SENIOR HOUSE OFFICERS WORK-RELATED STRESSORS, PSYCHOLOGICAL DISTRESS,AND CONFIDENCE IN PERFORMING CLINICAL TASKS IN ACCIDENT AND EMERGENCY- A QUESTIONNAIRE STUDY
S. Williams et al., SENIOR HOUSE OFFICERS WORK-RELATED STRESSORS, PSYCHOLOGICAL DISTRESS,AND CONFIDENCE IN PERFORMING CLINICAL TASKS IN ACCIDENT AND EMERGENCY- A QUESTIONNAIRE STUDY, BMJ. British medical journal, 314(7082), 1997, pp. 713-718
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.