Health Services of Hidalgo, Pachuca de Soto Hidalgo, MexicoMexico
Ex-academic of Department of Medicine and Master in Public Health in (UAEH) Hidalgo State University, Pachuca City, Hidalgo State, MexicoMexico
Master’s in Public Health Intern-UAEH Autonomous University of the State of Hidalgo. Pachuca de Soto, Hidalgo. MexicoMexico
Department of Nursing in (UAEH) Autonomous University of the State of Hidalgo. Pachuca de Soto, Hidalgo. MexicoMexico
Department of Medicine in (UAEH) Autonomous University of the State of Hidalgo. Pachuca de Soto, Hidalgo. MexicoMexico
CUCS-UdeG-University Center for Health Sciences - University of Guadalajara, MexicoMexico
Department of Pharmacy and Masters in Public Health in Coordinator of the Master’s Program in Public Health (UAEH)..Autonomous University of the State of Hidalgo. Pachuca de Soto, Hidalgo. Mexico Corresponding Author
Also available as PDF (figures and tables appear in the PDF).
Introduction. Chronic fatigue is a social and professional issue that affects labor, causing poor and constrained medical attention for patients. High demand for labor output from health professionals leads to irritability and depression. This syndrome is usually present in nurses and doctors who work in close contact with other people. Recently, job-related stress due to long work requirements has become one of the major debilitating factors for the mental and physical health of medical students. Aim. Determine the impact of chronic fatigue syndrome on resident physicians and on the quality of medical care. Method. A non-experimental observation was conducted on 50 medical residents of a hospital in Pachuca, Hidalgo, Mexico. Results. 90% of resident physicians report that they work for 30 continuous hours, 10% work 40 hours in three days per week; they show fatigue and emotional distress, people give little importance to rest and sleep well, without imagining the consequences of sleep deprivation and a low in our immune system, low protection and a source of stress. In fact, medical residents are constantly under a special training regime and stressful labor, with academic and working conditions that affect their mood and mental health. Conclusion. Doctors begin the training with a clinical practice legacy of ethical maxims learned by teachers and books, but what happens in practice and daily work, could originate violent emotional shocks
Keywords: Medical residents; chronic fatigue; health syndrome; depressed mood in healthcare; Medicalresidents; chronicfatigue; healthsyndrome; depressedmoodinhealthcare
Burnout, professional burnout or fatigue syndrome emerged in the 60’s, however, it was not until the 70’s, where Freudenberger, a volunteer psychiatrist, reportedonhisexperienceworkinginaclinic,which is why he defines to this syndrome, as: “State of fatigueorfrustrationthatisproducedbydedicationtoa cause,wayoflifeorrelationshipthatdoesnotproduce theexpectedreinforcement”[1].Recently,theWorld Health Organization (WHO) has defined it as “a syndromeresultingfromchronicworkstressthathasnot beensuccessfullymanaged[2].Inadditiontothis,its recentappearanceintheInternationalClassification ofDiseases(ICD-11)referstohavingthreeimportant characteristics:feelingofexhaustion(lackofenergy), mentaldistance,negativefeelingsregardingtheplace whereoneworksandafeelingoflackofeffectiveness andpersonalfulfillment[3]. Inadditiontohighlightingthatworkstressisthepreludetomentalillnesses [4].Internationalstudiesshowthatburnoutsyndrome ispresentinbetween27and75%ofresidentdoctors andcanvarydependingonlocation[5].Accordingto the Mexican Social Security Institute (IMSS), 75% of Mexicanssufferedfromfatigueduetoworkstress[6]. Highlightingthatthehealthsectorisoneofthemost affected[7].Especiallyinhealthprofessionalswhoare residentdoctors,whentheyworkandstudyinthehospitalsetting[8][9][10],thecombinationofbothactivitieswithlittlerestisthemaincausesoftheappearance ofthissyndromeinthismedicalprofession[11].Currentlyasoneofthemostimportantcausesofweakness thataffectsthehealthofprofessionals[12].Consideringthatworkstressishighlyrelatedtovariousadverse