"One size does not fit all" - lessons learned from a multiple-methods study of a resident wellness curriculum across sites and specialties.

Autor: Chaukos D; Mount Sinai Hospital/ University of Toronto Temerty Faculty of Medicine, 600 University Avenue, Toronto, Ontario, M5G1X5, Canada. Deanna.chaukos@sinaihealth.ca., Zebrowski JP; Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA., Benson NM; McLean Hospital/ Harvard Medical School, Belmont, MA, USA., Celik A; Hospital for Sick Children, Toronto, Canada., Chad-Friedman E; University of Maryland, College Park, MD, USA., Teitelbaum A; NYU Grossman School of Medicine, New York, NY, USA., Bernstein C; Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA., Cook R; Dell Medical School/University of Texas-Austin, Austin, TX, USA., Genfi A; Nava PBC, Washington, DC, USA., Denninger JW; Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: BMC medical education [BMC Med Educ] 2021 Nov 13; Vol. 21 (1), pp. 576. Date of Electronic Publication: 2021 Nov 13.
DOI: 10.1186/s12909-021-02995-z
Abstrakt: Background: There is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress. The authors conducted a multiple-methods study exploring contributors to wellbeing for junior residents in diverse medical environments who participated in a brief resilience and stress-reduction curriculum, the Stress Management and Resiliency Training Program for Residents (SMART-R).
Methods: Using a waitlist-controlled design, the curriculum was implemented for post-graduate year (PGY)-1 or PGY-2 residents in seven residency programs across three sites. Every three months, residents completed surveys, including the Perceived Stress Scale-10, General Self-Efficacy Questionnaire, a mindfulness scale (CAMSR), and a depression screen (PHQ-2). Residents also answered free-text reflection questions about psychological wellbeing and health behaviors.
Results: The SMART-R intervention was not significantly associated with decreased perceived stress. Linear regression modeling showed that depression was positively correlated with reported stress levels, while male sex and self-efficacy were negatively correlated with stress. Qualitative analysis elucidated differences in these groups: Residents with lower self-efficacy, those with a positive depression screen, and/or female residents were more likely to describe experiencing lack of control over work. Residents with higher self-efficacy described more positive health behaviors. Residents with a positive depression screen were more self-critical, and more likely to describe negative personal life events.
Conclusions: This curriculum did not significantly modify junior residents' stress. Certain subpopulations experienced greater stress than others (female residents, those with lower self-efficacy, and those with a positive depression screen). Qualitative findings from this study highlight universal stressful experiences early in residency, as well as important differences in experience of the learning environment among subgroups. Tailored wellness interventions that aim to support diverse resident sub-groups may be higher yield than a "one size fits all" approach.
Trial Registration: NCT02621801 , Registration date: December 4, 2015 - Retrospectively registered.
(© 2021. The Author(s).)
Databáze: MEDLINE
Externí odkaz: