤应激症状。针对医生情绪健康的综合项目对于促进同事关系和减轻继发性创伤应激症状很重要。安全和透明度以及群体处理机会被确定为积极的机构文化和同伴支持项目的要素。
