SENIOR HOUSE OFFICERS WORK-RELATED STRESSORS, PSYCHOLOGICAL DISTRESS,AND CONFIDENCE IN PERFORMING CLINICAL TASKS IN ACCIDENT AND EMERGENCY- A QUESTIONNAIRE STUDY

Objective: To investigate the relation between accident and emergency senior house officers' psychological distress and confidence in perfor ming clinical tasks and to describe work related stressors. Design: Qu estionnaire survey with data collected at four points during senior ho use officers' six month attachment to accident and emergency departmen ts. Subjects: 171 newly appointed accident and emergency senior house officers from 27 hospitals in the South Thames region. Main outcome me asures: Psychological distress measured with a 25 item questionnaire; confidence in performing a range of 35 clinical and practical activiti es (visual analogue scales); reported consultation stress factors, oth er work related stressors, and personal stressors. Results: Overall co nfidence scores in carrying out a range of clinical and practical acti vities increased significantly between the end of the first and the en d of the fourth month (Z=-6.05, P<0.001). Senior house officers with h igher psychological distress scores at the end of their first and four th month had significantly lower confidence scores (Z=-3.20, P<0.001; Z=-1.90, P<0.05). Senior house officers with lower increases in confid ence between the first and fourth month had significantly higher distr ess than those with greater increases (Z=-2.62, P<0.001), Factors iden tified as causing stress during consultations included difficulties wi th communication, certain clinical presentations, and department organ isational factors (particularly tile intensity of workload). Conclusio ns: Psychological distress is linked to confidence in senior house off icers. This supports the need to monitor and build confidence in senio r house officers and to address work related stressors. Additional com munication skills training needs to be considered.