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February 10, 1989, Vol 261, No. 6 >
ARTICLE | February 10, 1989

The Ravelled Sleeve of Care: Title and subTitle BreakManaging the Stresses of Residency Training FREE

John M. Colford, Jr, MD
[+] Author Affiliations

Read before the Northern California Scientific Meeting of the American College of Physicians, Monterey, Calif, Oct 17,1987.

Reprint requests to 400 Parnassus Ave, A405, San Francisco, CA 94143-0320 (Dr McPhee).


JAMA. 1989;261(6):889-893. doi:10.1001/jama.1989.03420060105041
Text Size: A A A
Published online
Article
References

Residency training is in crisis. There have been calls for change in both the lay press and the professional literature. Some prestigious residency programs have failed to fill their slots in the matching process. Legislation affecting residency programs has been proposed in several states. Increasingly active house staff unions are demanding changes. In this article we review the literature describing the stresses experienced by residents in training, the toll these stresses may take on residents, and the suggestions that have been made for reducing these stresses.

(JAMA 1989;261:889-893)

REFERENCES

1 +
Asch D, Parker R:  The Libby Zion case . N Engl J Med 1988;;318:771-774.
2 +
Tupper R:  What the debate on resident hours really means . Hosp Phys , (November) 1987;, pp 11-18.
3 +
Scherr L:  Decline in internal medicine careers: A foreboding trend . ACP Observer 1987;;2:22.
4 +
McCarty D:  Why are today's medical students choosing high-technology specialties over internal medicine? N Engl J Med 1987;;317:567-569.
5 +
Glick S:  The impending crisis in internal medicine training programs . Am J Med 1988;;84:929-932.
6 +
Barondess J:  The training of the internist: With some messages from practice . Ann Intern Med 1979;;90:412-417.
7 +
Schroeder SA, Showstack JA, Gerbert B:  Residency training in internal medicine: Time for change? Ann Intern Med 1986;;104:554-561.
8 +
Boyce-Smith G, Zier B, Deller JJ Jr:  Deficiencies in the training of internists: Results of a survey . West J Med 1977;;127:450-452.
9 +
Ziegler JL, Strull WM, Larsen RC, et al:  Stress and medical training . West J Med 1985;;142:814-819.
10 +
Cherniss C: Professional Burnout in Human Service Organizations . New York, Praeger Publishers, 1980;.
11 +
Mawardi B:  Satisfaction, dissatisfaction and causes of stress in medical practice . JAMA 1979;;241:1483-1486.
12 +
Smith JW, Denny WF, Witzke DB:  Emotional impairment in internal medicine house staff . JAMA 1986;;255:1155-1158.
13 +
Glickman R:  Housestaff training: The need for careful reform . N Engl J Med 1988;;318:780-782.
14 +
Friedman RC, Kornfeld DS, Bigger TJ:  Psychological problems associated with sleep deprivation in interns . J Med Educ 1973;;48:436-441.
15 +
Reznick R, Folse JR:  Effect of sleep deprivation on the performance of surgical residents . Am J Surg 1987;;154:520-525.
16 +
Friedman RC, Bigger TJ, Kornfeld DS:  The intern and sleep loss . N Engl J Med 1971;;285:201-203.
17 +
Leighton K, Livingston M:  Fatigue in doctors . Lancet 1983;;1:1280.
18 +
Deaconson TF, O'Hair DP, Levy MF, et al:  Sleep deprivation and resident performance . JAMA 1988;;260:1721-1727.
19 +
Wilkinson R:  After affect of sleep deprivation . J Exp Psychol 1963;;66:439.
20 +
Harding RM, Mills FJ:  Medical practice: Aviator medicine: II. Aircrew schedules and emergency considerations . Br Med J 1983;;287:37-39.
21 +
Blackwell B:  Prevention of impairment among residents in training . JAMA 1986;;255:1177-1178.
22 +
Sandson J:  Moonlighting medical students . N Engl J Med 1985;;312:864.
23 +
McCue J:  The distress of internship: Causes and prevention . NEngl J Med 1985;;312:449-452.
24 +
Koran L, Litt I:  House staff well-being . West J Med 1988;;148:97-101.
25 +
Loes M, Scheiber S:  The impaired resident . Ariz Med 1981;;38:777-779.
26 +
Girard DE, Elliott DL, Hickam DH, et al:  The internship: A prospective investigation of emotions and attitudes . West J Med 1986;;144:93-98.
27 +
