Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.
Emergency Care Consultants, Minneapolis, Minnesota.
West J Emerg Med. 2020 Dec 19;22(1):7-14. doi: 10.5811/westjem.2020.11.48884.
Recent research demonstrates burnout prevalence rates as high as 76% in emergency medicine (EM) residents. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) required that all training programs provide dedicated wellness education for their trainees as a requirement for accreditation. We aimed to conduct a systematic review of published wellness interventions conducted in EM residency programs following the implementation of the 2017 ACGME Common Program Requirements change in order to characterized published intervention and evaluate their effectiveness.
We applied a published approach to conducting systematic reviews of the medical education literature. We performed a search of the literature from January 1, 2017-February 1, 2020. Studies were included for final review if they described a specific intervention and reported outcomes with the primary goal of improving EM resident wellness. Outcomes were characterized using the Kirkpatrick training evaluation model.
Eight of 35 identified studies met inclusion criteria. Most described small convenience samples of EM residents from single training programs and used the satisfaction rates of participants as primary outcome data. Only quantitative assessment methods were used. Studies addressed only a limited number of factors affecting resident wellness. The majority of interventions focused on personal factors, although a few also included sociocultural factors and the learning and practice environment.
There is a relative dearth of literature in the area of research focused on interventions designed to improve EM resident wellness. Furthermore, the studies we identified are narrow in scope, involve relatively few participants, and describe programmatic changes of limited variety. Future directions include an increase and emphasis on multi-institutional studies, randomized controlled trials, qualitative methodology, and opportunities for funded research.
最近的研究表明，急诊医学（EM）住院医师的 burnout 患病率高达 76%。2017 年，研究生医学教育认证委员会（ACGME）要求所有培训计划为其学员提供专门的健康教育培训，作为认证的要求。我们旨在对 2017 年 ACGME 共同项目要求变更后在 EM 住院医师培训计划中实施的已发表的健康干预措施进行系统评价，以描述已发表的干预措施并评估其效果。
我们采用了一种已发表的方法来对医学教育文献进行系统评价。我们对 2017 年 1 月 1 日至 2020 年 2 月 1 日的文献进行了搜索。如果研究描述了具体的干预措施并报告了以改善 EM 住院医师健康为主要目标的结果，则纳入最终审查。使用 Kirkpatrick 培训评估模型来描述结果。
在 35 项确定的研究中，有 8 项符合纳入标准。大多数研究描述了来自单个培训计划的急诊住院医师的小便利样本，并将参与者的满意度作为主要结果数据。仅使用定量评估方法。研究仅涉及影响住院医师健康的有限数量的因素。大多数干预措施侧重于个人因素，尽管少数干预措施还包括社会文化因素和学习实践环境。
在旨在改善 EM 住院医师健康的干预措施研究领域，文献相对匮乏。此外，我们确定的研究范围狭窄，参与者相对较少，描述的计划变化种类有限。未来的方向包括增加和强调多机构研究、随机对照试验、定性方法以及资助研究的机会。
