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

职业压力与10个最常见的死亡原因中的7个有关，并占与工作有关的健康问题的37%和损失工作日的45%。长期或反复的应激暴露会改变对急性应激源的生理反应，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领域尤其普遍，并与糟糕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，包括承诺扩大医疗队伍，并确保提供支持来管理提供医疗保健的复杂且往往具有高度压力的性质。尽管压力通常被视为不受欢迎的，但值得注意的是，并不是所有的医生都在他们遇到的压力下犹豫不决。事实上，一些公司正在蓬勃发展。这项研究计划旨在从心理生理学的角度了解应对压力的变异性，以及这种变异性如何影响医生在研究生培训中的表现、发展和福祉。因此，它与UKRI跨委员会的研究优先事项保持一致，并要求跨心理学、生理学、教育学和卫生研究的跨学科方法。计划中的研究方案包括三项研究。第一项研究将使用横断面设计来检验医生在从医学院毕业后的早期培训阶段对压力的心理生理反应是否与其表现和幸福感有关。应激反应将使用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。绩效将使用标准工作场所评估项目进行评估。幸福感将通过WHO5指数等有效指标进行监测。第二项研究将使用纵向设计来监测医生在培训期间的压力反应，使用与研究1相同的指标。压力反应趋势将被评估与幸福感、工作场所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中例行进展监测的结果来评估，例如通过能力进步年度审查。欣欣向荣可以被定义为成功和发展的共同经历。这项研究将探索压力反应和成功之间的关系。根据研究一和研究二的结果，第三项研究将调查干预措施的效果，该干预旨在优化医生在培训中对压力的心理生理反应，以促进表现、发展和健康。具体地说，这项干预措施将旨在改变研究生实习生对压力和相关生理唤醒的看法，并衡量对随后的压力反应、工作场所评估表现、专业发展和成才的影响。更好地了解医学实习生的职业压力提供了前瞻性地识别可能受益于有针对性的早期支持的学习者的潜力，并促进了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，这一博士的发现可能有助于保障未来医疗工作人员的生产力和福祉，并最终提高患者的安全。

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.