Wellness issues and the emergency medicine resident

doi:10.1016/S0196-0644(00)70060-6

Annals of Emergency Medicine

Volume 35, Issue 4, April 2000, Pages 394-397

https://doi.org/10.1016/S0196-0644(00)70060-6 Get rights and content

Abstract

[Houry D, Shockley LW, Markovchick V. Wellness issues and the emergency medicine resident. Ann Emerg Med. April 2000;35:394-396.]

Introduction

Residency training has long been known to constitute a stressful time in the professional development of physicians. Patient care responsibilities including high patient loads and high patient mortality, peer competition, and long hours with possible sleep deprivation are common stressors for residents.¹ One study reported that a majority of residents noted distress sufficient to impair their work performance; additionally, 1 in 8 residents had a significant stress syndrome or emotional problem.² Emergency medicine residents have the added stressors of making demands on the time of other residents (consultations and admissions), disruption of circadian rhythms, decreased camaraderie and teamwork as a result of not working alongside emergency medicine resident colleagues, and isolation from other sources of social support.³ This article summarizes some of the common stressors for emergency medicine residents and provides strategies for coping and wellness behaviors.

Section snippets

Shift Work

Shift work itself can be a cause of stress for emergency medicine residents. Disruption of circadian rhythms and difficulty in dealing with sleep disorders from night shifts can cause stress and dissatisfaction among emergency medicine residents. Emergency physicians involved in rotating shift work have been shown to get less sleep and perform less effectively on manual or cognitive tests while working night shifts.⁴ In addition, residents who are already chronically sleep deprived may be

Chemical Dependence

Emergency medicine residents have periods of intense, highly stressful workloads, as well as access to most dependence-producing medications in their work.¹⁰ One study reported that emergency medicine residents have higher rates of substance use than residents in other specialties, and were significantly more likely to report current use of cocaine and marijuana.¹⁰ However, emergency medicine residents did not have high rates of daily substance use. In addition, substance use was lower for

Women’s Issues

Female physicians have unique stressors such as role strain, sexual harassment and discrimination, and the lack of female role models. A survey of members of the Emergency Medicine Residents Association reported that mean levels of stress and depression were higher for female residents than their male colleagues.¹⁵ Additionally, the role of female physicians, which often involves combining medicine, marriage, and motherhood, may cause stress for some women.¹⁶ Brown¹⁶ also reported that nearly

Interpersonal Relationships or the “Medical Marriage”

The practice of emergency medicine can place a marriage and family under additional stress.³ Nights, weekends, and holidays are usually considered family time, but emergency medicine physicians must work some of these shifts. A residency program also demands additional time and hours away from spouses and families. A survey of married female resident physicians found that the majority believed that they and their partners had communication difficulties, did not have enough time together, and

Personal Safety

Almost two thirds of emergency medicine residents worry about their own safety while working in the ED,²⁵ and 75% of ED hospital directors consider violence a “significant problem.”²⁶ Anglin et al²⁵ reported that only 50% of residents believed their hospital provided accurate security, and 22% of residents feared being assaulted or shot. The ED provides care to patients with all aspects of medical and social problems, including patients under detainment. In addition, ED gang-related violence

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^☆: Address for reprints and correspondence: Debra Houry, MD, MPH, Denver Health Medical Center, Department of Emergency Medicine, Mailcode 0108, 777 Bannock Street, Denver, CO 80204; E-mail [email protected] .

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Residents’ PerspectiveWellness issues and the emergency medicine resident☆

Abstract

Introduction

Section snippets

Shift Work

Chemical Dependence

Women’s Issues

Interpersonal Relationships or the “Medical Marriage”

Personal Safety

Ann Emerg Med.

Am J Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Levels and causes of stress among residents

J Med Educ.

Perceptions of housestaff stress and dysfunction within the academic medical center

Psychiatr Q.

The impact of long working hours on resident physicians

N Engl J Med.

Residents’ Perspective
Wellness issues and the emergency medicine resident☆