Wolfe E, Jones H:  Problems experienced by residents in internal medicine training . West J Med 1985;;142:570-572.
28 +
Cooke M:  Stress and coping in internal medicine residency . West J Med 1985;;142:547-548.
29 +
Lo B, Schroeder S:  Frequency of ethical dilemmas in a medical inpatient service . Arch Intern Med 1981;;141:1062-1064.
30 +
Landau C, Hall S, Wartman SA, et al:  Stresses and supports during residency training , in Division of Educational Measurement and Research: Research in Medical Education . Chicago, Association of American Medical Colleges, 1984;, pp 44-49.
31 +
Wachter R:  The impact of the acquired immunodeficiency syndrome on medical residency training . NEngl J Med 1986;;314:177-179.
32 +
McCall T:  The impact of long working hours on resident physicians . N Engl J Med 1988;;318:775-778.
33 +
Resident Services Committee, Association of Program Directors in Internal Medicine:  Stress and impairment during residency training: Strategies for reduction, identification and management . Ann Intern Med 1988;;109:154-161.
34 +
Clark DC, Salazar-Grueso E, Grabler P, et al:  Predictors of depression during the first six months of internship . Am J Psychiatry 1984;;141:1095-1098.
35 +
Valko R, Clayton P:  Depression in the internship . Dis Nerv Syst 1975;;36:26-29.
36 +
Graettinger J:  Internal medicine in the National Resident Matching Program 1987: The ides of March . Ann Intern Med 1988;;108:101-115.
37 +
Reuben D:  Psychological effects of residency . South Med J 1983;;76:380-383.
38 +
Siegel B, Fitzgerald F:  A survey on the prevalence of alcoholism among the faculty and housestaff of an academic teaching hospital . West J Med 1988;;148:593-595.
39 +
McAuliffe WE, Rohman M, Santangelo S, et al:  Psychoactive drug use among practicing physicians and medical students . N Engl J Med 1986;;315:805-810.
40 +
Landau C, Hall S, Wartman SA, et al:  Stress in social and family relationships during medical residency . J Med Educ 1986;;61:654-660.
41 +
Nelson F, Henry W:  Psychosocial factors seen as problems by family practice residents and their spouses . J Fam Pract 1978;;6:581-589.
42 +
Reuben D:  Depressive symptoms in medical house officers: Effects of level of training and work rotation . Arch Intern Med 1985;;145:286-288.
43 +
Ford CV, Wentz DK:  The internship year: A study of sleep, mood states, and psychophysiologic parameters . South Med J 1984;;77:1435-1442.
44 +
Steppacher RC, Mausner JS:  Suicide in male and female physicians . JAMA 1974;;228:323-328.
45 +
Pasnau R, Russell A:  Psychiatric resident suicide: An analysis of five cases . Am J Psychiatry 1975;;132:402-406.
46 +
Schiedermayer D:  Internship from a cost-benefit analysis . J Gen Intern Med 1986;;1:37.
47 +
Adler R, Werner ER, Korsch B:  Systematic study of four years of internship . Pediatrics 1980;; 66:1000-1008.
48 +
Mulhearn T:  Dirtball . JAMA 1982;;247:3059-3060.
49 +
Bergman AB, Rothenberg MB, Telzrow RW:  A retreat for pediatric interns . Pediatrics 1979;; 64:528-532.
50 +
 ACP testifies on proposal to limit residents' work hours . Am Coll Physicians Obs 1987;;7:8-9.
51 +
Becker GE, Wortmann RL, Silva J Jr:  Computerized house officer schedules at the University of Michigan . J Med Educ 1982;;57:308-315.
52 +
Shapiro J, Prislin MD, Larsen KM, et al:  Working with the resident in difficulty . Fam Med 1987;;19:368-375.
53 +
Herrington RE, Benzer DG, Jacobson GR, et al:  Treating substance-use disorders among physicians . JAMA 1982;;247:2253-2257.
54 +
Borenstein D:  Should physician training centers offer formal psychiatric assistance to house officers? A report on the major findings of a prototype program . Am J Psychiatry 1985;;142:1053-1057.
55 +
Glick I, Borus J:  Marital and family therapy for troubled physicians and their families: A bridge over troubled waters . JAMA 1984;;251:1855-1858.
56 +
Bergman A:  Marital stress and medical training: An experience with a support group for medical house staff wives . Pediatrics 1980;;65:944-947.
57 +
Berg J, Garrard J:  Psychosocial support in residency training programs . J Med Educ 1980;;55:851-857.
