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Mood changes during internship
Abstract
A prospective study using two standardized psychological tests, the Profile of Mood States (POMS) and the Self-Rating Depression Scale (SDS), was conducted in an effort to quantify the emotional changes experienced by internal medicine house staff members during the internship. In contrast to instruments used in previous investigations of this type, the POMS and the SDS are standardized tests with proven reliability and validity. The six mood factors measured, "tension-anxiety," "depression-dejection," "anger-hostility," "vigor-activity," "fatigue-inertia," and "confusion-bewilderment," are reported to be among those factors most often affected by the internship experience. Twenty-three interns completed both tests at four-month intervals during one academic year. One-way analysis of variance for repeated measures revealed that the level of only anger-hostility of the mood factors changed significantly during the year. The intensity of this factor increased between the first and third testing periods before dropping at the end of the year. In contrast to findings in previous studies, the depression and fatigue factors did not increase during the year. By characterizing interns' reactions to the stresses of postgraduate medical education, standardized psychological tests can contribute to improved understanding of these reactions and to more intelligent planning of support systems.
... 3,5 There is disagreement over whether female gender predisposes to depression or anger during residency. 3,5,6 The factor that most consistently predicts worsening mood is the amount of time from the beginning of the academic year, with increases in anger 1,6,7,9,10 and depression 4,7,10 being the most frequently reported. Other evidence shows normalization of mood by the end of the internship 10 and in the second year of residency. ...
... Other evidence shows normalization of mood by the end of the internship 10 and in the second year of residency. 2,9 These studies have significant variability in screening instrument used and sampling interval, and there are continuing efforts to develop better screening instruments. 11 We hypothesized that over the course of an academic year, when surveyed with an automated, anonymous, validated depression screening tool, EM residents would show worsening mood over the course of the year. ...
... The prevalence of depression in our subjects was similar to previously reported depression rates among the general public, attending physicians, medical students, and non-EM residents. [1][2][3][4][5][6]8 Our study used the CESD instrument to measure depression, while comparable studies used the Profile of Mood States (POMS), 1,5,7,9 Interpersonal Reactivity Index (IRI), 6 Self-Rating Depression Scale (SDS), 9 Beck Depression Index (BDI), 2,3,5 Spielberger State-Trait Anxiety Inventory, 3 Symptom Checklist-90-Revised (SCL-90-R), 4 or Likert scales. 10 While all of these are well validated across many demographic groups (and most, including the CESD, [12][13][14] have been validated for repetitive use and for use among our age range), our choice of the CESD was based on two major issues: ease of use and adaptability to an automated, anonymous, computerized system. ...
To describe the frequency of depression among emergency medicine (EM) residents by month, gender, rotation type, postgraduate year (PGY), and number of hours worked.
This was a prospective, nonblinded, cohort study of consenting EM residents in a four-year, 51-resident EM residency program from July 2003 to June 2004. Participants received an anonymous monthly survey via Web site that consisted of the Center for Epidemiologic Studies Depression Scale (CESD) and the resident's gender, PGY, number of hours worked in the previous week (< or =40, 41-60, 61-80 and >80), and rotation type (EM, intensive care unit, non-EM clinical, or other). Residents were excluded from analysis if they did not complete at least one survey during each season. For each resident, the peak score for each three-month period was recorded and analyzed with a mixed-model analysis of variance to account for a repeated-measures effect.
Fifty of 51 (98.0%) residents consented for participation. Nineteen (38%) were excluded because of incomplete data. The prevalence of depression was 12.1% (95% confidence interval [95% CI] = 7.5% to 19.0%; 15 of 124 scores). The women had numerically, but not statistically, significantly lower mean +/- standard deviation CESD scores than the men (6.4 +/- 6.8 vs. 8.7 +/- 8.6, p = 1.0). There was no significant difference in mean CESD score by month, PGY, rotation type, or number of hours worked.
Season, number of hours worked, rotation type, PGY, and gender all failed to predict depression among EM residents in this single-center trial. The prevalence of depression was comparable to that of the general population.
... Estudo prospectivo conduzido por Uliana et al. 44 , sobre modificações do humor ao longo do primeiro ano de Residência, revelou que, dos fatores relacionados ao humor, aquele que se modificou significativamente foi o fator raiva-hostilidade. Esses sentimentos (raiva e hostilidade) cresceram desde o início da Residência até o oitavo mês, decrescendo ao final do ano. ...
... ,20 e de Valko e Clayton 21 , que estudaram os efeitos da privação do sono e a incidência de depressão em residentes de primeiro ano. Desde então, um grande volume de trabalhos aparece na literatura, buscando identificar as fontes de estresse e seus efeitos nos residentes e na qualidade da assistência prestada aos pacientes[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]28,[35][36][37][38][39][40][41][42][43][44][45][46][47][48] .Um caso judicial famoso nos EUA 29 fez com que as deficiências da Residência Médica se tornassem públicas e objeto de ampla discussão na sociedade norte-americana. Em março de 1984, uma jovem de 18 anos chamada Libby Zion apresentou quadro febril e otalgia, tendo procurado atendimento médico em um pronto-socorro da cidade de Nova York, por orientação de seu médico particular. ...
A natureza estressante do treinamento na Residência Médica tem sido amplamente discutida na literatura. O objetivo deste artigo é apresentar dados sobre os principais fatores estressantes do treinamento e os efeitos desse estresse nos residentes e na qualidade da assistência prestada aos pacientes. A magnitude do estresse, durante o treinamento na Residência Médica, resulta da interação de três tipos de estresse: profissional, situacional e pessoal. São descritos os principais distúrbios comportamentais e disfunções profissionais que afetam os residentes, salientando-se a importância do conhecimento desses dados para o planejamento, organização e avaliação de programas de Residência Médica.
... Estudo prospectivo conduzido por Uliana et al. 44 , sobre modificações do humor ao longo do primeiro ano de Residência, revelou que, dos fatores relacionados ao humor, aquele que se modificou significativamente foi o fator raiva-hostilidade. Esses sentimentos (raiva e hostilidade) cresceram desde o início da Residência até o oitavo mês, decrescendo ao final do ano. ...
... ,20 e de Valko e Clayton 21 , que estudaram os efeitos da privação do sono e a incidência de depressão em residentes de primeiro ano. Desde então, um grande volume de trabalhos aparece na literatura, buscando identificar as fontes de estresse e seus efeitos nos residentes e na qualidade da assistência prestada aos pacientes[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]28,[35][36][37][38][39][40][41][42][43][44][45][46][47][48] .Um caso judicial famoso nos EUA 29 fez com que as deficiências da Residência Médica se tornassem públicas e objeto de ampla discussão na sociedade norte-americana. Em março de 1984, uma jovem de 18 anos chamada Libby Zion apresentou quadro febril e otalgia, tendo procurado atendimento médico em um pronto-socorro da cidade de Nova York, por orientação de seu médico particular. ...
