畢業後一般醫學訓練住院醫師工作壓力與滿意度之全國性調查分析

Analysis of Job Stress and Satisfaction among First Postgraduate Year Residents: A Nationwide Survey in Taiwan

呂碧鴻(Bee-Horng Lue) ； 高美英(Meei-Ying Kao) ； 陳秀蓉(Hsiu-Jung Chen) ； 王長偉(Chang-Wei Wang)

《Journal of Medical Education》 13卷2期 (2009/06) Pp. 113-121

https://doi.org/10.6145/jme.200906_13(2).0005

摘要

目的：畢業後第一年住院醫師(First postgraduate year, PGY1)訓練是最有壓力的一年，本研究調查PGY1醫師的壓力源與內容以及探討其工作滿意度與相關影響因素。研究方法：以2006年度PGY1醫師為研究對象，調查期間為2007年1月至6月。利用問卷調查方式進行工作壓力與滿意度的測量與資料收集。以因素分析檢測工作壓力來源。利用迴歸分析探索工作滿意度之預測因子。結果：共有555位醫師（回收率90.0%）參與研究。工作壓力源有工作情境壓力、情緒／病患需求壓力，醫學臨床技能壓力、親友生病與臨床病患處置壓力及個人因素壓力五種因素（解釋工作壓力變異量55.7%）。有38.0%之PGY1醫師經常感受到壓力。工作情境壓力與情緒／病患需求壓力為主要壓力源。將近七成之醫師感受到睡眠不足或值班時要常常保持警覺之壓力，六成左右的醫師有文書行政作業或工作過量之沉重壓力；55.0%的醫師感受害怕做錯事或發生訴訟事件之壓力。工作滿意度之最主要預測因子為工作情境壓力（解釋變異量為19.9%），其次為情緒支持（解釋變異量為9.7%）。結論：PGY1住院醫師主要壓力源是工作情境壓力與情緒／病患需求壓力，工作情境壓力影響工作滿意度。因為工作壓力將威脅身心健康與臨床表現，本研究建議建構諮商輔導機制與確實運作，以降低因住院醫師壓力影響所及之身心健康問題與提升醫療照護品質。

關鍵字

工作壓力 ； 工作滿意度 ； 畢業後第一年住院醫師

並列摘要

Purpose: The first year of postgraduate residency (PGY1) is the most stressful year. The aim of this study was to investigate the job stressors among PGY1 residents, to measure their job satisfaction and to explore any influencing factors. Methods: PGY1 residents in the academic year 2006 were the study subjects. The study was conducted from January to June 2007. The job stress and satisfaction data were collected via a questionnaire survey. The job stressors were examined by factor analysis. Stepwise multivariate regression analysis was used to explore the predictors related to job satisfaction. Results: A total of 555 PGY1 residents (response rate 90.0%) completed the survey. Five stressors were identified including working situational stress, clinical skill stress, emotional pressure/demands from patients, dealing with family and friends’ illness, and personal stress; these explained 55.7% of the total variance. Overall, 38.0% of the residents frequently or always perceived the presence of job stress. Working situational stress and the emotional pressure/demands from patients were the main stressors. Close to 70% of the residents felt they had insufficient sleep or that the need to be constantly alert on duty was very stressful. Furthermore, more than 60% of the residents perceived that there was excess pressure due to the clerical/administrative activities or an excessive workload. Finally, 55.0% of the residents felt threatened by the possibility of making a mistake or perceived the threat of litigation. The important significant predictors of job satisfaction were working situational stress, which explained 19.9% of the variance and emotional support, which explained 9.7% of variance. Conclusion: PGY1 residents perceived that most of their stress came from their working situation and the emotion pressure/demands of patients. The presence of working situational stress affected their job satisfaction. Developing assistance services for these residents or reinforcing the functioning of the current mentoring system are recommended in order to promote the well-being of these residents, which, in turn, would improve the quality of medical care provided.

並列關鍵字

job stress ； job satisfaction ； first postgraduate year residents

參考文獻

(2001).(Patient and physician safety and protection act of 2001, HR 3236, 107th Cong).

(2003).Graduate medical education directory 2002-2003.Chicago:American Medical Association.

Alexander D,Monk JS,Jonas AP(1985).Occupational stress, personal strain, and coping among residents and faculty members.J Med Educ.60,830-839.

Butterfield PS(1988).The stress of residency: a review of the literature.Arch Intern Med.148,1428-1435.

Chu Tzong-Shinn (Eds)(2009).Six core competencies in residency training.Taipei:Taiwan Association of Medical Education.