effects,bothphysicalandmental,especiallyinhealth services[13]. Recentstudiestalkabouttheassociationbetweengreaterworkloadandlessexperience,in turnfindingthattheappearanceofburnoutsyndrome and depression is more significant in residents and healthpersonnelwhoworkmorethan24hoursthan inmanagers.doctorsoranyotherpersonnel[14].Itis saidthatresidentdoctorsareavulnerablepopulation giventhehighhealthcare,intellectualandemotional demands,especiallyinthefirstyear[15].Inaddition tothis,theneurobiologyrelatedtothisconditionhighlightschangesinthecontrolofmedicalpractice,reductionofreasoning,decisionmakingandtheabilityto persevereinthefaceofchallenges,especiallyinthe faceofuncontrollablestress,motivationdecreases,as wellascommunicationandprofessionalbehaviortowardsthepatient[16].Therefore,inthebestofcases, thestudents’adaptationprocessmustbepresent.Itis saidthatoneinthreepeopleisnotabletoadaptdue toenvironmentalconditionsandindividualsusceptibility,whichleadstomooddisturbancesandcomplex mentalproblemsthataffecttheperformanceofthe residentdoctorshowingobviousbehavioralfailures andevidentslownessinreasoning;Thisrepresentsa decrease in medical skills for the job [17] [18]. This leadstoareductioninprofessionalperformance,identifiedassignificantlyaffectingtheEnvironmentand mentalhealthofdoctorsintheexerciseoftheirwork [19].Increasingthelikelihoodofmakingmedicalerrors [20].Inadditiontocompromisingthequalityofcare duetothedeteriorationofempathywithpatients.Increasingtheriskofcommittingiatrogenesis,malpractice,lowqualityofcareandincreasedhealthexpenditure[21].Especiallywhen,inadditiontotheburnout syndrome,sometypeofdisorderoccurs,suchasdepression,worldwidethesyndromeaffects41-76%of residentdoctors,anddepressionaffects7to56Forthis reason,Navinesandcollaboratorsmentionthat“Addressingandpreventingburnoutsyndromeduringresidencycontinuestobeapendingissue,whichshould takeintoaccountnotonlythepsychosocialaspects oftheworkenvironment,butalsotheunderlyingbiologicalchangesintheperson.”thatpresentsthem” [23].Amongtheinterventionstoadoptarepromoting occupationalhealth,organizationalmeasures,support fromsupervisors,feedback,clarificationoftheprofessionalrole,teamcultureandcopingstrategies[24].
Anobservational,notexperimentaldesignwasused on50medicalresidents. Thesampleconsistedof50 medicalresidentsofthefollowingmedicalspecialties: 7residentsofgeneralsurgery,11residentsofgynecologyandobstetrics,13residentsoffamilymedicine,9 residentsofemergencymedicine,and10werephysicians specializing in pediatrics. The scenario was a publichospitalinPachuca,Hidalgo,inMéxico,during 2015.
Aspartofthisresearch,50interns(medicinestudents in the last year of their careers, before social service)wereobserved,fromthem:14%wereingeneral surgery,22%intheserviceofgynecologyandobstetrics,26%infamilymedicineservice,while18%were intheserviceofemergencymedicineand20%inserviceofpediatrics.Oftheseinterns,theoneswhowere foundtospendmoretimeinthehospitalsettingwere: infirstplace,13peopleinfamilymedicineservice,followedby11peoplefromthedepartmentofgynecology andobstetrics,andfinally,10peoplefromthepediatric ward.(Table1).
Total 7 11 Percentage 14% 22%
Regardingtimeworked,90%ofinternsreportedworking during 30 continuous hours, and 10% said they hadturnedto40continuoushoursin3daysinaweek. Prevalenceofburnoutinphysiciansofthetwoinstitutionswas90%.(Table2).
Foreachofthestressdimensions,theprevalencewas presentasfollows:96%ofresearchparticipantswere emotionalexhaustion,94%hadsymptomsofdepersonalization,while10%wereunmotivatedtodotheir job.(Table3).
The following prevalence’s were also found: 100% ofsurgeryinternspresentedwithemotionalexhaustion,100%hadsymptomsofdepersonalization,while 14.28%feltunmotivatedtodotheirjob.Inthedepartmentofgynecologyandobstetrics,100%ofrespondentsweredrainedemotionallyand90.9%reported symptoms of depersonalization, while 9% were discouragedtodotheirjob.However,theemergencydepartment,100%hademotionalexhaustion,88%experienceddepersonalization,and11%areunmotivated towork.Asforthepediatricinterns,90%showedemotionalexhaustion,100%depersonalization.(Table4).