The stressful nature of Residency training has been largely discussed in the literature. The aim of this paper is to present some data about the stress of training and its effects on residents and on the quality of patient's care. The magnitude of stress results from the interaction of three categories of stresses: professional, situational and personal. The main behavioral disturbances and professional dysfunctions are described and the importance of these data for planning, organization and evaluation of Residency programs is emphasized.
... D uring the 1970s and 1980s, medical educators attempted to examine the quality of the personal and professional lives of residents. Several small nonrandomized studies found a higher incidence of depression (1)(2)(3)(4) and anger and hostility (5,6) in residents than in the general population. These findings were partly attributed to chronic sleep deprivation and fatigue (7)(8)(9)(10)(11). ...
... Despite the efforts of most training programs to improve professionalism in their graduates, more than half of the responding residents reported increasing cynicism, and 25% reported decreasing humanism during residency. Increasing cynicism has also been seen in medical students (45) and may be related to increasing anger during residency (5). ...
Although curricular reforms have attempted to address sources of stress in medical residency, no recent studies have examined the financial or emotional situations of current medicine residents.
To question medicine residents about financial status, educational debt, moonlighting, and psychological issues.
Survey distributed in a nonrandomized fashion to medicine residents.
All 415 U.S. medicine residency programs.
According to the questionnaire responses submitted by the 4128 (18%) participating residents, a substantial number of residents had financial and emotional distress that could have interfered with training. The reported educational debt was at least 100 000 for 737 (19%). The monthly disposable income was $100 or less for 1620 (43%) of the residents, and 637 residents (16%) could not afford safe housing. Among respondents in their 2nd through 5th year of postgraduate training, 2187 (52%) had insufficient funds to purchase books and equipment, and 678 (29%) could not afford the required fees for the American Board of Internal Medicine certifying examination; 2659 (33%) worked as moonlighters, and this percentage increased progressively with increasing educational debt. Four or five depressive symptoms during residency were reported by 1461 (35%) residents. Eight hundred ninety-nine residents (23%) thought they had become less humanistic over the course of their residency training; 2347 (61%) reported becoming more cynical. Female residents were more likely than male residents to report increased cynicism and multiple depressive symptoms. Increased cynicism and depressive symptoms were associated with increasing educational debt.
Despite recent curricular reforms, an alarming number of current medicine residents report depressive symptoms, increasing cynicism, and decreasing humanism, which were associated with increasing educational debt and a need to moonlight for financial survival. Ongoing curricular reform, legislative relief from early loan repayment, and salary increases may be necessary to address these problems.
... Another important potential impact of more limited work hours is change in residents' career satisfaction. Virtually all studies of residents' career satisfaction, emotions and attitudes at mid year have demonstrated negative findings, many of which have been reported in studies from this institution and from collaborations with others1234567891011121314. Indeed, many authors have proposed that excessive work hours have been at least to a degree responsible for those negative findings [3,5,6,12131415. ...
... Another important potential impact of more limited work hours is change in residents' career satisfaction. Virtually all studies of residents' career satisfaction, emotions and attitudes at mid year have demonstrated negative findings, many of which have been reported in studies from this institution and from collaborations with others1234567891011121314. Indeed, many authors have proposed that excessive work hours have been at least to a degree responsible for those negative findings [3,5,6,12131415. Thus one would intuitively think that fewer hours of duty might result in more favorable feelings about career satisfaction, emotions and attitudes. ...
To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes.
A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions.
The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions.
With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements.
... também apontaram a privação do sono e a incidência de depressão entre residentes de primeiro ano como os principais efeitos do processo de aprendizagem, bem como o uso rotineiro de auxiliares farmacológicos para controlar a privação de sono e reduzir a sonolência, Pesquisa conduzida porUliana et al. (1984) apontou a raiva e a hostilidade como os fatores relacionados ao humor que mais se mostraram presentes durante a residência.Hurwitz et al. (1987) destacaram o isolamento social, a ausência da família e a fadiga crônica como os fatores mais associados à depressão.Gilbert et al. (2006) identificaram que o adoecimento dos médicos está especialmente relacionado à presença de sentimentos de desvalorização da profissão, ressentimento pela perda de poder do saber médico e pela percepção da medicina como negócio. No Brasil, a situação de gravidade em relação à saúde dos residentes motivou a senadora Maria do Carmo Alves submeter ao exame da Comissão de Assuntos Sociais (CAS) o Projeto de Lei do Senado (PLS) n o 157, de 2017, que estabelece a obrigatoriedade de prestação de assistência psiquiátrica e psicológica aos médicos residentes e aos alunos de graduação em Medicina. ...
O ingresso nos cursos de medicina provoca mudanças no estilo de vida dos acadêmicos, em função de vários fatores estressantes, dentre eles a intensa dedicação aos estudos. O objetivo deste estudo foi analisar a qualidade de vida dos médicos-residentes de um hospital de ensino federal, no estado de Minas Gerais. O método de pesquisa adotado foi o levantamento de dados ( survey) , por meio do questionário WHOQOL-Bref, com uma amostra de 254 residentes. Para a análise dos dados recorreu-se à estatística descritiva. Os resultados apontam percepções quanto a qualidade de vida global e geral da saúde de não estar satisfeito nem insatisfeito com a condição. Os domínios Físico e Meio Ambiente foram aqueles que apresentaram as facetas com médias mais baixas, exigindo especial atenção para com os fatores sono e repouso, sentimentos negativos, recursos financeiros, lazer e qualidade do ambiente físico, que articulados podem afetar a disposição e a capacidade para o trabalho, favorecendo os sentimentos de desânimo, ansiedade, mau humor e até depressão. A ausência de monitoramento do estado emocional pode incorrer em maior risco para estados depressivos, consumo álcool e disfunções conjugais.
... While the tool has been used in several physician populations, [65][66][67][68][69][70][71] it is not well validated in the medical field. [72][73][74][75][76] The enthusiasm of IM interns was found to give way to sustained depression, anger, and fatigue at the end of internship. ...
Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.
... 8 So, the first year of residency can begin with excitement, which could rapidly be followed by self-doubt and awareness of realistic limitations. 3 In consequence, a lot of residents experience a high level of stress, 3 anger and hostility, 9 or depression during their residencies. 10 That can affect their ability to deliver good patient care, followed by well-documented effects on error rate and adverse outcomes. ...
Objectives:
Residents beginning their specialization in pediatrics and emergency medicine (EM) are rapidly involved in oncall duties. Early acquisition of crisis resource management by novice residents is essential for patient safety, but traditional training may be insufficient. Our aim was to investigate the impact of a 2-day simulation-based course on residents to manage pediatric and neonatal patients.
