英国医学杂志中文版2014年12月第6期
Burnout among first year internal medicine residents is common and well known. It can lead to suboptimal patient care, errors, poor quality of life, and depression. Data on burnout in the first weeks of residency as compared with the remainder of the first year have not been published.
In 20 years of service as head of an academic department of medicine, I have encountered residents who were selected for their overall good performance as students and interns, yet their initial function at the start of their residency programme was almost appalling. With a little practice, they can be spotted easily: their presentations of patients are fumbled; they run around the department with obvious hyperactivity, yet little is accomplished; they actually seem stunned. Thus, residents should never be judged prematurely according to their performance over the first weeks. Just as a myocardium stunned by repetitive episodes of ischaemia may resume full function, a resident stunned by the many new responsibilities and amount of material he or she has to command, may improve given a supportive learning environment and time to adjust.
In my experience, most stunned residents recover within a relatively short time. The steepness of their improvement curve attests to the acuity of their predicament and its high potential of reversibility. Senior hospital physicians need to be more aware of what might be termed "the stunned resident syndrome." Providing a more gentle, gradual, and supportive initiation into the complicated routines of residency might alleviate the problem.
BMJ 2012;345:e6436
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