title: Resident and attending physician perception of maladaptive response to stress in residents.
abstract: BACKGROUND
  Residency stress has been shown to interfere with resident well-being and patient safety. We developed a survey research study designed to explore factors that may affect perception of a maladaptive response to stress.
  
  
  METHODS
  A 16-item survey with 12 Likert-type perception items was designed to determine how often respondents agreed or disagreed with statements regarding the resident on the trigger tape. A total of 438 respondents from multiple institutions completed surveys.
  
  
  RESULTS
  Attending physicians were more likely than residents to agree that the resident on the trigger tape was impaired, p<0.0001; needed to seek professional counseling, p=0.0003; should be removed from the service, p=0.002; was not receiving adequate support from the attending physician, p=0.007; and was a risk to patient safety, p=0.02. Attending physicians were also less likely to agree that the resident was a good role model, p=0.001, and that the resident should be able to resolve these issues herself/himself, p<0.0001.
  
  
  CONCLUSIONS
  Our data suggest that resident physicians may not be able to adequately detect maladaptive responses to stress and that attending physicians may be more adept at recognizing this problem. More innovative faculty and resident development workshops should be created to teach and encourage physicians to better observe and detect residents who are displaying maladaptive responses to stress.
authors.affiliation: Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL, USA; lriesenberg@uab.edu.
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Riesenberg
authors.affiliation: Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.affiliation: Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Berg
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.affiliation: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Davis
authors.affiliation: Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Davis
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Arielle
authors.initials: A
authors.lastname: Schaeffer
authors.affiliation: Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hargraves
authors.affiliation: Christiana Care Health System, Newark, DE, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Little
mesh_terms: D000428:Alcohol Drinking; D003430:Cross-Sectional Studies; D003625:Data Collection; D004499:Education, Dental, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D013315:Stress, Psychological / Q000175:diagnosis*; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires; D013663:Teaching
keywords: graduate medical education; residents; stress; stress management