Methods:
First year residents participated in the course. They completed two questionnaires concerning perceived stress and self-efficacy in technical skills (TSs) and non-TSs (NTSs) at 3 times: before (T0), after (T1), and 6 weeks after the course (T2).
Results:
Eleven pediatric and 5 EM residents participated. At T0, stress about "communicating with parents" (P = 0.022) and "coordinating the team" (P = .037) was significantly higher among pediatric compared with EM residents; self-efficacy was not different between the specialities. After training, perceived stress about "managing a critical ill child" and perceived stress total significantly decreased among EM residents, whereas it remained the same among pediatricians (respectively, P = 0.001 and P = 0.016). Regarding self-efficacy, it had significantly increased in both groups (P < 0.001). Specifically, the increase in TSs self-efficacy was significant after the training (p = .008) and after 6 weeks (p < .001), and the increase in NTs self-efficacy was only significant after 6 weeks (P = 0.014).
Conclusions:
Our course improved perceived stress, TSs, and NTSs self-efficacy of residents. This encourages us to formalize this as a prerequisite for admission to the pediatric and EM residency.
... In one study, depression severity continued to rise throughout intern year, with no improvement at the end of the year. The remaining three studies did not find any change in severity of depression during the intern year (Ford et al., 1984;Gordon et al., 1986;Uliana et al., 1984). In a cohort of 43 residents followed throughout their residency, depression severity peaked during the intern year, improved significantly during the second and third years, but never decreased to baseline (Girard et al., 1991). ...
Objective: To complete a systematic review of the literature addressing major depression in resident physicians. Methods: In 2013, the authors completed a systematic review of articles addressing major depression in physicians in United States residency programs. The following keywords were used: anxiety, stress, and mood, medical residents or interns, physician residents, graduate medical education, depression, stress or anxiety, and suicide. Results: The prevalence of depression in resident physicians is higher than that of the general population. Many sociodemographic and residency-associated factors have been studied in their relation to resident physician depression. Only physical health, an unhappy childhood, and stress at work were found to have association with depression, while the amount of call, lifestyle, age, income, and season of the year were not associated with depression. Other factors had an equivocal relationship. Depression in resident physicians is associated with medical errors, decreased ability to handle work-related stress, leaves of absence, discontinuation of medical training, disruption in personal lives, and suicide. Intervention with treatment for depression, using a low-cost, confidential, off-campus program, was successful. However, physicians may hesitate to seek treatment for mental illness because of the professional consequences, such as difficulty with medical licensing, hospital privileges, and malpractice insurance. Conclusions: Major depression is common in resident physicians in the United States. It has a negative impact on the lives of the doctors and the patients whom they treat. There appear to be effective ways of assisting residents with major depression available to training programs.
... Importante frisar que a consequência do estresse vivido durante o processo de residência médica sobre a saúde física e mental dos futuros médicos está bem documentada tanto na literatura nacional quanto internacional (Aach, et al., 1988;Bing-You, 1993;Clark, Salazar-Gruesco, Grabler, & Fawcet, 1984;Colford & McPhee, 1989;Herzog, Wyshad, & Stern, 1984;Hurwitz, Beiser, Nichol, Patrick, & Kozak, 1987;Lo & Schroeder, 1981;L.A Nogueira-Martins, 1991;Reuben, Novack, Wachtel, & Wartman, 1984;Small, 1981;Smith, Denny, & Witzke, 1986;Uliana, Hubbell, Wyle, & Gordon, 1984;Valko & Clayton, 1975 Desta forma, parece haver um descompasso entre os estudos que apontam quais são os aspectos inerentes a este tipo de atividade profissional que causam sofrimento e os estudos de estresse que tem como objeto os profissionais de saúde, já que esses estudos têm apontado aspectos que não são inerentes a este tipo de atividade como as principais causas de sofrimento entre os profissionais de saúde. ...
... A consistent pattern of findings that emotions vary throughout the school years was observed in eight studies (Mitchell et al. 2005). In two studies (Ford & Wentz 1984; Uliana et al. 1984), it was found that ''Anger-Hostility'' scores rose during the first year of residency training. Another study reported that scores on an additional scale such as Fatigue- Inertia worsened throughout the year (Gordon et al. 1986). ...
In a paradigm of physician performance we propose that both "cognitive" and "noncognitive" components contribute to the performance of physicians-in-training and in-practice. Our review of the relevant literature indicates that personality, as an important factor of the "noncognitive" component, plays a significant role in academic and professional performances. We describe findings on 14 selected personality instruments in predicting academic and professional performances. We question the contention that personality can be validly and reliably assessed from admission interviews, letters of recommendation, essays, and personal statements. Based on conceptual relevance and currently available empirical evidence, we propose that personality attributes such as conscientiousness and empathy should be considered among the measures of choice for the assessment of pertinent aspects of personality in academic and professional performance. Further exploration is needed to search for additional personality attributes pertinent to medical education and patient care. Implications for career counseling, assessments of professional development and medical education outcomes, and potential use as supplementary information for admission decisions are discussed.
... La depresión ha sido considerada por años concomitante al entrenamiento médico y se ha visto que en gran parte depende del año de entrenamiento y de la rotación. Varios estudios han encontrado aumentos significativos en el nivel de enojo (Ford, 1984;Gordon, 1986;Uliana, 1984), lo cual podría explicarse por la teoría de que, dinámicamente, la depresión es enojo internalizado. ...
Recent studies have shown an increase in psychiatric symptomatology in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety, depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger...
... Most problems occur during internship, when as many as one in three interns experiences depression (41). Interns commonly show substantial levels of anger and hostility (42), and sleep loss is associated with anxiety, tension, confusion, fatigue, irritability, inappropriate affect, memory deficits, and difficulty in thinking clearly (4,(43)(44)(45). Female residents working more than 100 hours per week may be at increased risk for preterm delivery (46). ...
Long work hours during residency are a time-honored tradition. Efforts have recently been made to shorten work hours. This paper examines the main arguments supporting reform: that sleep deprivation is harmful to patients and residents and that it is exploitative. Because the data on the harms and benefits are mixed and because exploitation is difficult to prove, a stronger argument for reducing work hours is an ethical one: that overwork interferes with the development of professional values and attitudes that are an essential part of the moral curriculum of residency. Providing a climate that promotes moral growth during training is an important curricular objective that may be better achieved by shortening work hours, providing better resident supervision, and using substitute workers for some of the noneducational tasks of residency.
