Posttraumatic Stress Disorder in Emergency Medicine Residents

Vanyo, Lara; Sorge, Randy; Chen, Angela; Lakoff, Daniel

doi:10.1016/j.annemergmed.2017.07.010

Cited by 20 publications

(14 citation statements)

References 34 publications

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“…86 Other components could include strategies to help deal with the wide range of issues that may be encountered during residency, such as stress management, behavioral issues, marriage or family problems, financial troubles, substance abuse, disruptive colleagues, or mental health issues. 85,[87][88] In addition to institutional programs, residency curricula have been shown to be beneficial. 45,86,[90][91][92][93][94][95][96][97] Studies recommend a multicomponent wellness curriculum, including resilience, professionalism, emotional wellness, physician suicide, social wellness, financial wellness, team building, and mindfulness.…”

Section: Organization-level Interventionsmentioning

confidence: 99%

Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors

Parsons

Bailitz

Chung

et al. 2020

WestJEM

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BACKGROUND Burnout syndrome was defined in the 1970s as a triad of emotional exhaustion (EE), depersonalization (DP), and a low sense of personal accomplishment (PA). 1 Almost half of physicians report burnout, and emergency physicians (EP) are near the top of the list. 2 In 2018, 48% of EPs reported burnout. 3 Physician burnout has been shown to negatively correlate with patient safety, quality of care, physician professionalism, and patient satisfaction. 4,5 In EPs, burnout was associated with increased frequency of self-reported, suboptimal patient care, including admitting or discharging patients early, not communicating effectively with patients, ordering more tests, not treating patients' pain, and not communicating important handoffs. 6 Additionally, burnout has been associated with substance use, relationship issues, depression, and suicide. 5,7,8 Originally, burnout was believed to manifest in those who practiced medicine for a prolonged amount of time. However, recent evidence has shown that burnout may begin as early as medical school and residency. 9-10 In fact, recent studies on emergency medicine (EM) residents reported burnout rates ranging from 65-76%. 9,11 Across all fields of medicine, residents have shown higher rates of burnout when compared to medical students and early-career physicians. 9,10 In response to this data indicating early onset of burnout,

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Section: Organization-level Interventionsmentioning

confidence: 99%

Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors

Parsons

Bailitz

Chung

et al. 2020

WestJEM

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“…3,8,10,11 Residents involved in the care of patients who die after failed resuscitation attempts may require additional psychological and bereavement support given increased risk of adverse psychological outcomes. 31 Finally, consideration should be given to resident exposure to deaths that occur at home with hospice. While nonescalation deaths in the hospital may expose residents to comfortdirected care and a more natural dying process, deaths occurring at home present a unique learning and training opportunity.…”

Section: Resident Exposure To Mode Of Deathmentioning

confidence: 99%

Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Trowbridge

Bamat

Griffis

et al. 2020

Academic Pediatrics

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OBJECTIVE: Pediatric residents are expected to be competent in end-of-life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures. METHODS: Retrospective chart review of all deceased patients at one children's hospital over 3 years collected patient demographics, time, and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented. RESULTS: Of 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths); however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of lifesustaining therapy (41%), followed by nonescalation (31%) and failed resuscitation (15%). During their postgraduate year (PGY)-1, <1% of residents encountered a patient death. During PGY-2 and PGY-3, 96% and 78%, respectively, of residents encountered at least 1 death. During PGY-2, residents encountered a mean of 3.5 patient deaths (range 0-12); during PGY-3, residents encountered a mean of 1.4 deaths (range 0-5). Residents observed for their full 3-year residency encountered a mean of 5.6 deaths (range 2-10). CONCLUSIONS: Pediatric residents have limited but variable exposure to EOL care, with most exposures in the ICU after withdrawal of life-sustaining technology. Educators should consider how to optimize EOL education with limited clinical exposure, and design resident support and education with these variable exposures in mind.

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“…With regards to stress at work, anxiety rates among residents have been reported to range from 8 to 40% [8–11]. Rates of work-related PTSD among residents are reported to be around 10% [12, 13]. Furthermore, residents lack experience and have no formal preparation for exceptional situations, such as terror attacks, yet they play an important role in the care pathways of victims.…”

Section: Introductionmentioning

confidence: 99%

The impact of the Paris terrorist attacks on the mental health of resident physicians

Grégory¹,

Lepinau²,

Buyer³

et al. 2019

BMC Psychiatry

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Background On November 13, 2015, terrorist attacks took place in Paris. One hundred and twenty-nine people were immediately killed and 302 needed emergency care. Many resident physicians were on the front line of the medical response. Our aim was to report the frequency of symptoms of post-traumatic stress disorder (PTSD), anxiety and depression among resident physicians after the Paris terrorist attacks. Methods Anonymous questionnaires, including the Impact of Event Scale- Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), were emailed two months after the attacks to 2413 Parisian resident physicians. Exposure to the attacks was defined as having direct clinical contact with one of the victims up to one week after the attacks, being one of the victims, or having one among close relatives. Results The questionnaire was completed by 680 (28.2%) residents. Eighty-four (12.4%) reported symptoms of PTSD (IES-R ≥ 33), 76 (11.2%) reported symptoms of anxiety (HADS anxiety score > 10) and 16 (2.4%) reported symptoms of depression (HADS depression score > 10). Exposed residents had higher IES-R scores than non-exposed residents (18.8 ± 16.6 versus 14.2 ± 12.0, p = 0.001), and 40 (18.5%) of them reported symptoms of PTSD, compared to 44 (9.5%) of the non-exposed residents ( p = 0.001). Conclusions There was a high frequency of symptoms of mental distress among our respondents. Dedicated screening and care strategies must be considered in the event of new attacks. Electronic supplementary material The online version of this article (10.1186/s12888-019-2058-y) contains supplementary material, which is available to authorized users.

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Posttraumatic Stress Disorder in Emergency Medicine Residents

Cited by 20 publications

References 34 publications

Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors

Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors

Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

The impact of the Paris terrorist attacks on the mental health of resident physicians

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