title: Stress and its association with working efficiency of junior doctors during three postgraduate residency training programs.
abstract: BACKGROUND
  The residency training period in the medical profession is well known for physical and mental stress, which may affect cognitive function and practical life. The aims of this study were to assess prevalence of stress among the resident trainees of the three medical specialties of Saudi Commission for Health Specialties (SCHS) training programs, namely, Internal Medicine, Emergency Medicine, Family Medicine, and their association with training years, sex, and marital status. This study also aimed to correlate the stress levels with the working efficiency and self-perceived general health problems.
  
  
  METHODS
  Resident trainee physicians of SCHS were invited to complete a stress inventory Kessler 10, which is used for stress measurement. Pearson's chi-square test (χ (2)) and odds ratios (ORs) were used to quantify the associations between categorical variables. A P-value of <0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 318 (out of 389, with the response rate of 82%) resident trainees participated in this study. The mean (± standard deviation) age of the study population was 27.9 (±1.6) years. The results showed 70.4% of resident trainees had stressful conditions, which consisted of severe stress: 22.6%, moderate stress: 20.4%, and mild stress: 27.4%. During the 1st year (R-1), moderate stress (OR =5.87; 95% confidence interval =2.93-17.79; P=0.001) and severe stress (OR =11.15; 95% confidence interval =4.35-28.51; P=0.0001) levels were quite high. The highest stress level was found in Emergency Medicine (80.5%), followed by Internal Medicine (73.6%), and Family Medicine (63.2%) (χ (2)=6.42; P=0.04). The stress level decreased with the increase of years of training in Emergency Medicine (χ (2)=23.76; P<0.0001) and Internal Medicine (χ (2)=60.12; P<0.0001), whereas increased in Family Medicine (χ (2)=11.80; P=0.008). High stress level was significantly associated with absence from duty days (χ (2)=28.48, P<0.0001), inefficient day activities (χ (2)=39.15; P<0.0001), and general health problems (χ (2)=45.27; P<0.0001) of resident trainees.
  
  
  CONCLUSIONS
  We found significantly high levels of stress among the resident trainees of SCHS. High levels of stress may have an effect on their working efficiency and general physical health. The high stress level decreased efficient day activity and made the trainees absent from the workplace.
authors.affiliation: Department of Medical Education, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hamza Mohammad
authors.initials: HM
authors.lastname: Abdulghani
authors.affiliation: Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mohammed Meteb
authors.initials: MM
authors.lastname: Al-Harbi
authors.affiliation: Department of Medical Education, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Irshad
keywords: postgraduate; residency training; specialties; stress