O ingresso nos programas de residência provoca mudanças no estilo de vida dos profissionais de saúde em função da presença de vários fatores estressantes, dentre eles, as intensas cobranças, diminuição do tempo para a vida social, distanciamento dos amigos e da família e poucas oportunidades de lazer. O objetivo deste estudo foi analisar a qualidade de vida dos residentes de um Programa Integrado Multiprofissional de um hospital de ensino federal localizado no Estado de Minas Gerais. O método de pesquisa adotado foi o survey, por meio do questionário WHOQOL-Bref, com uma amostra de 55 residentes. A técnica utilizada para a análise de todas as escalas foi a estatística univariada, com medidas de posição e tendência central (média) e dispersão dos dados. Os resultados apontam que os residentes tenderam à maior positividade nas facetas que remetem à baixa percepção de dor e desconforto, seguida de satisfação com o acesso aos serviços de saúde, satisfação com as condições de moradia, dinheiro suficiente para satisfazer as necessidades e satisfação com o suporte que recebe de amigos, enquanto a percepção de negatividade está mais fortemente presente nas facetas relacionadas à satisfação com a capacidade de trabalho, sentimentos de estar aproveitando a vida e ter energia suficiente para o dia a dia. Conclui-se que há a necessidade de monitoramento do estado emocional dos residentes a fim de prevenir estados de adoecimento físico, depressivos e outras disfunções socioemocionais.
Quem fala o faz desde um lugar que ocupa no presente ou que ocupou no passado. O texto apresentado neste livro foi construído tendo como base, em parte, um conjunto de experiências acumuladas pelo autor, no exercício de diversas atividades acadêmicas e profissionais; a mais importante parte do livro, contudo, está representada pelos depoimentos dos médicos residentes que participaram de uma pesquisa realizada na Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP). Este livro pretende ser uma espécie de porta-voz dos jovens médicos em treinamento nos Programas de Residência Médica. Dar voz a eles é participar da construção da história da medicina. Fazer com que os residentes se ouçam e sejam ouvidos é o principal objetivo.
Escrevo a partir de experiências pessoais e profissionais atuais que venho adquirindo na qualidade de professor da Disciplina de Psicologia Médica e Psiquiatria Social, Supervisor do Serviço de Interconsulta em Saúde Mental do Hospital São Paulo e coordenador do Núcleo de Assistência e Pesquisa em Residência Médica (NAPREME).
Falo também a partir de experiências e vivências mais remotas como estudante de medicina, residente, preceptor de residentes, coordenador do Programa de Residência Médica em Psiquiatria e presidente da Comissão de Residência Médica.
Este livro está baseado em uma tese que estudou as dificuldades vividas pelos residentes na tarefa assistencial e os fatores estressantes identificados por eles durante o treinamento. Ele fala de heróis e heroínas da Medicina. Personagens anônimos do dia-a-dia, do cotidiano dos hospitais. Fala de jovens profissionais em treinamento que trabalham muito, que cuidam de pessoas, por vezes em situações extremas. Fala de jovens que crescem e se desenvolvem. De jovens que sofrem. Fala de vitórias e conquistas. De fracassos e frustrações. Fala de vida.
Ao dar vozes a esses heróis e heroínas, tenho a expectativa de que seus depoimentos possam ser conhecidos pelos novos residentes que, todo ano, estão iniciando seu treinamento nos serviços de emergência, enfermarias e ambulatórios dos nossos hospitais. Espero também que suas vozes possam alcançar os preceptores, supervisores e professores envolvidos com o treinamento de residentes.
O texto também tem por objetivo apresentar uma parcela da extensa literatura científica existente sobre Residência Médica. Aquele que se interessar por conhecer de forma mais aprofundada estudos sobre este tema irá observar a presença de um crescente e contínuo esforço no sentido de avaliar a natureza e magnitude do estresse na Residência Médica e de testar modelos de intervenção visando aprimorar este sistema educacional, que tem sido considerado a melhor forma de capacitação profissional em Medicina.
Introduction Recent studies have shown an increase in psychiatric symptomatology in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety, depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger. It has also been documented that there is a significant link between certain personality traits and the presence or absence of mental symptoms, regardless of the situations to which people are exposed. The feature with the highest association with the presence of symptomatology is neuroticism, while the personality traits that are most conducive to the achievement of academic success and better adaptation and, therefore, a lower number of symptoms are empathy and kindness. The purpose of this study was to establish a diagnosis of the mental health and personality traits of medical students in the high performance groups and compare them with those of the groups of students that performed poorly during the first two years of the degree course. This transversal, exploratory study involved the participation of 370 students from the UNAM Medical School: 220 belonged to the high performance groups, called educational quality nuclei (NUCE), while 1 50 were repeat students. The variables considered were: age, sex, type of group (NUCE or repeat), academic year (first or second year of the degree), place of origin and type of high school from which they had graduated (public or private). Two instruments were used to measure personality traits and psychiatric symptomatology: the Big Five Personality Traits and the Symptom Check List-90. The results of the study show that in both groups (repeat students and NUCE) over 85% were from the Federal District. Repeat students were mainly women (85.3%) and students from public schools (93.6%). As for the high performance group (NUCE), 83.1 % were from private schools and just 1 6.9% from public schools. Repeat students showed personality traits that included neuroticism and very little openness compared with the high performance groups, which displayed traits of greater openness and less neuroticism, with p
Graduate physicians face formidable developmental tasks during residency training as they prepare for their professional careers. Adapting to becoming a skilled physician involves assuming and mastering many professional responsibilities for the proper care of patients while taking on many personal obligations such as marriage, parenthood, and financial independence. Adaptation requires physicians to cope successfully with a series of stresses that have been divided into three categories: situational, professional, and personal stresses. Each category is reviewed and both general and specific recommendations are offered to reduce the level of stress. Normal and abnormal responses to the stresses of residency training are described, and guidelines are provided for recognizing the impaired resident early. Recommendations are made for managing the residency program and treating the resident, should he or she become impaired.
We report the stress observed during the residency training. The more frequent causes are related to proffessional ability. The stress induced common anxiety symptoms, with minor repercussion in the daily activities. Despite the relationship between stress and psychopathology, the individual component play an important role: i.e. females are more stressed, but without more symptoms, and they cope with stress more effectively. Some personality features were also associated to the stress and psychopatology. Changes in the use of coping behaviours during the full residence period were not observed, and the use of efficacious behaviours were associated with less symptoms. The use of these coping behaviours were related to work, self-consolation, distraction and support seeking.
