以医学教育中的韧性课程应对医生职业倦怠流行病：系统综述。
Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review.
机构信息
Department of Family Medicine, Faculty of Medicine, University of Ottawa, 451 Ch. Smyth Rd. (2024), Ottawa, ON, K1H 8M5, Canada.
Health Sciences Library, University of Ottawa, Ottawa, ON, K1H 8M5, Canada.
出版信息
BMC Med Educ. 2021 Feb 1;21(1):80. doi: 10.1186/s12909-021-02495-0.
BACKGROUND
A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME.
METHODS
We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool.
RESULTS
Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups.
CONCLUSIONS
Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.
背景
医学教育中的各种压力源导致本科医学教育（UGME）和研究生医学教育（PGME）水平都出现了职业倦怠现象。因此，UGME 和 PGME 课程最近开始探索基于韧性的干预措施。由于这些干预措施还处于起步阶段，因此对于它们在促进学员韧性方面的效果知之甚少。本系统评价旨在综合现有研究证据，评估 UGME 和 PGME 中韧性课程的效果。
方法
我们使用 MEDLINE、EMBASE、PsycINFO、教育资源信息中心（ERIC）和 Education Source 从其建立到 2020 年 6 月进行了全面的文献搜索。纳入报告 UGME 和 PGME 环境中韧性课程效果的研究。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南对现有研究进行定性分析。使用 ROBINS-I 工具评估偏倚风险。
结果
符合纳入标准的研究有 21 项。其中 13 项为单臂研究，6 项为准实验，2 项为 RCT。38%（8/21；n=598）在 UGME 实施，62%（13/21，n=778）在 PGME 实施。持续时间、交付和课程主题存在显著异质性，只有两项研究实施了相同的培训模式。同样，课程结果衡量指标也存在很大差异，大多数研究报告说韧性有适度改善，而三项研究报告说培训完成后韧性恶化。总体偏倚风险评估为中度，只有少数课程之前得到了其他研究小组的验证。
结论
研究结果表明，韧性课程可能对医学学员有益。韧性培训是医学教育中一个新兴的领域，值得进一步研究。需要进一步的研究来构建在医学教育中培养韧性的最佳方法。
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