蓬勃发展作为干预指南：一项针对普通外科住院医师的全国多中心研究。
Flourishing as a guide to intervention: a national multicenter study of general surgery residents.
作者信息
Greenberg Anya L, Boscardin Christy, Lebares Carter C
机构信息
Department of Surgery, University of California San Francisco, San Francisco, CA USA.
Department of Medicine, University of California San Francisco, San Francisco, CA USA.
出版信息
Global Surg Educ. 2022;1(1):12. doi: 10.1007/s44186-022-00014-3. Epub 2022 Mar 31.
PURPOSE
Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have been limited. Here we provide early data on modifiable targets, potential interventions, and comparative impact.
METHODS
In this cross-sectional survey-based study of mixed-level residents at 16 academic General Surgery training programs, gender-identity, race, post-graduate year, and gap years were self-reported. Correlation between our primary outcome variable, flourishing, and measures of resilience (mindfulness, personal accomplishment [PA], workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, perceived stress, anxiety, workplace demand) were assessed.
RESULTS
Of 891 recipients, 300 responded (60% non-male, 41% non-white). Flourishing was significantly positively correlated with all measured resilience factors and negatively correlated with all measured risk factors. In multivariable modelling, mindfulness, PA, and workplace support were positively and significantly associated with flourishing, with PA having the strongest resilience effect. Depression and anxiety were negatively and significantly associated with flourishing, with depression having the strongest risk effect.
CONCLUSIONS
Our results suggest that interventions that increase mindfulness, workplace support, and PA, as well as those that decrease depression and anxiety may particularly impact flourishing (i.e., global wellbeing) in surgical trainees. These findings provide preliminary guidance on allocation of resources toward wellbeing interventions. In particular, cognitive (i.e., mindfulness) training is a feasible intervention with modest but significant association with flourishing, and potential indirect effects through influence on PA, anxiety and depression.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s44186-022-00014-3.
目的
医生的身心健康对于最大化患者体验、护理质量和医疗价值至关重要。在增强蓬勃发展（相对于仅仅减少病理状态）方面，用于指导和评估干预措施效果的客观指标一直有限。在此，我们提供关于可改变目标、潜在干预措施和比较影响的早期数据。
方法
在这项基于横断面调查的研究中，对16个学术性普通外科培训项目的不同层级住院医师进行调查，他们自行报告了性别认同、种族、研究生年级和间隔年情况。评估了我们的主要结局变量——蓬勃发展，与复原力指标（正念、个人成就感[PA]、工作场所支持、工作场所掌控）以及风险指标（抑郁、情绪耗竭、去个性化、感知压力、焦虑、工作场所需求）之间的相关性。
结果
在891名受访者中，有300人做出回应（60%为非男性，41%为非白人）。蓬勃发展与所有测量的复原力因素呈显著正相关，与所有测量的风险因素呈负相关。在多变量建模中，正念、PA和工作场所支持与蓬勃发展呈显著正相关，其中PA具有最强的复原力效应。抑郁和焦虑与蓬勃发展呈显著负相关，其中抑郁具有最强的风险效应。
结论
我们的结果表明，增加正念、工作场所支持和PA的干预措施，以及减少抑郁和焦虑的干预措施，可能对外科住院医师的蓬勃发展（即整体幸福感）产生特别影响。这些发现为将资源分配到促进身心健康的干预措施上提供了初步指导。特别是，认知（即正念）训练是一种可行的干预措施，与蓬勃发展有适度但显著的关联，并且可能通过对PA、焦虑和抑郁的影响产生间接效应。
补充信息
在线版本包含可在10.1007/s44186 - 022 - 00014 - 3获取的补充材料。
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