Introduction: Recent studies have shown an increase in psychiatric symptomatology in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety, depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger. It has also been documented that there is a significant link between certain personality traits and the presence or absence of mental symptoms, regardless of the situations to which people are exposed. The feature with the highest association with the presence of symptomatology is neuroticism, while the personality traits that are most conducive to the achievement of academic success and better adaptation and, therefore, a lower number of symptoms are empathy and kindness. The purpose of this study was to establish a diagnosis of the mental health and personality traits of medical students in the high performance groups and compare them with those of the groups of students that performed poorly during the first two years of the degree course. This transversal, exploratory study involved the participation of 370 students from the UNAM Medical School: 220 belonged to the high performance groups, called educational quality nuclei (NUCE), while 150 were repeat students. The variables considered were: age, sex, type of group (NUCE or repeat), academic year (first or second year of the degree), place of origin and type of high school from which they had graduated (public or private). Two instruments were used to measure personality traits and psychiatric symptomatology: the Big Five Personality Traits and the Symptom Check List-90. The results of the study show that in both groups (repeat students and NUCE) over 85% were from the Federal District. Repeat students were mainly women (85.3%) and students from public schools (93.6%). As for the high performance group (NUCE), 83.1% were from private schools and just 16.9% from public schools. Repeat students showed personality traits that included neuroticism and very little openness compared with the high performance groups, which displayed traits of greater openness and less neuroticism, with p<0.01. In general, students from NUCE groups showed traits of greater extraversion, empathy and diligence compared with repeaters. Psychiatric symptomatology was more severe among the repeat group than the NUCE group (p<0.05). The psychiatric symptomatology displayed by both groups included: obsession-compulsion, depression and anxiety. In the comparisons, the two groups showed significant differences in total symptomatology. There were also differences in the following symptomatology, by order of importance: phobia, interpersonal sensitivity, somatization, anxiety, obsessive-compulsive disorder and psychoticism (p<0.05). Differences were found between academic years, with second-year students showing greater symptomatology; women displayed the greatest symptomatology. No differences were found for the interaction between sex and academic year. The analysis of structural models was used to determine the relationship between the variables being studied, with significant correlation coefficients with p<.05 being found between personality and sex, personality and type of high school, as well as type of group and suicidal ideation, academic year and psychiatric symptomatology, personality and suicidal ideation and personality and psychiatric symptomatology. The results of the study coincided with those in the literature, although there were some differences between the two groups of students. Repeat students displayed greater levels of psychiatric symptomatology compared with students in the high performance groups. This suggests that students who perform less well in their degree courses also report higher mean responses in psychiatric symptomatology, mainly on scales of somatization, anxiety, phobia and interpersonal sensitivity. As for type of personality, students in the high performance group reported higher average scores on the scales of extraversion, empathy and openness, with the exception of the neuroticism scale. This suggests that personality features may be predictors of better academic performance as well as greater intellectual skill. This finding is reinforced by the repeater group's results, since they report higher scores in the personality trait of neuroticism. The diligence scale was the same for both groups. The study corroborated the fact that second-year students display the greatest symptomatology, with women reporting higher averages in psychiatric symptomatology scores (mean=7.3). Sex is associated with greater empathy and solidarity, with women achieving higher scores in both personality traits. Although the neuroticism trait is also associated with the female sex and suicidal ideation, scores for this trait were higher for men. This trait can be considered a predictor for both suicidal ideation and the presence of a higher number of psychiatric symptoms. Lastly, the symptomatology in which these students obtained the highest scores is related to the obsessive-compulsive disorder, a situation which we consider may be due to the type of screening test used. It is a fact that studying medicine involves continuously stressful conditions. For these students, however, seeking help to cope with the presence of psychiatric symptomatology is extremely complicated since they regard it as a form of weakness. This raises the need to develop large-scale programs to orient students in order to enable them to identify symptoms at an early stage, which in turn will permit timely treatment.
Objectives: To develop and test a scaled program evaluation questionnaire focusing on resident satisfaction with workload, learning environment, and stress.
Design/participants: Phase 1: A cross-section of 92 residents from five programs completed questionnaires for factor analysis and descriptive statistics. Phase 2: A three-year prospective study of questionnaire responses in a single program.
Questionnaire development: After extensive literature review, 33 Likert-scaled statements were written, dealing with situational, personal, and professional issues. After pilot testing, the 92 questionnaires obtained in Phase 1 were factor analyzed, resulting in three distinct scales: workload, faculty/learning environment, and stress.
Interventions: Program changes in Phase 2 included the introduction of a night float between 1989 and 1990, and an increase in senior resident call between 1990 and 1991.
Results: Phase 1: The first-year residents reported significantly less stress and generally greater satisfaction with workload and learning environment than did the second- or third-year residents. Marked differences between programs were also present in the mean scores on all three scales. Phase 2: The introduction of a night float did not significantly affect response to the questionnaire, but the increase in nights on call significantly increased stress and dissatisfaction with the faculty/learning environment.
Conclusions: This study demonstrates the techniques needed to develop and use scaled program evaluation questionnaires. It is hoped that widespread use and validation of such instruments may result in greater responsiveness to the needs of trainees and more facilitative environments in which to acquire medical knowledge.
Abstract:
Objectives: The present study aimed to evaluate factors influencing the quality of life among caregivers of patients suffering from schizophrenia. Methods: A cross-sectional study was performed to assess patient and caregiver factors influencing the quality of life of 100 caregivers of patients with schizophrenia who attended the psychiatric outpatient clinic at Hawler teaching hospital during the period of 15th of July to 15th of October 2012. The study adopted the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to assess caregivers' quality of life domains (Physical, Psychological, Social and Environmental). Results: The mean scores of the WHOQOL-BREF in physical, psychological, social and environmental domains were 53.03, 52.91, 59.25, and 47.40 consecutively. Younger and employed caregivers had a better physical quality of life. Male and single status predicted better psychological quality of life. Second degree relatives in addition to shorter illness duration were associated with better social quality of life. Furthermore, better financial income predicts better quality of life across all domains. Conclusion: Several factors determine the quality of life among caregivers of patients with schizophrenia. Understanding quality of life of caregivers is crucial to improve the quality of care to patients with the condition.
In Japan, the increasing frequency of mental health problems in postgraduate dental trainees has recently become apparent. To our knowledge, there has been no previous research to investigate the influence of the type of training program on the mental health of dental residents during one year of postgraduate clinical training. Therefore, the purpose of this study was to compare changes in the mental health of two groups of dental trainees at Kyushu University Hospital, Fukuoka, Japan: those who undertook a rotation training program and those who trained solely in one department (the control group). Study subjects in both groups completed the Profile of Mood States (POMS) and the General Health Questionnaire (GHQ) at five intervals throughout the postgraduate training year. Analysis of the questionnaire responses were performed by Student's t-test, analysis of variance, Bonferroni's test, and the chi-square test. Statistical tests showed differences in the mean scores of POMS-30 subscales and GHQ-28. The mood of anger was the factor that seemed to best describe the trainees' response to stress. The study results led to the conclusion that dental trainees' mental health is influenced by the type of training program and that dental trainees in rotation training programs may need more mental health support.
