Decreasing GME training stress to foster residents' professionalism
Decreasing GME training stress to foster residents' professionalism
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DOI：
10.1097/00001888-200409000-00003
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发表时间：
2004-09-01
影响因子：
7.4
通讯作者：
Mareiniss, DP
中科院分区：
文献类型：
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作者：
Mareiniss, DP
作者评估了目前对住院医师培训中医疗专业精神的关注。研究生医学教育认证委员会（ACGME）最近颁布的住院医师专业要求与当前培训的气氛有关。作者首先回顾了最近的一项研究，该研究表明，通过马斯拉克职业倦怠量表（Maslach burnout Inventory）评估，不专业的行为可能与职业倦怠显著相关。在该清单的要素中，去人格化被证明与不专业的行为和行为显著对应。回顾了一些评估住院医师治疗和压力的调查和研究，并确定了三个培训压力的来源：(1)住院医师的虐待，(2)财务压力，以及(3)医疗领域的悲观和不确定性。这些压力源的程度和影响在人格解体、抑郁和不专业行为方面进行了讨论和评估。每一种压力都与居民的负面影响相关，如人格解体、满意度下降、抑郁和倦怠。反过来，这种影响被发现可能导致居民的不专业行为。根据这些发现，作者建议对当前的研究生医学培训环境进行几项修改，以减轻这些压力源，促进专业精神，提高士气。预防虐待、减轻经济压力、增加教育机会和树立榜样被认为是有益的干预措施，可以培养专业精神和防止不当行为。作者指出，这种环境变化可能比伦理研讨会或课堂培训更有效地培养年轻医生的专业精神。因此，作者建议改变环境以减少住院医师压力，这是促进新的ACGME要求和专业理想的最有效手段。
The author evaluates current concerns over medical professionalism in residency training. The recent professionalism requirements for residents promulgated by the Accreditation Council for Graduate Medical Education (ACGME) are discussed in relation to the atmosphere of current training. The author first reviews a recent study showing that unprofessional behavior may significantly correlate with burnout, as evaluated by the Maslach Burnout Inventory. Among the elements of that inventory, depersonalization is shown to significantly correspond to unprofessional actions and behavior. Several surveys and studies evaluating residency treatment and stress are reviewed and three sources of training stress are identified: (1) abusive treatment of residents, (2) financial pressures, and (3) pessimism and uncertainty in the medical field. The extent and effects of these stressors are discussed and evaluated in relation to depersonalization, depression, and unprofessional behavior. Each of these pressures is found to correlate with negative effects on residents, such as depersonalization, decreased satisfaction, depression, and burnout. In turn, such effects are found to potentially cause unprofessional behavior among residents.In light of these findings, the author suggests several modifications to the current graduate medical training environment to mitigate such stressors, promote professionalism, and increase morale. Prevention of abusive treatment of residents, alleviation of financial pressure, increased educational opportunities, and role modeling are suggested as beneficial interventions that may foster professionalism and prevent inappropriate behavior. The author indicates that such environmental changes would likely foster professionalism in young physicians more effectively than would ethics seminars or in-class training. Accordingly, the author suggests environmental changes to decrease residency stress as the most effective means of promoting the new ACGME requirements and the ideals of professionalism.