Thefollowingtablepresentsthemainaxestoconceptualframework.(seetable5)
Duringtheemergencyrotationoftheundergraduate medicalschool,weusedtoabout80appointmentsduringthenightshift.Ononeoccasion,[anotherintern] wassoexhaustedthatapatientwithacutecholecystitis,whowastobegivenanasogastrictube,placeda Foleycatheterforurinedrainageinstead[ofthenasogastrictube].Itwasalsocommontoshareexperiences ofvividdreamsrelatedtotheworkinthehospital,we evenaskedtheresultsofthelaboratoryteststoour family. Wealsohadnoideaofthetime[ofday]after thefirst30hoursofworkwithoutrest,anddidnotdistinguishtheday[from]nightlockedupinthedelivery room,withartificiallightallthetime.Narrativeofdoctorduringinternship Duringtheemergencyrotationoftheundergraduate medicalschool,weusedtoabout80appointmentsduringthenightshift. Ononeoccasion, [anotherintern] wassoexhaustedthatapatientwithacutecholecystitis,whowastobegivenanasogastrictube,placeda
13 9 10 50 26% 18% 20% 100%
Foleycatheterforurinedrainageinstead[ofthenasogastrictube].Itwasalsocommontoshareexperiences ofvividdreamsrelatedtotheworkinthehospital,we evenaskedtheresultsofthelaboratoryteststoourfamily.Wealsohadnoideaofthetime[ofday]afterthefirst 30hoursofworkwithoutrest,anddidnotdistinguish theday[from]nightlockedupinthedeliveryroom,with artificiallightallthetime.
ThereisaprevalenceofBurnoutsyndromeinmedical residents,demonstratingthatphysicianswhoperforma specialtyarelikelytodevelopthissyndrome,andthereforethisreducesthequalityoftheirwork, andinthe samewayaffectsboththeirphysicalintegrityandtheir emotionalhealth[8][9][10][11][12][13][17][18].With these data, we can develop new techniques of trainingandbetterworkplanswhichreducetheprevalence ofthissyndromeinmedicalprofessionals,thusallowingthemtoadequatelyrecoverbothphysically,andimprovetheirqualityofcareandworkforcedevelopment. Itisimportanttonotethatburnoutsyndromemanifests itselfandnegativelyimpactsthehealthofmedicalresidentsandthat,regardlessofaffectingtheirqualityof life,itaffectsthequalityofcarethatpatientsreceive [19][20][21]. Theseresultsmakeitpossibletodetect areasofopportunity,includingreducingtheworkload ofresidents,whichwouldincreasethequalityofhealth care.
Emotional stress arises in health professionals as a resultofoverworkandextremeenergyrequirements, whichtriggersphysical,emotionalandattitudinalexhaustion.However,thedevelopmentofthissyndrome willdependonthepersonalityoftheprofessionaland theorganizationoftheplacewhereheworks, asthe disruptionintheworkplacethreatenstheorderandthe performancecapabilityoftheresidentphysician.This occurswhenthereisalackofclarityofrolesandtasks thatmustbeperformed,inadditiontherearefactors such as having bad relationships with management, unionorinstitution,whichincreasestheriskconsider-
Total 50 Percentage 100%
Table 3. PrevalenceofBurnoutSyndromebyMaslachInventory.
Total 48 47 Corresponding 96% 94%
ablyand,incombinationwithotherfactors,canleadto gradualincreaseofthesyndrome.
This syndrome significantly impacts physicians and health personnel regardless of sex or age when they areexposedtothepreviouslymentionedconditions,regardlessofwhethertheyworkforapublicorprivate healthinstitution.
imals Theauthorsdeclarethatnoexperimentshave beenconductedonhumansoranimalsforthisresearch. Confidentialityofthedata Theauthorsdeclarethat thenamesoftheresidentsorpatientsdonotappearin thisarticle.
Righttoprivacyandinformedconsent Theauthors declarethatpatientdatadoesnotappearinthisarticle. Financing Any.
MEGH:originalideaoftheproject,designoftheresearch, datacollection,elaborationofthemanuscriptandanalysisoftheinformation.JCRL:originalideaoftheproject, designoftheresearch,datacollection,elaborationof themanuscriptanalysisoftheinformation,revisionand criticalanalysisofthemanuscript,designandstructuringofthefinalversionofthearticle.EGTO,ORFCH,CTSP, MCLZ,LCHE,andJRV:elaborationofthemanuscriptand analysisoftheinformation,revisionandcriticalanalysis ofthemanuscript,Literaturereviewandsupportinthe applicationofsurveys.
Theauthorsdeclarethatthereisnoconflictofinterest forthepublicationofthisresearchpaper.
ArtificialIntelligence.TheauthorsdeclarethatAIwas notusedinthepreparationofthisresearch.
Theauthorsofthepresentresearcharticlewouldlike to acknowledge and truly thank the collaboration of YeseniaElizabethRuvalcabaCobián,whohasaB.Ain 90%
5 45 50 10% 90% 100%
TeachingEnglishasaForeignLanguage,forhercontributionsontherevisionandtranslationofthearticle; situation which allows the possibility to increase the transferringandmodificationofscientificknowledge.