Concern has been expressed for a number of years about the long working hours and consequent sleep loss often experienced by junior hospital doctors. In recent months there has been renewed pressure for the demanding work schedules, common in many hospitals, to be changed. Concern centres on two related areas, namely the potential effects on the doctors work performance and the effects on their health. This paper reviews the literature relating to both areas and assesses how far the expressed need for change is supported by existing evidence. In addition attention is drawn to aspects of sleep loss and work performance requiring further investigation.
The results of a survey of 255 house staff conducted to determine the prevalence of depressive symptoms in interns and residents indicated that 25% of the sample population manifested depressive symptoms at the time of the study, and 34% reported a clinical depression within the previous year. Moreover, whereas 58% of the house staff reported that no attending staff inquired about their emotional well-being 73% stated that they would welcome such an inquiry.
To evaluate whether the negative emotions and attitudes that residents develop during internship continue throughout the remaining years of their residency, the authors undertook a four-year prospective study of two classes of internal medicine residents who completed their training in 1985 and 1986 in a residency program based at the Oregon Health Sciences University. Every two to three months over all three years of training, the residents indicated on Likert-type scales their levels of agreement with questions about their career satisfaction and emotional states, and the satisfying and dissatisfying aspects of their residency experiences. Between the internship and the end of their residencies, the physicians indicated significant improvements in their emotions and attitudes. Those experiences identified as satisfying continued to be so, whereas those considered dissatisfying became less so. Although more research of other classes of residents is needed, the findings suggest that while internal medicine internships may be dysphoric, the residents' emotional states and attitudes tend to normalize during the remainder of the residency.
Postgraduate residency training requires young physicians to make the difficult transition from student to doctor. Recent
evidence suggests that this period is associated with significant depression, anger, cynicism and emotional withdrawal, and
there are concerns about its effect on the attitudes and future functioning of physicians. The perceived stresses are not
unique to physicians and represent, in part, a need for personal growth that is common in the human service professions. Training
programs can be more helpful to residents as they move through this transition. More attention must be paid to needs for sleep
and time away from the hospital. Residents require more support and guidance in the personal aspects of becoming a physician,
and programs can do much better at helping residents develop the communication skills needed to be an effective physician.
The benefit of these efforts may be the development of physicians less likely to become impaired and more likely to give competent
humane care to their patients.
To examine the need for preventive and treatment interventions, a prevalence study was conducted to ascertain the rate of depressive symptomatology and other negative mood states among 112 first-year residents. The participation rate was 54%. Subjects (N = 61) were administered the Beck Depression Inventory and Profile of Mood States in personal interview sessions. The Profile measures five negative mood states, namely, "tension-anxiety," "depression-dejection," "anger-hostility," "fatigue-inertia," "confusion-bewilderment," and one positive state, "vigor-activity." A 15.5% rate of depression was found, which is lower than a rate of 23.5%, also measured by Beck's inventory, among a sample of university undergraduates and 19.9% among an adult sample from the general population. No differences were observed among residency programs or sex on Beck's scale; however, significantly higher scores were found for women on the "depression-dejection" dimension of the Profile. The mean scores on all negative mood dimensions of the Profile were below the mean for university undergraduate norms. Neither sleep nor hours worked over the past week were associated with increased Beck scores. These results indicate that sleep deprivation and long work hours did not contribute to depression among the subjects who participated in the study. Female interns, however, appear to be at increased risk of depression, and adequate support systems need to be provided.
Evidence is reviewed demonstrating the high level of drug and alcohol abuse and marital disharmony among physicians and the particularly high rate among anaesthetists. The relationship between these factors and the effects of fatigue is explored. The current evidence for reduction in physician performance and vigilance resulting from fatigue and sleep loss is reviewed. Supplementary indirect evidence is surveyed which suggests that increased experience may not compensate adequately for this reduced performance. Since hours of work can be controlled, it is essential that anaesthetists, their professional organizations and regulatory agencies ensure that pressure for efficiency does not result in fatigue and the consequent compromise of both patient and physician health and safety.
A review of empiric studies of the stresses of residency training and descriptions of intervention programs and mental health resource surveys published since 1980 indicated that inadequate sleep and fatigue are major stressors for residents, but they are only part of a more complex situation influenced by time demands, social support, and maturational factors. Other important stressful aspects of training appear to be those that interfere with social support. Increased anger, not depression, is emerging as the predominant mood change during residency, but the effects of any mood change on patient care have not been studied. Despite growing evidence of the need for change in training programs, especially attention to the affiliative needs of residents, few intervention programs have been reported.
We prospectively examined perceptions of the doctor-patient relationship among interns in two different internal medicine training programs five times during the internship year. All 59 interns in the University of California, Irvine-Long Beach and the Oregon Health Sciences University Medical Programs participated in the study during the 1982-83 internship year. We serially administered a questionnaire that contained four major items: (1) a choice of one of six empirically developed role paradigms of the doctor-patient relationship; (2) a checklist of positive and negative aspects of internship; (3) a measure of level of satisfaction with the decision to become a physician; and (4) a rating list of mood descriptors. The six role paradigms portrayed a variety of positive and negative aspects of the doctor-patient relationship. At the beginning of the year, the interns were quite positive about the doctor-patient relationship and preferentially endorsed collegial models. As the year progressed, they endorsed significantly fewer positive and more negative models (P less than 0.001). Most respondents endorsed two models, one positive: "expert resource (doctor)--active cooperative participant (patient)" and one negative: "clerk, paperwork processor (doctor)--subscriber, seeker of eligibility (patient)." By the end of the year approximately half of the interns endorsed a positive and half a negative model. Interns selecting a negative model of the doctor-patient relationship identified more negative and fewer positive aspects of internship than those selecting a positive model. Specifically, they significantly more often (P less than 0.001) identified too much paper work and coping with difficult patients as negative aspects of internship.(ABSTRACT TRUNCATED AT 250 WORDS)
Postgraduate residency training requires young physicians to make the difficult transition from student to doctor. Recent evidence suggests that this period is associated with significant depression, anger, cynicism and emotional withdrawal, and there are concerns about its effect on the attitudes and future functioning of physicians. The perceived stresses are not unique to physicians and represent, in part, a need for personal growth that is common in the human service professions. Training programs can be more helpful to residents as they move through this transition. More attention must be paid to needs for sleep and time away from the hospital. Residents require more support and guidance in the personal aspects of becoming a physician, and programs can do much better at helping residents develop the communication skills needed to be an effective physician. The benefit of these efforts may be the development of physicians less likely to become impaired and more likely to give competent humane care to their patients.