58 +
Strahilevitz A:  Initiating support groups for pediatric house officers . Clin Pediatr 1982;;21:529-531.
59 +
Ziegler J, Kanas N:  A stress discussion group for medical interns . J Med Educ 1984;;59:205-207.
60 +
Reuben DB, Novack DH, Wachtel TJ, et al:  A comprehensive support system for reducing house staff distress . Psychosomatics 1984;;25:815-820.
61 +
Siegal B, Donnelly J:  Enriching personal and professional development: The experience of a support group for interns . J Med Educ 1978;;53:908-914.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Asch D, Parker R:  The Libby Zion case . N Engl J Med 1988;;318:771-774.
2 +
Tupper R:  What the debate on resident hours really means . Hosp Phys , (November) 1987;, pp 11-18.
3 +
Scherr L:  Decline in internal medicine careers: A foreboding trend . ACP Observer 1987;;2:22.
4 +
McCarty D:  Why are today's medical students choosing high-technology specialties over internal medicine? N Engl J Med 1987;;317:567-569.
5 +
Glick S:  The impending crisis in internal medicine training programs . Am J Med 1988;;84:929-932.
6 +
Barondess J:  The training of the internist: With some messages from practice . Ann Intern Med 1979;;90:412-417.
7 +
Schroeder SA, Showstack JA, Gerbert B:  Residency training in internal medicine: Time for change? Ann Intern Med 1986;;104:554-561.
8 +
Boyce-Smith G, Zier B, Deller JJ Jr:  Deficiencies in the training of internists: Results of a survey . West J Med 1977;;127:450-452.
9 +
Ziegler JL, Strull WM, Larsen RC, et al:  Stress and medical training . West J Med 1985;;142:814-819.
10 +
Cherniss C: Professional Burnout in Human Service Organizations . New York, Praeger Publishers, 1980;.
11 +
Mawardi B:  Satisfaction, dissatisfaction and causes of stress in medical practice . JAMA 1979;;241:1483-1486.
12 +
Smith JW, Denny WF, Witzke DB:  Emotional impairment in internal medicine house staff . JAMA 1986;;255:1155-1158.
13 +
Glickman R:  Housestaff training: The need for careful reform . N Engl J Med 1988;;318:780-782.
14 +
Friedman RC, Kornfeld DS, Bigger TJ:  Psychological problems associated with sleep deprivation in interns . J Med Educ 1973;;48:436-441.
15 +
Reznick R, Folse JR:  Effect of sleep deprivation on the performance of surgical residents . Am J Surg 1987;;154:520-525.
16 +
Friedman RC, Bigger TJ, Kornfeld DS:  The intern and sleep loss . N Engl J Med 1971;;285:201-203.
17 +
Leighton K, Livingston M:  Fatigue in doctors . Lancet 1983;;1:1280.
18 +
Deaconson TF, O'Hair DP, Levy MF, et al:  Sleep deprivation and resident performance . JAMA 1988;;260:1721-1727.
19 +
Wilkinson R:  After affect of sleep deprivation . J Exp Psychol 1963;;66:439.
20 +
Harding RM, Mills FJ:  Medical practice: Aviator medicine: II. Aircrew schedules and emergency considerations . Br Med J 1983;;287:37-39.
21 +
Blackwell B:  Prevention of impairment among residents in training . JAMA 1986;;255:1177-1178.
22 +
Sandson J:  Moonlighting medical students . N Engl J Med 1985;;312:864.
23 +
McCue J:  The distress of internship: Causes and prevention . NEngl J Med 1985;;312:449-452.
24 +
Koran L, Litt I:  House staff well-being . West J Med 1988;;148:97-101.
25 +
Loes M, Scheiber S:  The impaired resident . Ariz Med 1981;;38:777-779.
26 +
Girard DE, Elliott DL, Hickam DH, et al:  The internship: A prospective investigation of emotions and attitudes . West J Med 1986;;144:93-98.
27 +
Wolfe E, Jones H:  Problems experienced by residents in internal medicine training . West J Med 1985;;142:570-572.
28 +
Cooke M:  Stress and coping in internal medicine residency . West J Med 1985;;142:547-548.
29 +
Lo B, Schroeder S:  Frequency of ethical dilemmas in a medical inpatient service . Arch Intern Med 1981;;141:1062-1064.
30 +
Landau C, Hall S, Wartman SA, et al:  Stresses and supports during residency training , in Division of Educational Measurement and Research: Research in Medical Education . Chicago, Association of American Medical Colleges, 1984;, pp 44-49.
31 +
