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Residency Program Factors Associated With Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study.

ABSTRACT: PURPOSE:To investigate the associations between program-level variables such as organizational structure, workload, and learning environment and residents' development of depressive symptoms during internship. METHOD:Between 2012 and 2015, 1,276 internal medicine interns from 54 U.S. residency programs completed the Patient Health Questionnaire-9 (PHQ-9) before internship, and then quarterly throughout the internship. The training environment was assessed via a resident questionnaire and average weekly work hours. The authors gathered program structural variables from the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA online) and program research rankings from Doximity. Associations between program-level variables and change in depressive symptoms were determined using stepwise linear regression modeling. RESULTS:Mean program PHQ-9 scores increased from 2.3 at baseline to 5.9 during internship (mean difference 3.6; SD 1.4; P < .001), with the mean increase ranging from -0.3 to 8.8 (interquartile range 1.1) among included programs. In multivariable models, faculty feedback (? = -0.37; 95% CI: -0.62, -0.12; P = .005), learning experience in inpatient rotations (? = -0.28; 95% CI: -0.54, -0.02; P = .030), work hours (? = 0.34; 95% CI: 0.13, 0.56; P = .002), and research ranking position (? = -0.25; 95% CI: -0.47, -0.03; P = .036) were associated with change in depressive symptoms. CONCLUSIONS:Poor faculty feedback and inpatient learning experience, long work hours, and high institutional research rankings were associated with increased depressive symptoms among internal medicine interns. These factors may be potential targets for interventions to improve wellness and mental health among these professionals.

SUBMITTER: Pereira-Lima K

PROVIDER: S-EPMC6538448 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Residency Program Factors Associated With Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study.

Pereira-Lima Karina K Gupta Rahael R RR Guille Constance C Sen Srijan S

Academic medicine : journal of the Association of American Medical Colleges 20190601 6

<h4>Purpose</h4>To investigate the associations between program-level variables such as organizational structure, workload, and learning environment and residents' development of depressive symptoms during internship.<h4>Method</h4>Between 2012 and 2015, 1,276 internal medicine interns from 54 U.S. residency programs completed the Patient Health Questionnaire-9 (PHQ-9) before internship, and then quarterly throughout the internship. The training environment was assessed via a resident questionna ...[more]

PMID: 30570500

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Project description:BackgroundDespite the Clinical Learning Environment Review's recommendations of their use, patient safety event reporting systems are underutilized by residents.ObjectiveWe aimed to identify perceived barriers to event reporting amongst internal medicine residents and implement a targeted quality improvement initiative to address the identified barriers and increase overall resident event report rates.MethodsA total of 94 Internal Medicine (IM) residents participated in the educational intervention in 2018. We measured residents' perception of barriers to event reporting and employed the results of the questionnaire to create a skill-based educational workshop. We conducted the plan-do-study-act model to test a structured educational intervention and its effectiveness on pre-post IM residents' event report rates and compared it to report rates of Non-Internal Medicine (Non-IM) residents. Additionally, we assessed pre-post intervention knowledge, skills, and attitudes in event reporting.Results94/94 (100%) of IM residents had a significantly higher median percent of patient safety event reporting when compared to pre-intervention (23.6% compared to 5.88%, p-value = 0.0030) and when compared to Non-IM residents (23.6% compared to 5.31%, p-value = 0.0002). Residents performed better on the post-test compared to the pre-test (90% compared to 30%, p-value = 0.0001) for knowledge. 100% of the critical action items were completed and 90% of participants reported their perception of the event reporting process improved.ConclusionsBy elucidating common reasons why residents are not reporting patient safety events, a specific intervention can be created to target the identified impediments and improve resident event reporting.AbbreviationsIM: Internal Medicine IM; Non-IM: Non-Internal Medicine; IOM: Institute of Medicine I; ACGME CLER: Accreditation Council for Graduate Medical Education Clinical Learning Environment Review; GME: Graduate Medical Education; IRB: Institutional Review Board; PDSA: Plan, Do, Study, Act.

Dataset Information

Residency Program Factors Associated With Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study.

Publications

Residency Program Factors Associated With Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study.

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