STUDYING THE ASSOCIATION BETWEEN POSTGRADUATE TRAINEES’ WORK HOURS, STRESS AND THE USE OF MALADAPTIVE COPING STRATEGIES
AbstractBackground: The growing debate regarding long working hours of postgraduate trainees has beenreceiving considerable attention recently. This greater workload contributes to increasing stress.Our objective was to specifically study the association between long working hours, stress and thegreater use of ‘maladaptive’ coping strategies. Methods : A cross-sectional descriptive study wascarried out on all interns and residents at the Aga Khan University Hospital during February toMay, 2005. Level of stress was measured by use of General Health Questionnaire (GHQ-12) andthe use of maladaptive coping mechanisms through Brief Cope-28. Results: 55.1 % scored overthe threshold for mild stress i.e. GHQ > 3, while more than 46% of the trainees scored over thethreshold of more than 4 for morbid stress. Trainees under stress reported more working hours onaverage as compared to those not under stress, 83.8 and 74.7 hours respectively. At the sametime, those working for longer hours were more likely to have used these negative copingmechanisms, which would further contribute to more stress rather than relieving it. Conclusions:Significant levels of stress have been identified. Along with this, those working for longer hourswere more likely to have used these negative coping mechanisms. Reduction of working hours isimportant. Simultaneously, interventions need to be planned at imparting knowledge, awarenessand skills to cope with various kinds of stressors encountered by a trainee during his/her training.Additionally, limits need to be devised for the working hours of the trainees.Keywords: Postgraduate, resident, intern, working hours, stress, maladaptive coping strategies,GHQ-12, Brief Cope, Pakistan, Medical Education.
Howard SK, Gaba DM. Trainee fatigue: Are new limits on
work hours enough? CMAJ 2004; 170(6): 975-76.
Howard SK, Gaba DM, Rosekind MR, Zarcone VP. The
risks and implications of excessive daytime sleepiness in
resident physicians. Acad Med 2002; 77(10): 1019-25.
Parshuram CS, Dhanani S, Kirsh JA, Cox PN. Fellowship
training, workload, fatigue and physical stress: a prospective
observational study. CMAJ 2004; 170(6): 965-70.
Weinstein DF. Duty hours for resident physicians--tough
choices for teaching hospit als. N Engl J Med 2002;
Resident Services Committee, Association of Program
Directors in Internal Medicine. Stress and Impairment during
Residency Training: Strategies for Reduction, Identification,
and Management. Ann Int Med 1988; 109:154-61.
Steinbrook R. The Debate over Residents' Work Hours. N
Engl J Med. 2002; 347(16):1296-1302
Gaba DM, Howard SK. Patient safety: Fatigue among
clinicians and the safety of patients. N Engl J Med 2002;
Baldwin DC Jr, Daugherty SR. Sleep deprivation and fatigue
in residency training: results of a national survey of first - and
second-year residents. Sleep. 2004; 27(2):217-23.
Baldwin DC Jr, Daugherty SR, Tsai R, Scotti MJ Jr. A
national survey of residents' self-reported work hours:
thinkin g beyond specialty. Acad Med 2003; 78(11):1154-63.
Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi
M, Fateh A. The 12-item General Health Questionnaire
(GHQ-12): translation and validation study of the Iranian
version. Health Qual Life Outcomes 2003; 1(1):66.
Kapur N, Borrill C, Stride C. Psychological morbidity and
job satisfaction in hospital consultants and junior house
officers: multicentre, cross sectional survey. BMJ. 1998;
Carver CS. You want to measure coping but your protocol’s
too long: consider the Brief COPE. Int J Behav Med 1997;
Vosvick M, Koopman C, Gore-Felton C, Thoresen C,
Krumboltz J, Spiegel D. Relationship of functional
quality of life to strategies for coping with the stress of
living with HIV/AIDS. Psychosomatics 2003;