Mood changes of interns during the internship year were studied using the Profile of Mood States (POMS), a standardized adjective checklist. All 35 interns in the University of California, Irvine-Long Beach Medical Program completed the POMS at internship orientation and at five other times during the year. Of the six mood factors measured by the POMS, four changed significantly during the testing period. Anger-hostility scores were higher (p less than 0.01) in December than at orientation and remained so throughout the year. Tension-anxiety scores were higher (p less than 0.01) and fatigue-inertia scores were lower (p less than 0.01) at orientation than at any other time during the year. Vigor-activity scores were higher (p less than 0.01) at orientation than at the end of the year. Depression-dejection and confusion-bewilderment scores did not change significantly during the study period. Recognition of these mood changes is helpful for drawing the attention of house staff and faculty members to emotional stresses of training, and for identifying issues for discussion in intern support groups.
In a prospective survey for changes in emotions and attitudes of all medical interns of The Oregon Health Sciences University (N = 22) at six intervals during the 1982-1983 academic year, both positive and negative emotional changes were noted. Satisfaction with the decision to become a physician decreased during the period, a change that correlated directly with depression and fatigue and inversely with excitement and importance.
As residency programs adapt to the need to promote primary care, the importance of quantitating qualitative issues increases. In this study, a questionnaire based on reported residency stressors was answered by 238 internal medicine residents. The Profile of Mood States (POMS) was also completed by 64. Factor analysis derived three scales reflecting emotional distress and satisfaction with the workload and learning environment. Emotional distress correlated positively with POMS scores indicating depression and dejection and was inversely related to workload. Workload satisfaction was significantly higher in programs with fewer admissions and lower in programs with greater patient loads. Responses did not differ by postgraduate year of training. Residents in different programs showed significant differences in emotional distress and workload but not learning environment. Residents in university programs indicated more stress and less satisfaction with workload than those in community programs. This study supports the validity of the three scales and provides insights into elements of the educational process that are difficult to quantitate.
A structural equation analysis of data collected from 484 members of the Emergency Medicine Residents Association was used to test a model in which peer support and work-group cohesiveness predicted role ambiguity. Role ambiguity was then specified as a predictor of work-related stress. Stress was hypothesized to affect depression and work satisfaction. The analysis confirmed the direct relationship between stress and depression and indicated that support from peers and the work group reduces stress. This impact is influenced by the amount of role ambiguity perceived by residents. Peer support, role ambiguity, and stress explain 52% of the variance in depression reported by residents. Residents are more satisfied with their work when their peers are supportive and when levels of occupational stress and role ambiguity are not high. The model accounted for 47% of the variance in reported work satisfaction. The results suggest that role ambiguity leads to perceptions of stress. This perceived stress, in the absence of strong support groups, results in increased depressive symptomatology and decreased work satisfaction.
To develop and test a scaled program evaluation questionnaire focusing on resident satisfaction with workload, learning environment, and stress.
Phase 1: A cross-section of 92 residents from five programs completed questionnaires for factor analysis and descriptive statistics. Phase 2: A three-year prospective study of questionnaire responses in a single program. QUESTIONNAIRE DEVELOPMENT: After extensive literature review, 33 Likert-scaled statements were written, dealing with situational, personal, and professional issues. After pilot testing, the 92 questionnaires obtained in Phase 1 were factor analyzed, resulting in three distinct scales: workload, faculty/learning environment, and stress.
Program changes in Phase 2 included the introduction of a night float between 1989 and 1990, and an increase in senior resident call between 1990 and 1991.
Phase 1: The first-year residents reported significantly less stress and generally greater satisfaction with workload and learning environment than did the second- or third-year residents. Marked differences between programs were also present in the mean scores on all three scales. Phase 2: The introduction of a night float did not significantly affect response to the questionnaire, but the increase in nights on call significantly increased stress and dissatisfaction with the faculty/learning environment.
This study demonstrates the techniques needed to develop and use scaled program evaluation questionnaires. It is hoped that widespread use and validation of such instruments may result in greater responsiveness to the needs of trainees and more facilitative environments in which to acquire medical knowledge.
To examine the effect of a night float call system (NFS), a battery of neuropsychologic tests was administered to housestaff after call during an overnight call system (ONCS), and the results were compared with the results obtained during a NFS. Although NFS housestaff were less sleep-deprived, results of tests of psychomotor function were not different. Importantly, both groups had high depression, hostility, and anxiety scores. NFS housestaff had small but significantly lower depression scores, which, if not due to time of year, may represent a positive effect of the NFS. Future investigation should be directed at clarifying the aspects of residency training that adversely affect housestaff mood.
To study the dimensions of anxiety and anger experienced by a statewide sample of South Carolina family practice residents.
A total of 350 family practice residents from seven programs participated. Each resident completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Profile of Mood States, the Hassles Scale, the Maslach Burnout Inventory, and the State-Trait Anger Expression Inventory (STAXI) on at least one occasion. We analyzed reported anxiety and anger by gender, year of training, race, marital status, type of program (community hospital versus university), location of program, and season of the year.
Residents reported lower levels of anxiety and anger across most dimensions compared with the adult populations on which the tests were standardized and with other resident and practicing physician populations. The residents did not demonstrate excessive levels of anger as a trait or in response to situations, nor did they significantly suppress anger. Although the residents reported a higher frequency of hassles than did normal populations, they did not consider these hassles severe. A higher than normal level of depersonalization was found among male, Caucasian, and third-year residents.
These family medicine residents did not experience excessive levels of anxiety or anger during residency training either as a trait, state or somatic response. Extensive social and emotional "in-house" support, attention to stress-management skills, and the moderate personality characteristics of family practice residents help explain these findings. Initial assessment of psychological functioning and early remediation and program support during training may significantly reduce the potential for residents' impairment.
The clinical performances of physicians have come under scrutiny as greater public attention is paid to the quality of health care. However, determinants of physician performance have not been well elucidated. The authors sought to develop a theoretical model of physician performance, and explored the literature about factors affecting resident performance.
Using expert consensus panel, in 2002-03 the authors developed a hypothesis-generating model of resident performance. The developed model had three input factors (individual resident factors, health care infrastructure, and medical education infrastructure), intermediate process measures (knowledge, skills, attitudes, habits), and final health outcomes (affecting patient, community and population). The authors used factors from the model to focus a PubMed search (1967-2002) for all original articles related to the factors of individual resident performance.
The authors found 52 original studies that examined factors of an individual resident's performance. They describe each study's measurement instrument, study design, major findings, and limitations. Studies were categorized into five domains: learning styles/personality, social/financial factors, practice preferences, personal health, and response to job environment. Few studies examined intermediate or final performance outcomes. Most were single-institution, cross-sectional, and survey-based studies.
Attempting to understand resident performance without understanding factors that influence performance is analogous to examining patient adherence to medication regimens without understanding the individual patient and his or her environment. Based on a systematic review of the literature, the authors found few discrete associations between the factors of individual resident and the resident's actual job performance. Additionally, they identify and discuss major gaps in the educational literature.
