Limitation of duty hour regulations for pediatric resident wellness
Limitation of duty hour regulations for pediatric resident wellness
复制标题
儿科住院医师健康值班时间规定的限制
作者：
Osamu Nomura;H. Mishina;Yoshinori Kobayashi;A. Ishiguro;Hirokazu Sakai;Hiroyuki Kato
工作时间规定已被纳入住院医师计划，以解决心理健康问题并改善健康状况。在这里，我们阐明了实施通宵呼叫轮班制度后抑郁症状的患病率以及与居民职业倦怠或抑郁相关的因素。在日本东京的一家三级儿科和围产期医院进行了一项顺序探索性混合方法研究。共有41名儿科住院医生参加了横断面调查。我们测定并比较了实施轮班制前后抑郁症状的患病率和实际工作时间。对4名住院医生进行了跟踪访谈，以探讨可能引发或预防抑郁和职业倦怠的因素。每周平均工作时间从75.2 小时降至64.9 小时。在实施轮班制度之前和之后，抑郁症状的患病率保持相似。倦怠量表中的情绪衰竭和去人格化与抑郁显著相关。高工作量、不耐受压力、人际关系困难以及在工作与生活平衡方面的代沟可能会导致职业倦怠。压力容忍度、工作负荷监控和平衡、适当的监督和同伴支持可以预防职业倦怠。尽管通宵呼叫轮班制度在减少工作时间方面是有效的，但它在管理儿科住院医生心理健康问题方面的有效性仍不清楚。住院医生健康计划是一项额外的战略，它们的目标应该是促进同行支持和改善住院医生与教职员工的互动。这种方法可能有利于不同世代、信仰结构相互冲突的医生之间的关系。
Abstract Duty hour regulations have been placed in residency programs to address mental health concerns and to improve wellness. Here, we elucidate the prevalence of depressive symptoms after implementing an overnight call shift system and the factors associated with burnout or depression among residents. A sequential exploratory mixed methods study was conducted in a tertiary care pediatric and perinatal hospital in Tokyo, Japan. A total of 41 pediatric residents participated in the cross-sectional survey. We determined and compared the prevalence of depressive symptoms and the number of actual working hours before and after implementing the shift system. A follow-up focus-group interview with 4 residents was conducted to explore the factors that may trigger or prevent depression and burnout. Mean working hours significantly decreased from 75.2 hours to 64.9 hours per week. Prevalence of depressive symptoms remained similar before and after implementation of the shift system. Emotional exhaustion and depersonalization from the burnout scale were markedly associated with depression. High workload, stress intolerance, interpersonal difficulties, and generation gaps regarding work–life balance could cause burnout. Stress tolerance, workload monitoring and balancing, appropriate supervision, and peer support could prevent burnout. Although the overnight call shift system was effective in reducing working hours, its effectiveness in managing mental health issues among pediatric residents remains unclear. Resident wellness programs represent an additional strategy and they should be aimed at fostering peer support and improvement of resident–faculty interactions. Such an approach could be beneficial to the relationship between physicians of different generations with conflicting belief structures.
影响因子：
158.5
作者：
Landrigan, CP;Rothschild, JM;Czeisler, CA
通讯作者：
Czeisler, CA
影响因子：
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作者：
Sen, Srijan;Kranzler, Henry R.;Krystal, John H.;Speller, Heather;Chan, Grace;Gelernter, Joel;Guille, Constance
通讯作者：
Guille, Constance