title: Senior house officers' work related stressors, psychological distress, and confidence in performing clinical tasks in accident and emergency: a questionnaire study.
abstract: OBJECTIVE
  To investigate the relation between accident and emergency senior house officers' psychological distress and confidence in performing clinical tasks and to describe work related stressors.
  
  
  METHODS
  Questionnaire survey with data collected at four points during senior house officers' six month attachment to accident and emergency departments.
  
  
  METHODS
  171 newly appointed accident and emergency senior house officers from 27 hospitals in the South Thames region.
  
  
  METHODS
  Psychological distress measured with a 25 item questionnaire; confidence in performing a range of 35 clinical and practical activities (visual analogue scales); reported consultation stress factors, other work related stressors, and personal stressors.
  
  
  RESULTS
  Overall confidence scores in carrying out a range of clinical and practical activities increased significantly between the end of the first and the end of the fourth month (Z = -6.05, P < 0.001). Senior house officers with higher psychological distress scores at the end of their first and fourth month had significantly lower confidence scores (Z = -3.20, P < 0.001; Z = -1.90, P < 0.05). Senior house officers with lower increases in confidence between the first and fourth month had significantly higher distress than those with greater increases (Z = -2.62, P < 0.001). Factors identified as causing stress during consultations included difficulties with communication, certain clinical presentations, and department organisational factors (particularly the intensity of workload).
  
  
  CONCLUSIONS
  Psychological distress is linked to confidence in senior house officers. This supports the need to monitor and build confidence in senior house officers and to address work related stressors. Additional communication skills training needs to be considered.
authors.affiliation: Department of General Practice and Primary Care, King's College School of Medicine and Dentistry, London.
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.forename: J
authors.initials: J
authors.lastname: Dale
authors.forename: E
authors.initials: E
authors.lastname: Glucksman
authors.forename: A
authors.initials: A
authors.lastname: Wellesley
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D004739:England; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D009784:Occupational Diseases / Q000523:psychology*; D011364:Professional Practice; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D000078329:Workforce; D016526:Workload