Thriving under pressure: occupational stress and the performance, development and wellbeing of doctors in training (12/21)

职业压力与10种最常见的死亡原因中的7种有关，占与工作有关的健康问题的37%和损失工作日的45%。慢性或反复的压力暴露改变了对急性压力源的生理反应，并可能通过自主神经，免疫，心血管或心理功能的持续变化导致健康状况不佳。职业压力在医疗保健领域尤其普遍，并与长期职业和健康结果不佳有关。劳动力发展和生产力是NHS英格兰长期计划的核心，包括承诺扩大医疗劳动力，并确保提供支持，以管理提供医疗保健的复杂性和往往高度紧张的性质。虽然压力通常被视为不可取的，值得注意的是，并不是所有的医生在他们遇到的压力下摇摇欲坠。的确，有些人会茁壮成长。该研究计划旨在从心理生理学的角度了解压力反应的变化，以及这种变化如何影响研究生培训医生的表现，发展和福祉。因此，它与UKRI跨理事会研究优先事项保持一致，并需要跨心理学，生理学，教育和健康研究的跨学科方法。拟议的研究方案包括三项研究。第一个将使用横截面设计，以检查是否心理生理反应的压力与性能和健康的医生从医学院毕业后的早期培训阶段。将使用主观自我报告项目和客观生理测量（例如使用阻抗或心电图、唾液皮质醇和α淀粉酶）评估应激反应。绩效将使用标准工作场所评估项目进行评估。第二项研究将采用与第一项研究相同的措施，采用纵向设计，监测医生在培训过程中的压力反应。将评估压力反应趋势与健康、工作场所表现和职业发展的关系。专业发展将通过主观自我报告和研究生培训中常规进展监测的结果进行评估，例如通过能力进展年度审查。繁荣可以被定义为成功和发展的共同经历。这项研究将探讨压力反应和蓬勃发展之间的关系。根据研究一和二的结果，第三项研究将调查旨在优化心理生理反应的干预措施对培训医生的绩效，发展和福祉的影响。具体而言，这种干预旨在改变研究生学员看待压力和相关生理唤醒的方式，并测量对随后的压力反应，工作场所评估表现，专业发展和繁荣的影响。更好地了解医学学员的职业压力提供了潜在的前瞻性识别可能受益于有针对性的早期支持的学习者，并促进循证干预措施的发展，使医生具备在压力下茁壮成长所需的能力。因此，这位博士的研究结果可能有助于保障未来医疗保健工作人员的生产力和福祉，并最终提高患者安全。

Occupational stress is linked with 7 of the 10 commonest causes of death, and accounts for 37% of work-related ill health and 45% of lost working days. Chronic or repeated stress exposure alters the physiological response to acute stressors and may cause ill health through persisting changes in autonomic, immune, cardiovascular or psychological function. Occupational stress is particularly endemic in healthcare, and is associated with poor long-term career and health outcomes. Workforce development and productivity is central to the NHS England Long Term Plan, including commitments to expand the medical workforce and ensure that support is available to manage the complex and often highly stressful nature of delivering healthcare.Although stress is typically seen as undesirable, it is noticeable that not all doctors falter under the stress they encounter. Indeed, some thrive. This programme of research aims to understand variability in response to stress from a psychophysiological perspective, and how such variability influences the performance, development and wellbeing of doctors in postgraduate training. It thereby aligns with UKRI cross-council research priorities and requires an interdisciplinary approach across psychology, physiology, education and health research. The intended research programme comprises three studies. The first will use a cross-sectional design to examine whether psychophysiological responses to stress are associated with performance and wellbeing in doctors in the early stages of training after graduation from medical school. Stress responses will be assessed using subjective self-report items and objective physiological measurements, for example using impedance- or electro-cardiography, salivary cortisol and alpha amylase. Performance will be assessed using standard workplace assessment items. Wellbeing will be monitored with validated measures such as the WHO5 index.The second study will use a longitudinal design to monitor stress responses in doctors in training over time, using the same measures as in study 1. Stress response trends will be evaluated for associations with wellbeing, performance in the workplace and professional development. Professional development will be assessed by subjective self-report and by the outcome of routine progress monitoring in postgraduate training, for example through the Annual Review of Competence Progression. Thriving can be defined as a joint experience of success and development. This study will explore relationships between stress responses and thriving.Depending on the findings of studies one and two, a third study will investigate the effects of an intervention designed to optimise psychophysiological responses to stress for performance, development and wellbeing in doctors in training. Specifically, this intervention will aim to alter the way postgraduate trainees view stress and associated physiological arousal, and measure the effect on subsequent stress responses, workplace assessment performance, professional development and thriving.A better understanding of occupational stress in medical trainees offers the potential to prospectively identify learners who might benefit from targeted early support, and to facilitate the development of evidence-based interventions to equip doctors with the capabilities required to thrive under pressure. Therefore, the findings of this PhD may help safeguard the productivity and wellbeing of the future healthcare workforce and, ultimately, improve patient safety.