Wachter R:  The impact of the acquired immunodeficiency syndrome on medical residency training . NEngl J Med 1986;;314:177-179.
32 +
McCall T:  The impact of long working hours on resident physicians . N Engl J Med 1988;;318:775-778.
33 +
Resident Services Committee, Association of Program Directors in Internal Medicine:  Stress and impairment during residency training: Strategies for reduction, identification and management . Ann Intern Med 1988;;109:154-161.
34 +
Clark DC, Salazar-Grueso E, Grabler P, et al:  Predictors of depression during the first six months of internship . Am J Psychiatry 1984;;141:1095-1098.
35 +
Valko R, Clayton P:  Depression in the internship . Dis Nerv Syst 1975;;36:26-29.
36 +
Graettinger J:  Internal medicine in the National Resident Matching Program 1987: The ides of March . Ann Intern Med 1988;;108:101-115.
37 +
Reuben D:  Psychological effects of residency . South Med J 1983;;76:380-383.
38 +
Siegel B, Fitzgerald F:  A survey on the prevalence of alcoholism among the faculty and housestaff of an academic teaching hospital . West J Med 1988;;148:593-595.
39 +
McAuliffe WE, Rohman M, Santangelo S, et al:  Psychoactive drug use among practicing physicians and medical students . N Engl J Med 1986;;315:805-810.
40 +
Landau C, Hall S, Wartman SA, et al:  Stress in social and family relationships during medical residency . J Med Educ 1986;;61:654-660.
41 +
Nelson F, Henry W:  Psychosocial factors seen as problems by family practice residents and their spouses . J Fam Pract 1978;;6:581-589.
42 +
Reuben D:  Depressive symptoms in medical house officers: Effects of level of training and work rotation . Arch Intern Med 1985;;145:286-288.
43 +
Ford CV, Wentz DK:  The internship year: A study of sleep, mood states, and psychophysiologic parameters . South Med J 1984;;77:1435-1442.
44 +
Steppacher RC, Mausner JS:  Suicide in male and female physicians . JAMA 1974;;228:323-328.
45 +
Pasnau R, Russell A:  Psychiatric resident suicide: An analysis of five cases . Am J Psychiatry 1975;;132:402-406.
46 +
Schiedermayer D:  Internship from a cost-benefit analysis . J Gen Intern Med 1986;;1:37.
47 +
Adler R, Werner ER, Korsch B:  Systematic study of four years of internship . Pediatrics 1980;; 66:1000-1008.
48 +
Mulhearn T:  Dirtball . JAMA 1982;;247:3059-3060.
49 +
Bergman AB, Rothenberg MB, Telzrow RW:  A retreat for pediatric interns . Pediatrics 1979;; 64:528-532.
50 +
 ACP testifies on proposal to limit residents' work hours . Am Coll Physicians Obs 1987;;7:8-9.
51 +
Becker GE, Wortmann RL, Silva J Jr:  Computerized house officer schedules at the University of Michigan . J Med Educ 1982;;57:308-315.
52 +
Shapiro J, Prislin MD, Larsen KM, et al:  Working with the resident in difficulty . Fam Med 1987;;19:368-375.
53 +
Herrington RE, Benzer DG, Jacobson GR, et al:  Treating substance-use disorders among physicians . JAMA 1982;;247:2253-2257.
54 +
Borenstein D:  Should physician training centers offer formal psychiatric assistance to house officers? A report on the major findings of a prototype program . Am J Psychiatry 1985;;142:1053-1057.
55 +
Glick I, Borus J:  Marital and family therapy for troubled physicians and their families: A bridge over troubled waters . JAMA 1984;;251:1855-1858.
56 +
Bergman A:  Marital stress and medical training: An experience with a support group for medical house staff wives . Pediatrics 1980;;65:944-947.
57 +
Berg J, Garrard J:  Psychosocial support in residency training programs . J Med Educ 1980;;55:851-857.
58 +
Strahilevitz A:  Initiating support groups for pediatric house officers . Clin Pediatr 1982;;21:529-531.
59 +
Ziegler J, Kanas N:  A stress discussion group for medical interns . J Med Educ 1984;;59:205-207.
60 +
Reuben DB, Novack DH, Wachtel TJ, et al:  A comprehensive support system for reducing house staff distress . Psychosomatics 1984;;25:815-820.
61 +
Siegal B, Donnelly J:  Enriching personal and professional development: The experience of a support group for interns . J Med Educ 1978;;53:908-914.

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