将第一年住院医师的蓬勃发展作为全球幸福感衡量指标的一项纵向队列试点研究。
Flourishing as a Measure of Global Well-being in First Year Residents: A Pilot Longitudinal Cohort Study.
作者信息
Lebares Carter C, Greenberg Anya L, Shui Amy, Boscardin Christy, van der Schaaf Marieke
机构信息
Department of Surgery, University of California, San Francisco, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
出版信息
J Med Educ Curric Dev. 2021 May 31;8:23821205211020758. doi: 10.1177/23821205211020758. eCollection 2021 Jan-Dec.
BACKGROUND
Physician well-being is critical to optimal learning and performance, yet we remain without validated measures to gauge the efficacy of well-being curricula for trainees. This study evaluates initial evidence of flourishing as a valid measure of global well-being in postgraduate-year-1 residents (PGY-1s), providing a means of assessing well-being intervention efficacy.
STUDY DESIGN
In this single-site study of PGY-1s participating in Enhanced Stress Resilience Training (ESRT), an online questionnaire of published measures was administered at baseline (T1, just before PGY-1), post-ESRT (T2, 7 weeks later), and at PGY-1 end (T3, 11 months later). The Mental Health Continuum (MHC) was used to assess our primary outcome variable, flourishing, a well-established metric of psychosocial thriving in non-physicians that can be treated continuously or categorically. Correlation between flourishing and both resilience (mindfulness and workplace support) and risk (emotional exhaustion, depersonalization, stress, depressive symptoms, anxiety, and workplace demand) factors was assessed at each time-point and longitudinally.
RESULTS
Forty-five interns completed the survey at T1, 37 at T2, and 21 at T3; 21 responded at all time points. MHC score was significantly positively correlated with mindfulness (β = 1.47, SE = 0.35, < .001) and workplace support (β = 2.02, SE = 1.01, = .05) longitudinally, and at all time points. Flourishing was significantly negatively correlated with depressive symptoms (β = -7.48, SE = 1.68, < .001), stress (β = -1.28, SE = 0.29, < .001), and anxiety (β = -1.74, SE = 0.38, < .001) longitudinally and at all time points, and significantly negatively correlated with emotional exhaustion (β = -2.65, SE = 0.89, = .003) longitudinally and at T1 (β = -3.36, SE = 1.06, = .003).
CONCLUSION
Flourishing showed appropriate correlation with established resilience and risk factors, thus supporting its concurrent validity as a measure of global well-being in this population. As such, the MHC may provide a simple, meaningful assay of well-being and an effective tool for evaluating the efficacy of well-being interventions. Further validation requires a larger, multi-center study.
背景
医生的幸福感对于最佳学习和工作表现至关重要，但我们仍缺乏经过验证的措施来衡量针对实习生的幸福感课程的效果。本研究评估了蓬勃发展作为研究生一年级住院医师（PGY - 1）总体幸福感有效衡量指标的初步证据，提供了一种评估幸福感干预效果的方法。
研究设计
在这项针对参与增强压力恢复力训练（ESRT）的PGY - 1的单中心研究中，在基线（T1，PGY - 1之前）、ESRT后（T2，7周后）和PGY - 1结束时（T3，11个月后），对已发表的测量指标进行在线问卷调查。心理健康连续体（MHC）用于评估我们的主要结果变量——蓬勃发展，这是一个在非医生群体中用于衡量心理社会繁荣的成熟指标，可以连续或分类处理。在每个时间点及纵向评估蓬勃发展与恢复力（正念和工作场所支持）以及风险（情绪耗竭、去个性化、压力、抑郁症状、焦虑和工作场所需求）因素之间的相关性。
结果
45名实习生在T1完成了调查，37名在T2完成，21名在T3完成；21名在所有时间点都有回复。MHC得分在纵向以及所有时间点均与正念（β = 1.47，SE = 0.35，< 0.001）和工作场所支持（β = 2.02，SE = 1.01， = 0.05）显著正相关。蓬勃发展在纵向以及所有时间点均与抑郁症状（β = -7.48，SE = 1.68，< 0.001）、压力（β = -1.28，SE = 0.29，< 0.001）和焦虑（β = -1.74，SE = 0.38，< 0.001）显著负相关，并且在纵向以及T1时与情绪耗竭（β = -2.65，SE = 0.89， = 0.003）显著负相关（T1时β = -3.36，SE = 1.06， = 0.003）。
结论
蓬勃发展与既定的恢复力和风险因素显示出适当的相关性，从而支持其作为该人群总体幸福感衡量指标的同时效度。因此，MHC可能提供一种简单、有意义的幸福感测定方法以及评估幸福感干预效果的有效工具。进一步验证需要更大规模的多中心研究。
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