To evaluate career satisfaction, emotional states and positive and negative experiences among residents in primary care and speciality programmes in 1 academic medical centre prior to the implementation of the Accreditation Council for Graduate Medical Education's (ACGME) duty hour requirements.
Cross-sectional survey.
All 581 residents in the academic health centre were asked to participate voluntarily in a confidential survey; 327(56%) completed the survey.
Compared to their primary care colleagues, speciality residents had higher levels of satisfaction with career choice, feelings of competence and excitement, lower levels of inferiority and fatigue and different perceptions of positive and negative training experiences. However, 77% of all respondents were consistently or generally pleased with their career choices. The most positive residents' experiences related to interpersonal relationships and their educational value; the most negative experiences related to interpersonal relationships and issues perceived to be outside of residents' control. Age and training level, but not gender also influenced career satisfaction, emotional states and positive and negative opinions about residency.
Less satisfaction with career choice and more negative emotional states for primary care residents compared to speciality residents probably relate to the training experience and may influence medical students' selections of careers. The primary care residents, compared to speciality residents, appear to have difficulty in fulfilling their ideals of professionalism in an environment where they have no control. These data provide baseline information with which to compare these same factors after the implementation of the ACGME duty hours' and competency requirements.
Studies in on-call residents have shown that mood is worsened by fatigue as indicated by increased scores on measures of depression, anxiety, confusion, and anger using the Profile of Mood States (POMS). In prior sleep deprivation studies, mood has been shown to be more affected than either cognitive or motor performances. The purpose of this study was to examine the effect of the 80-hour work week regulations on resident mood in general and in a post-call period (PC).
Institutional Review Board approval was obtained to survey the residents and publish the results. POMS is a 65-item adjective questionnaire that includes subscales for measuring tension-anxiety, anger-hostility, depression-dejection, vigor-activity, fatigue-inertia, and confusion-bewilderment, with the summation of the scales forming a total mood disturbance score. Surgical residents were tested at a 9 am didactic curriculum session (9 am has been shown to correlate with the nadir of performance). Residents were tested after nights off call (NOC) or after PC. Time asleep in the preceding 24 hours and other demographic data were also collected. Acute fatigue (AF) was defined as <4 hours sleep. The two-sample t-test and linear regression were used to assess differences between groups.
A total of 123 standardized POMS mood questionnaires were administered on 4 occasions to 51 surgical residents, 35 men and 16 women at levels PGY-1 through PGY-5. Overall, 33 tests (27%) were taken after PC and 90 (73%) were taken after NOC. Acute fatigue residents had a mean sleep time of 2.2 (+/-1.5) hours, whereas rested (R) residents had a mean sleep time of 6.7 (+/-2.2) hours (whether PC or NOC). No statistical differences in mean values of vigor, anger, depression, concentration, fatigue, tension, or total score were observed between PC and NOC or between AF and R residents. There was no significant relationship between acute sleep deprivation and total mood disturbance, whether PC or NOC. In linear relationships, NOC total score and hours slept had r2 = 0.01 (p = 0.44), whereas PC total score and hours slept had r2 = 0.07 (p = 0.14).
Although POMS was given 4 times, only 27% were PC, which reflects our 1 in 4 night in-house coverage. In contrast to earlier studies, resident mood, as measured by POMS, is no longer related to PC/NOC or acute fatigue. Previous studies have shown that loss of sleep was associated with declining mood. The lack of such a relationship in this study may be related to the new regulations. It has been assumed that people can adapt to chronic sleep loss but have a harder time coping with the effects of acute sleep deprivation. If, however, the new regulations have relieved chronic sleep deprivation, then a well-rested resident can periodically cope with the effects of acute sleep deprivation. Perhaps by eliminating chronic sleep debt, work hour restrictions seem to have removed the negative impact of PC seen in the prior era. Further studies should increase the number of residents studied, have numerous repeat NOC and PC pairs in same subjects, compare different services with different workloads, junior and senior residents, and in-house and at-home call schedules.
The aim of the present study was to investigate the influences of lifetime subthreshold depression and major depression before internship on the changes in psychopathology and subjective quality of life during internship.
A total of 151 interns at Seoul National University Hospital completed questionnaires including World Health Organization Quality of Life Assessment Instrument, Brief Version (WHOQOL-BREF), Symptom Checklist-90-Revised (SCL-90-R), and Beck Depression Inventory (BDI) twice at an interval of 6 months. Their lifetime diagnosis of depression before internship was made using the Korean version of Mini International Neuropsychiatric Interview (MINI), Modified Form for Self-Administration.
Significant changes over time were detected including total score in the BDI and the Somatization, Depression, Anxiety, and Phobic Anxiety dimension scores in the SCL-90-R as well as all four domain scores in WHOQOL-BREF. In addition, in all scores except Somatization dimension score, group difference existed. Post-hoc comparisons showed that interns without lifetime depression were significantly different from those with lifetime subthreshold depression and those with lifetime major depression.
Even a subthreshold-level, lifetime depression before internship has an adverse effect on the psychopathology and the subjective quality of life during internship. Therefore, earlier detection, monitoring, and management of this population would be needed throughout the intern year and beyond.
A syndrome of dysphoria and impaired mentation afflicting young physicians is described. Complaints involve a perceived inability to remember recently read medical literature and a perceived lack of ability and "memory lapses" in the clinical care of patients. This syndrome occurs at a time when the young physicians' professional role is in transition and when he has just assumed increased clinical responsibilities. Resolution of the syndrome may be facilitated by a suggested protocol.
The authors used a questionnaire technique to determine the magnitude of the problem of emotional illness and poor performance during psychiatric residency, the procedures that are used to screen for or help disturbed residents, and characteristics that differentiate residents who are at risk. The data indicated that residents who have problems that lead to termination are rarely free of emotional disturbance. The general belief that women, foreign medical graduates, and minority group members are at higher risk for problems during residency was not supported; however, younger residents and transfers from other programs appeared to be at risk. A disturbing finding was the high rate of suicide reported. The authors stress the need for further work with the "marginal" resident and for research on screening and supportive procedures.
This paper is a report of the findings of a 1978 follow-up survey on senior medical students in North Carolina tracing changes in their professional orientations since their freshman year. The professional orientations concern four health care problem areas: physicians' relationship with patients, political and economic change in the medical profession, the treatment of women physicians and patients, and geographic and specialty maldistribution of physicians. Medical students generally become more conservative on political and economic issues in the profession and less committed to choosing a practice based on patient need. Although most seniors have maintained their desire to help people, they are more realistic about physicians' limitations than they were during their freshman year. Seniors have more definite opinions on issues concerning women physicians and patients, some becoming more sympathetic with women and some representing a conservative backlash.