An Assistant Professor of Psychiatry at the University of Alabama, Birmingham.
A Clinical Assistant Professor of Psychiatry at the NYU Grossman School of Medicine, New York.
Psychodyn Psychiatry. 2021 Winter;49(4):543-561. doi: 10.1521/pdps.2021.49.4.543.
Burnout and moral injury within medicine have steadily increased over the last decades, especially among those providing care during the COVID-19 pandemic. The term has been used to describe clinician distress and a syndrome of emotional exhaustion, a diminished sense of personal accomplishment, and depersonalization. Burnout has a significant impact on both job performance and patient care. Moral injury occurs when external circumstances interact with a person's cherished beliefs and standards. When the tension between them cannot be reconciled, the felt integrity of the individual is disrupted and the person experiences distress. The consultative aspect in consultation-liaison psychiatry (CLP) presents challenges that may predispose the young clinician to burnout and moral injury, especially during fellowship training. CLP psychiatrists also have a liaison role that could catalyze systemlevel change to enhance the mental well-being of their colleagues. This article reviews clinically relevant psychodynamic aspects of burnout and moral injury during CLP training. In addition, the authors propose strategies to enhance career growth and prevent and address moral injury during training to generate fulfilling professional development.
在过去几十年中,医学领域的倦怠和道德伤害稳步增加,尤其是在 COVID-19 大流行期间提供护理的人群中。这个术语被用来描述临床医生的痛苦和一种情绪疲惫、个人成就感降低和去人性化的综合征。倦怠对工作表现和患者护理都有重大影响。当外部环境与个人珍视的信仰和标准相互作用时,就会发生道德伤害。当它们之间的紧张关系无法调和时,个人的完整性就会受到干扰,个人就会感到痛苦。联络精神病学中的咨询方面存在挑战,这可能使年轻的临床医生容易出现倦怠和道德伤害,尤其是在研究员培训期间。联络精神病学家还具有联络作用,可以促进系统层面的变革,增强同事的心理健康。本文回顾了联络精神病学培训期间与倦怠和道德伤害相关的临床相关心理动力学方面。此外,作者提出了在培训期间促进职业发展和预防及解决道德伤害的策略,以产生充实的专业发展。