Examining stress and responses to stress in medical students and new medical graduates.

MOST MEMBERS OF THE MEDICAL PROFESSION feel stressed at some time. If stress is ongoing, impairment may occur (defined as being unable to safely or reliably perform one's role). A continuum appears to exist between functioning well, being distressed and becoming impaired, with external (environment-related) and internal (personal-related) stressors determining where an individual will lie on the continuum. We are conducting a study which aims to determine whether distress in new medical graduates can be predicted before the graduates become impaired and unable to safely or reliably perform their role. Study commencement Our study, which commenced in 1997, initially looked at predictors for " troubled " and " troublesome " interns. Hospital based focus groups comprising interns (postgraduate Year 1), resident medical officers (postgraduate Year 2 and above), ward-based nursing staff and medical administrators reported on internal and external stressors for junior medical staff. Residents and nurses reported similar external stressors, whereas the internal stressors reported by the two groups were quite different (Box 1). Residents tended to report issues relating to " troubled " interns (eg, poor support , few outside interests), whereas nurses identified factors relating more to " troublesome " interns (eg, poor attitude, unprofessionalism). In other words, resident staff seemed to be able to identify their stressed and at-risk peers before effects on performance were observed (Box 1). Our study has subsequently moved through three distinct phases. In Phase 1 (1997), 151 interns from seven primary allocation centres (centres which employ first-year postgraduate doctors) around New South Wales were approached and specific tools were administered, at orientation and at midyear , to assess " burnout " , 1 alexithymia (not being emotionally sensitive or expressive, and having externally oriented thinking), 2 and social support. 3 General demographic characteristics were also obtained. These data were correlated with " assessed performance " data for the interns in the study, as determined from term evaluations by their supervisor. Results from this pilot cohort suggested that alexithymia was a possible predictor of a resident in difficulty, ultimately leading to poor performance. In Phase 2 of the study (1998), the entire NSW cohort of interns (482) from all primary and secondment allocation centres across the State were approached and the same questionnaire tools administered. Scores for two of the subscales of the Maslach Burnout Inventory — " a sense of personal accomplishment " and " emotional exhaustion " — indicated an …