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

在10种最常见的死亡原因中，有7种与职业压力有关，37%的工作相关疾病和45%的工作日损失与职业压力有关。慢性或反复的压力暴露会改变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而导致健康不良。职业压力在医疗保健行业尤为普遍，并与不良的长期职业和健康结果有关。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和经常高度紧张的性质。尽管压力通常被认为是不受欢迎的，但值得注意的是，并非所有的医生都在遇到压力时犹豫不决。事实上，一些公司兴旺发达。本研究项目旨在从心理生理学的角度理解压力反应的可变性，以及这种可变性如何影响研究生培训医生的表现、发展和福祉。因此，它与UKRI跨委员会的研究重点保持一致，需要在心理学、生理学、教育和健康研究方面采取跨学科的方法。拟进行的研究方案包括三项研究。第一项研究将采用横断面设计来检验医生在医学院毕业后早期培训阶段对压力的心理生理反应是否与表现和幸福感有关。应激反应将通过主观自我报告项目和客观生理测量来评估，例如使用阻抗或心电图、唾液皮质醇和α淀粉酶。将使用标准的工作场所评估项目来评估绩效。将采用世卫五指数等有效措施监测健康状况。第二项研究将采用纵向设计，使用与研究1相同的测量方法，监测接受培训的医生在一段时间内的压力反应。将评估压力反应趋势与健康、工作表现和专业发展的关系。专业发展将通过主观自我报告和研究生培训的常规进度监测结果来评估，例如通过年度能力进步审查。繁荣可以定义为成功和发展的共同体验。这项研究将探索压力反应和繁荣之间的关系。根据第一和第二项研究的结果，第三项研究将调查一项干预措施的效果，该干预措施旨在优化心理生理反应，以促进培训医生的表现、发展和健康。具体而言，该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，并测量其对后续压力反应、工作场所评估绩效、专业发展和繁荣的影响。更好地了解医学培训生的职业压力，就有可能前瞻性地确定可能受益于有针对性的早期支持的学习者，并促进制定循证干预措施，使医生具备在压力下茁壮成长所需的能力。因此，本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.