Determinants of Stress and Effects on Performance in Internal Medicine Residents

DETERMINANTS OF STRESS AND EFFECTS ON PERFORMANCE IN INTERNAL MEDICINE RESIDENTS By Sarah Ellen Braun, B.A. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2015. Major Director: Stephen Auerbach, Ph.D. Professor of Psychology Department of Psychology The purpose of the present study was to assess: a) perceived stress, burnout, depression, and empathy at three time points in internal medicine residents, b) the role of gender and trait mindfulness in stress response during residency and c) to evaluate the impact these variables have on performance evaluations. Additionally, specific tasks of the residency that may contribute to the experience of stress and burnout were evaluated to test a model of job strain. Stress predicted subsequent burnout and depression. Burnout predicted subsequent depression, and stress mediated this relationship. Women reported higher mean levels of empathy and burnout than men. The exploratory measure of job strain was not significantly related to stress outcomes. The acting with awareness facet of mindfulness was negatively related to burnout and depression. Performance was both negatively and positively related to stress outcomes. The results are discussed within the context of the current literature. Determinants of Stress and Effects on Performance in Internal Medicine Residents Stress in the workplace is an important topic in psychological research (Lazarus, 2013). Across disciplines, occupational stress has been shown to negatively affect employee quality of life, satisfaction, and performance. When stress levels are high, maladaptive outcomes increase, and performance in the work place is negatively affected. Burnout has long been used as a measure of stress response in the workplace. “Burnout” has been operationalized as a combination of three dimensions: depersonalization, emotional exhaustion, and lack of personal accomplishment. The symptoms of work-related burnout may be clinically similar to depression (McKnight & Glass, 1995). There is substantial evidence that work-related burnout can lead to subsequent depression (Hakanene, Schaufeli, & Ahola, 2008; Toker & Biron, 2012). Other health issues linked to work-related burnout include cardiovascular disease, poor adrenal functioning, anxiety, and suicide (Melamed, Shirom, Toker, Berliner, & Shapira, 2006; Toker, Shirom, Shapira, Berliner, & Melamed, 2005). A vocational group for which the adverse impact of stress has long been documented is health care professionals (IsHak et al., 2009; Lemkau et al., 1988; Martin et al., 1997; Purdy et al., 1987). Common pressures for health care professionals include a highly demanding work schedule, stressful clinical judgment, and the social influences of a hierarchical culture (Martin et al., 1997; Thomas, 2004). Physicians at the front line of care – family medicine, internal medicine, and emergency care – experience heightened levels of burnout when compared to other specialties and when compared to the national average (Shanafelt et al., 2012). Residents are particularly prone to experience negative effects of stress related to job demands (Durning et al., 2013; Dyrbye et al., 2014; Purdy, Lemkau, Rafferty, & Rudisill, 1987).