改善住院医师的职业倦怠与幸福感：基层干预与正规项目课程的影响比较

Improving burnout and well-being among medicine residents: Impact of a grassroots intervention compared to a formal program curriculum.

作者信息

Sheer Amy J, Estores Irene M, Nickels Rachel, Radhakrishnan Nila, Goede Dianne L, Mramba Lazarus K, Lo Margaret C

机构信息

Department of Medicine, Division of General Internal Medicine, University of Florida College of Medicine, FL, USA.

Department of Medicine, Hospital Staff Physician, Malcolm Randal Veteran Affairs Medical Center, FL, USA.

出版信息

J Educ Health Promot. 2021 Jul 30;10:250. doi: 10.4103/jehp.jehp_1378_20. eCollection 2021.

DOI:10.4103/jehp.jehp_1378_20

PMID:34485547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8396059/

Abstract

BACKGROUND

With growing resident burnout, Accreditation Council for Graduate Medical Education issued new requirements for program interventions to optimize resident well-being. Little evidence exists on how to best teach resiliency to residents. This study assesses the impact of both a grassroots intervention and formal resiliency curriculum on resident burnout and well-being.

MATERIALS AND METHODS

From November 2016 to August 2017, residents in a large Internal Medicine Residency Program participated in grassroots wellness interventions from the resident-led Gator Council in Gainesville, FL USA. From August 2017 to June 2018, residents participated in a formal program-driven resiliency curriculum. Wellness interventions included monthly morning reports, bimonthly workshops, and biannual noon conferences. Pre- and postintervention Maslach Burnout Inventory (MBI) and Physician Well-Being Index (PWBI) assessed the effect of both interventions on resident burnout and well-being. Statistical analyses used Student's -test, Fisher's exact tests, and linear regression model.

RESULTS

One hundred and twenty-two residents participated in grassroots interventions. One hundred and seventeen (87 residents, 35 students) participated in formal curriculum. Mean MBI scores for all three sections did not differ between pre -and postgrassroots intervention (emotional exhaustion [EE] = 0.46; depersonalization [DP] = 0.43; personal accomplishment [PA] = 0.73]) or between pre- and postcurriculum (EE = 0.20; DP = 0.40; PA = 0.51). Students scored higher burnout levels compared to residents in EE ( = 0.001) and PA ( = 0.02). Pre- versus postcurriculum PWBI scores did not differ among residents ( = 0.20), while PWBI scores improved among students ( = 0.01).

CONCLUSIONS

This study found no improvement in resident burnout or well-being from a bottom-up and top-down approach. Our results imply the need for an early wellness curriculum to improve student well-being given their higher level of burnout. System-wide efforts are vital to combat physician burnout.

摘要

背景

随着住院医师职业倦怠情况日益严重，毕业后医学教育认证委员会出台了新的项目干预要求，以优化住院医师的健康状况。关于如何最有效地向住院医师传授复原力，目前几乎没有证据。本研究评估了基层干预和正式的复原力课程对住院医师职业倦怠和健康状况的影响。

材料与方法

2016年11月至2017年8月，美国佛罗里达州盖恩斯维尔一个大型内科住院医师项目的住院医师参加了由住院医师主导的鳄鱼委员会开展的基层健康干预活动。2017年8月至2018年6月，住院医师参加了一个由项目驱动的正式复原力课程。健康干预活动包括每月的早间汇报、每两个月一次的工作坊以及每半年一次的午间会议。干预前后使用马氏职业倦怠量表（MBI）和医师健康指数（PWBI）评估两种干预措施对住院医师职业倦怠和健康状况的影响。统计分析采用学生t检验、费舍尔精确检验和线性回归模型。

结果

122名住院医师参加了基层干预活动。117人（87名住院医师，35名学生）参加了正式课程。基层干预前后，MBI所有三个部分的平均得分均无差异（情感耗竭[EE]=0.46；去人格化[DP]=0.43；个人成就感[PA]=0.73），课程前后也无差异（EE=0.20；DP=0.40；PA=0.51）。在情感耗竭（P=0.001）和个人成就感（P=0.02）方面，学生的职业倦怠水平得分高于住院医师。住院医师课程前后的PWBI得分无差异（P=0.20），而学生的PWBI得分有所提高（P=0.01）。