论文标题：“A steep learning curve”: junior doctor perspectives on the transition from medical student to the health-care workplace

期刊：BMC Medical Education

作者：Nancy Sturman et al

发表时间： 2017/5/26

数字识别码：10.1186/s12909-017-0931-2

原文链接：https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0931-2?utm_source=Other_website&utm_medium=Website_links&utm_content=DaiDen-BMC-BMC_Medical_Education-Multidisciplinary-China&utm_campaign=BMCS_USG_BSCN_DD_BMCMEdu

发表于BMC Medical Education的一篇论文聚焦专业医务人员的漫漫求学路，揭示了他们在从医学生到初级医师的角色升级中付出的代价。

众所周知，从医学生迈向初级医师是一个令人生畏又充满挑战的过渡。尽管精神紧绷并“深陷困境”可以敦促他们获得更多经验，习得更多知识，但这也增加了他们的压力。在这个漫长而艰难的转变期间，他们需要在认真领悟新角色的同时，负责好对患者的护理。这样的岗位要求和护理患者的职责是否会让他们没时间没精力好好照顾自己呢？

昆士兰大学医学院的研究人员在Sturman博士主导的一项研究中对这一问题进行了调查。研究人员从各种各样的医院环境中对初级医师进行招募，并与他们进行访谈来了解他们调整从医学生到初级医师的角色时的经历。在此过程之后，两名临床学者和一名实习医师对所收集的信息进行了描述性分析。

研究结果印证了一些持续性的概念，可分为“陡峭的学习曲线”、“人际关系与团队合作”以及“寻求帮助”三大重要主题。一名受访者表示，“当你成为一名实习医师时，会出现身为医学生不会出现的难以置信的自我怀疑”。总体而言，参与者们将这个过渡期描述为对身体、心理和情感的考验。

研究发现，转型中的初级医师的主要遭遇是自信心下降、无法更好地照顾自己以及社交幸福感降低。看来，虽然初级医师专注于照顾他人，并乐于向资深医师提出与患者有关的问题，但是他们却不愿意提及自己的个人问题。

为了尝试了解造成这一现象的原因，研究人员提出了专业人员工作环境中存在的一些关键因素，这些因素可能导致这些负面影响。

首先，支持性团队结构能够缓解这种遭遇的压力，然而该结构可能会被资深医师和初级医师之间存在的分歧所阻碍，正如一名参与者暗示，“你正同时处于食物链的底层和食物链中间的某个地方，因为你正在做决定并指导患者护理，但同时你也处于该链条的最底层”。

其次，专业人员在医院内各个团队来回流动可能导致医师之间的联系断裂进一步加剧。仅维系点头之交，不仅影响初级医师的社交幸福感，还会影响他们的工作技能。

这项研究提示医学教育工作者要提高对初级医师在这一学习阶段所遭受的个人损害的认识，并提出，改进的团队支持系统和教学方法可以有助于从学生到专业人员的坎坷过渡平稳地进行。

这项研究还提供了经历过这种压力性变化的初级医师所吸取到的经验教训，正如一名受访者表示，“我会给予的建议是，不要害怕，每个人都会乐于帮助你，并且每个人都会乐于为你指引道路，不要害怕提出问题，因为最终所有这些都会惠及患者”。

如果初级医师的幸福感得到提升，这或许还会对他们的同事，甚至是他们所治疗的患者产生积极影响。

摘要：

Background

The transition from medical student to hospital-based first year junior doctor (termed “intern” in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. Although manageable challenges and transitions are a stimulus to learning, levels of burnout in junior medical colleagues are concerning. In order to prepare and support medical graduates, educators need to understand contemporary junior doctor perspectives on this transition.

Methods

Final-year University of Queensland medical students recruited junior doctors working in diverse hospital settings, and videorecorded individual semi-structured interviews about their transition from medical student to working as a junior doctor. Two clinical academics (NS and JT) and an intern (ZT) independently conducted a descriptive analysis of interview transcripts, and identified preliminary emerging concepts and themes, before reaching agreement by consensus on the major overarching themes.

Results

Three key themes emerged from the analysis of 15 interviews: internship as a “steep learning curve”; relationships and team; and seeking help. Participants described the intern transition as physically, mentally and emotionally exhausting. They learned to manage long days, administrative and clinical tasks, frequent interruptions and time pressures; identify priorities; deal with criticism without compromising key relationships; communicate succinctly; understand team roles (including their own status within hospital hierarchies); and negotiate conflict. Participants reported a drop in self-confidence, and difficulty maintaining self-care and social relationships. Although participants emphasised the importance of escalating concerns and seeking help to manage patients, they appeared more reluctant to seek help for personal issues and reported a number of barriers to doing so.

Conclusion

Findings may assist educators in refining their intern preparation and intern training curricula, and ensuring that medical school and intern preparation priorities are not seen as competing. Insights from non-medical disciplines into the organisational and relational challenges facing junior doctors and their health-care teams may enhance inter-professional learning opportunities. Workplace support and teaching, especially from junior colleagues, is highly valued during the demanding intern transition.

阅读论文原文，请访问

https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0931-2?utm_source=Other_website&utm_medium=Website_links&utm_content=DaiDen-BMC-BMC_Medical_Education-Multidisciplinary-China&utm_campaign=BMCS_USG_BSCN_DD_BMCMEdu

期刊介绍：BMC Medical Education is an open access journal publishing original peer-reviewed research articles in relation to the training of healthcare professionals, including undergraduate, postgraduate, and continuing education. The journal has a special focus on curriculum development, evaluations of performance, assessment of training needs and evidence-based medicine.

2017 Journal Metrics

Citation Impact

1.511 - 2-year Impact Factor

1.938 - 5-year Impact Factor

1.169 - Source Normalized Impact per Paper (SNIP)

（来源：科学网）