普通外科住院医师培训经历：一项关于种族/民族幸福感差异的多中心研究。
The General Surgery Residency Experience: A Multicenter Study of Differences in Wellbeing by Race/Ethnicity.
作者信息
Greenberg Anya L, Cevallos Jenny R, Ojute Feyisayo M, Davis Denise L, Greene Wendy R, Lebares Carter C
机构信息
From the Department of Surgery, University of California San Francisco, San Francisco, CA.
Department of Medicine, University of California San Francisco, San Francisco, CA.
出版信息
Ann Surg Open. 2022 Jul 18;3(3):e187. doi: 10.1097/AS9.0000000000000187. eCollection 2022 Sep.
OBJECTIVES
We explored differences by race/ethnicity in regard to several factors that reflect or impact wellbeing.
BACKGROUND
Physician wellbeing has critical ramifications for the US healthcare system, affecting clinical outcomes, patient experience, and healthcare economics. Within surgery, literature examining the association between race/ethnicity and wellbeing has been limited and inconclusive.
METHODS
Residents at 16 academic General Surgery training programs completed an online questionnaire. Racial/ethnic identity, gender identity, post-graduate year (PGY) level, and gap years were self-reported. Differences by race/ethnicity in flourishing (global wellbeing) as well as factors reflecting resilience (mindfulness, personal accomplishment, workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, stress, anxiety, workplace demand) were assessed.
RESULTS
Of 300 respondents (response rate 34%), 179 (60%) were non-male, 123 (41%) were residents of color (ROC), and 53 (18%) were from racial/ethnic groups that are underrepresented in medicine (UIM). Relative to White residents, ROC have significantly lower flourishing and higher anxiety, and these remain significant when adjusting for gender, PGY level, and gap years. Relative to residents overrepresented in medicine (OIM), UIM residents have significantly lower emotional exhaustion and depersonalization after adjusting for gender, PGY level and gap years.
CONCLUSIONS
Disparities in resident wellbeing based on race/ethnicity and UIM/OIM status exist. However, the experience of ROC is not homogeneous. As part of the transformative process to address systemic racism, eliminate disparities in surgical training, and reconceptualize wellbeing as a fundamental asset for optimal surgeon performance, further understanding the specific contributors and detractors of wellbeing among different individuals and groups is critical.
目的
我们探讨了种族/族裔在反映或影响幸福感的几个因素方面的差异。
背景
医生的幸福感对美国医疗系统具有至关重要的影响，影响临床结果、患者体验和医疗经济学。在外科领域，研究种族/族裔与幸福感之间关联的文献有限且尚无定论。
方法
16个学术性普通外科培训项目的住院医师完成了一份在线问卷。种族/族裔身份、性别认同、研究生年级（PGY）水平和间隔年由自我报告。评估了种族/族裔在蓬勃发展（整体幸福感）以及反映复原力（正念、个人成就感、工作场所支持、工作场所掌控）和风险（抑郁、情感耗竭、去个性化、压力、焦虑、工作场所需求）方面的差异。
结果
在300名受访者中（回复率34%），179名（60%）为非男性，123名（41%）为有色人种住院医师（ROC），53名（18%）来自医学领域代表性不足的种族/族裔群体（UIM）。相对于白人住院医师，ROC的蓬勃发展水平显著较低且焦虑程度较高，在调整性别、PGY水平和间隔年后，这些差异仍然显著。相对于医学领域代表性过高的住院医师（OIM），UIM住院医师在调整性别、PGY水平和间隔年后，情感耗竭和去个性化程度显著较低。
结论
基于种族/族裔和UIM/OIM身份的住院医师幸福感存在差异。然而，ROC的经历并非同质化。作为解决系统性种族主义、消除外科培训差异以及将幸福感重新概念化为最佳外科医生表现的基本资产这一变革过程的一部分，进一步了解不同个体和群体幸福感的具体促进因素和不利因素至关重要。
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