title: The psychological and physiological effects of acute occupational stress in new anesthesiology residents: a pilot trial.
abstract: BACKGROUND
  Occupational stress in resident physicians has profound implications for wellness, professionalism, and patient care. This observational pilot trial measured psychological and physiological stress biomarkers before, during, and after the start of anesthesia residency.
  
  
  METHODS
  Eighteen physician interns scheduled to begin anesthesia residency were recruited for evaluation at three time points: baseline (collected remotely before residency in June 2013); first-month visit 1 (July); and follow-up visit 2 (residency months 3 to 5, September-November). Validated scales were used to measure stress, anxiety, resilience, and wellness at all three time points. During visits 1 and 2, the authors measured resting heart-rate variability, responses to laboratory mental stress (hemodynamic, catecholamine, cortisol, and interleukin-6), and chronic stress indices (C-reactive protein, 24-h ambulatory heart rate and blood pressure, 24-h urinary cortisol and catecholamines, overnight heart-rate variability).
  
  
  RESULTS
  Thirteen interns agreed to participate (72% enrollment). There were seven men and six women, aged 27 to 33 yr. The mean ± SD of all study variables are reported.
  
  
  CONCLUSIONS
  The novelty of this report is the prospective design in a defined cohort of residents newly exposed to the similar occupational stress of the operating environment. Because of the paucity of literature specific to the measures and stress conditions in this investigation, no data were available to generate a priori definition of primary outcomes and a data analytic plan. These findings will allow power analysis for future design of trials examining occupational stress and stress-reducing interventions. Given the importance of physician burnout in our country, the impact of chronic stress on resident wellness requires further study.
authors.affiliation: From the Department of Anesthesiology (J.H.E., J.S., T.N.K., D.P.C., T.R.L.), Department of Psychology (M.M.C.), Division of Hematology, Department of Medicine (T.D.S.), and Department of Cardiovascular Diseases (B.D.J.), Mayo Clinic, Rochester, Minnesota; and Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan (J.R.C.).
authors.forename: John H
authors.initials: JH
authors.lastname: Eisenach
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Clark
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Johnson
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Kruse
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chantigian
authors.forename: Jason R
authors.initials: JR
authors.lastname: Carter
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Long
mesh_terms: D000208:Acute Disease; D000328:Adult; D000776:Anesthesiology / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D016272:Occupational Health; D013315:Stress, Psychological / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology*; D011795:Surveys and Questionnaires
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