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      Prevalence of stress in junior doctors during their internship training: a cross-sectional study of three Saudi medical colleges’ hospitals

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          Abstract

          Background

          Medical science is perceived as a stressful educational career, and medical students experience monstrous stress during their undergraduate studies, internship, and residency training, which affects their cognitive function, practical life, and patient care. In the present study, an assessment of the prevalence of self-perceived stress among new medical graduates during their internship training has been performed, and correlations of self-perceived stress with sex, marital status, and clinical rotations have been evaluated.

          Patients and methods

          Interns of the King Khalid, King Abdulaziz, and King Fahd University hospitals in Saudi Arabia were invited to complete a stress inventory known as the Kessler 10, which is used for stress measurement. Apart from stress evaluation, the questionnaire collected personal data, such as age, sex, and marital status, in addition to information relevant to hospital training, assigned duties, and clinical training rotations.

          Results

          Our results showed that nearly 73.0% of interns were under stressed conditions. Most of the interns were affected by a severe level of stress (34.9%), followed by mild (19.3%) and moderate (18.8%) levels of stress. The stress level was significantly higher (84.0%) among female interns in comparison with male interns (66.5%) (odds ratio =2.64; confidence interval =1.59–4.39; P<0.0002). There were statistically significant differences between the percentages of male and female interns ( P≤0.047) at mild, moderate, and severe stress levels. Marital status had no role in causing stress. The highest stress level was reported by interns during the clinical rotations of medicine (78.8%), followed by surgery (74.7%), pediatrics (72.4%), obstetrics and gynecology (70.1%), and emergency (58.3%). The prevalence of stress among the interns and their corresponding clinical rotations in all three hospitals had significant linear correlations ( r≥0.829, P≤0.041).

          Conclusion

          We found a significantly high level of stress among the medical interns. High stress may have negative effects on cognitive functioning, learning, and patient care. Hence, medical interns need support and subsequent interventions to cope with stress.

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          Most cited references53

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          Burnout in medical residents: a review.

          This study aimed to review current knowledge on burnout in medical residents, including reported prevalence rates, and to establish which risk and resistance factors contribute to or prevent burnout in medical residents. We conducted a comprehensive search of the literature published between 1975 and 2005, using the Medline, EMBASE (from 1989) and PsychINFO databases. A total of 19 studies met our inclusion criteria. Only 5 studies appeared to meet more than 2 of the Cochrane quality criteria. The different studies report widely varying burnout rates among medical residents, ranging from 18% to 82%. Predictors of burnout can be characterised as either occupational or individual. Inconsistent results were reported with regard to the effects of some of these factors on burnout. Four of the 16 occupational risk factors appeared to be strongly related to burnout. The 11 individual risk factors examined were only weakly or moderately related to burnout. Research on burnout among medical residents is scarce. The weak quality of the studies, the wide variety and limited predictive power of the predictor variables included and the inconsistent findings illustrate the need for a more systematic design with regard to future research among medical residents. A future research model should take account of the individual, occupational and training demands experienced by medical residents.
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            Variation of mood and empathy during internship.

            Internship is a time of great transition, during which mood disturbances are common. However, variations in mood and empathy levels throughout the internship year have not been investigated. To examine mood patterns and changes in empathy among internal medicine residents over the course of the internship year. Cohort study of interns involving completion of survey instruments at 4 points: time 1 (June 2000; Profile of Mood States [POMS] and Interpersonal Reactivity Index [IRI]), times 2 and 3 (November 2000 and February 2001; POMS), and time 4 (June 2001; POMS and IRI). Internal medicine residency program at a university-based medical center. Sixty-one interns. Baseline scores of mood states and empathy; trends in mood states and empathy over the internship year. Response rates for time 1 were 98%; for time 2, 72%; for time 3, 79%; and for time 4, 79%. Results of the POMS revealed that physicians starting their internship exhibit less tension, depression, anger, fatigue, and confusion and have more vigor than general adult and college student populations (P<.001 for all). Results of the IRI showed better baseline scores for perspective taking (P<.001) and empathic concern (P =.007) and lower scores for personal distress (P<.001) among interns compared with norms. Five months into internship, however, POMS scores revealed significant increases in the depression-dejection (P<.001), anger-hostility (P<.001), and fatigue-inertia (P<.001) scales, as well as an increase in IRI personal distress level (P<.001). These increases corresponded with decreases in the POMS vigor-activity scores (P<.001) and IRI empathic concern measures (P =.005). Changes persisted throughout the internship period. We found that, in this sample, enthusiasm at the beginning of internship soon gave way to depression, anger, and fatigue. Future research should be aimed at determining whether these changes persist beyond internship.
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              The emotional impact of medical errors on practicing physicians in the United States and Canada.

              Being involved in medical errors can compound the job-related stress many physicians experience. The impact of errors on physicians was examined. A survey completed by 3,171 of the 4,990 eligible physicians in internal medicine, pediatrics, family medicine, and surgery (64% response rate) examined how errors affected five work and life domains. Physicians reported increased anxiety about future errors (61%), loss of confidence (44%), sleeping difficulties (42%), reduced job satisfaction (42%), and harm to their reputation (13%) following errors. Physicians' job-related stress increased when they had been involved with a serious error. However, one third of physicians only involved with near misses also reported increased stress. Physicians were more likely to be distressed after serious errors when they were dissatisfied with error disclosure to patients (odds ratio [OR] = 3.86, confidence interval [CI] = 1.66, 9.00), perceived a greater risk of being sued (OR = .28, CI = 1.50, 3.48), spent greater than 75% time in clinical practice (OR = 2.20, CI = 1.60, 3.01), or were female (OR = 1.91, CI = 1.21, 3.02). Only 10% agreed that health care organizations adequately supported them in coping with error-related stress. Many physicians experience significant emotional distress and job-related stress following serious errors and near misses. Organizational resources to support physicians after errors should be improved.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                1176-6328
                1178-2021
                2014
                25 September 2014
                : 10
                : 1879-1886
                Affiliations
                [1 ]Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                [2 ]Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
                [3 ]Department of Family and Community Medicine, University of Dammam, Dammam, Saudi Arabia
                Author notes
                Correspondence: Hamza Mohammad Abdulghani, Department of Medical Education, College of Medicine, King Saud University, PO Box 230155, Riyadh 11321, Saudi Arabia, Tel +966 11 469 9177, Fax +966 11 467 1967, Email hamzaabg@ 123456gmail.com
                Article
                ndt-10-1879
                10.2147/NDT.S68039
                4196886
                25328389
                b65e5300-abbf-429a-bf24-a62967a1015b
                © 2014 Abdulghani et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Neurology
                medical education,clinical rotation,medicine,surgery,pediatrics
                Neurology
                medical education, clinical rotation, medicine, surgery, pediatrics

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