Grush Kira A, Christensen Wendy, Lockspeiser Tai, Adams Jennifer E
Acad Med. 2025 Mar 1;100(3):325-330. doi: 10.1097/ACM.0000000000005940. Epub 2024 Dec 4.
Health care workers exposed to traumatic events while working with patients are at risk for secondary traumatic stress (STS). Data on this phenomenon in medical students are limited. This prospective study examines the trajectory and prevalence of STS among medical students during clinical clerkships.
The study at The University of Colorado School of Medicine was conducted in 2 phases: the first evaluated STS across multiple time points in a single year (n = 187); the second assessed STS prevalence at the end of the clerkship year in 3 cohorts (2020-2023) (n = 482). The study used a validated Secondary Traumatic Stress Scale (STSS). Multilevel growth curve modeling was used to explore the change trajectory of STSS scores across the year after controlling for covariates.
In phase 1, the quadratic trend coefficient was negative (-1.56), indicating a predicted trajectory in STSS total scores that started lower at clerkship year start, reached an apex during the year, and decreased by year end ( P < .001). The intercept (32.73) and linear (5.17) coefficient estimates together (37.90) predicted a total score increase indicating mild STS to a total score at the cutoff for moderate STS between July-October ( P < .001). The only statistically significant covariate was reporting an influential psychiatric condition (4.86, P < .001). Phase 2 revealed an end-of-year prevalence of moderate to severe STS of 35.7%, stable across all 3 cohorts. In phase 2, STS categories were significantly different for those reporting a psychiatric condition ( P = .007).
Medical student STS symptoms increase during the clerkship year and do not return to baseline for many by the end. More research is warranted to understand risk and protective factors for STS, strategies to mitigate symptom development, and how much of the observed STS is attributable to the COVID-19 pandemic.
医护人员在为患者提供服务时接触到创伤性事件，有遭受继发性创伤应激（STS）的风险。关于医学生中这一现象的数据有限。这项前瞻性研究调查了临床实习期间医学生中STS的发展轨迹和患病率。
科罗拉多大学医学院的这项研究分两个阶段进行：第一阶段在一年中的多个时间点评估STS（n = 187）；第二阶段评估三个队列（2020 - 2023年）实习年末的STS患病率（n = 482）。该研究使用了经过验证的继发性创伤应激量表（STSS）。在控制协变量后，采用多水平生长曲线模型探索全年STSS分数的变化轨迹。
在第一阶段，二次趋势系数为负（-1.56），表明STSS总分的预测轨迹在实习年初较低，在年中达到顶点，到年底下降（P < .001）。截距（32.73）和线性（5.17）系数估计值之和（37.90）预测总分增加，表明7月至10月间从轻度STS到中度STS临界值的总分增加（P < .001）。唯一具有统计学意义的协变量是报告有影响的精神疾病（4.86，P < .001）。第二阶段显示，三个队列中中度至重度STS的年末患病率为35.7%，且保持稳定。在第二阶段，报告有精神疾病的学生的STS类别有显著差异（P = .007）。
医学生的STS症状在实习期间会增加，到实习结束时，许多学生的症状并未恢复到基线水平。有必要开展更多研究，以了解STS的风险和保护因素、减轻症状发展的策略，以及观察到的STS中有多少可归因于新冠疫情。
