第一年住院醫師工作壓力、過勞情形縱貫性研究

隨著醫療需求攀升，醫師的工作負荷持續增加，尤其第一年住院醫師（R1）處於醫療現場的最前線，需適應高壓工作環境、角色轉換與專科訓練等多重挑戰，長期的身心健康狀況令人擔憂。本研究旨在探討R1工作壓力、過勞情形隨訓練時間變化之趨勢，與人口背景變項、工作性質變項在跨時間層次上對過勞變化程度之影響。本研究採縱貫性設計，便利取樣中南部三間教學醫院之R1，透過問卷於專科訓練一年間進行四次收案(第一、四、八、十二個月底)，兩年度共計126份有效樣本。問卷內容涵蓋人口學變項、工作特性、醫師工作壓力自評表與過勞量表。研究結果顯示，R1訓練第八個月（T3）之之工作壓力、過勞情形均顯著高於訓練第一個月（T1）；而訓練每增加一個月，過勞情形會上升0.3分。女性、曾於其他科/院受訓的R1，以及有參與COVID-19專責病房照護者在T1的過勞情形顯著較高，且女性在後續訓練階段的過勞程度仍顯著高於男性。區分科別後分析顯示，內科系R1在T3的過勞程度顯著高於T1內、外科系組女性過勞情形均顯著高於男性。此外，無論是否依科別分組，R1工作壓力每增加1分，過勞程度均會隨之上升0.25-0.38分不等，但工作壓力與過勞程度變化率並不具跨時間層次的交互作用。本研究發現，工作壓力可穩定預測R1於訓練階段的過勞程度，但其影響力隨時間推移並未有顯著增強或減弱。各專科獨特的工作特性、性別差異、工作環境與個人適應速度等因素，均可能導致R1經歷不同程度、類別的過勞變化，且即使R1已逐漸適應職場，過勞情形仍可能未見明顯緩解。本研究促進對R1訓練期間過勞情形變化之了解，呼籲訓練機構應特別留意其訓練初期的壓力感受，持續關注過勞情形的長期發展，並建議未來研究深入探討不同壓力源對過勞類型的影響，以促進住院醫師的心理健康與福祉改善。

As medical demands continue to rise, physicians face an increasing workload. The First-year residents (R1s), positioned at the forefront of medical care, must adapt to a high-pressure work environment, role transitions, and specialized training, all of which present significant challenges. Their long-term physical and mental health remains a concern. This study aims to examine the changes of R1s' job stress and burnout over time and the influence of demographic and job-related factors on burnout across different time points.This study employs a longitudinal design and utilizes convenience sampling from R1s at three teaching hospitals in central and southern Taiwan. Data were collected through surveys at four time points over one year of specialty training, resulting in a total of 126 valid samples across two years. The questionnaire included demographic variables, job characteristics, the Physician Work Stress Self-Assessment Scale, and the Burnout Scale.Results indicate that both work stress and burnout levels at the eighth month of training (T3) were significantly higher than those at the first month (T1), with burnout increasing by 0.3 points per additional month of training. Female R1s, those who had received training in other specialties or hospitals, and those involved in COVID-19 ward care reported significantly higher burnout levels at T1. Moreover, female R1s continued to experience significantly higher burnout levels than their male counterparts throughout the training period. Analysis by specialty revealed that internal medicine R1s exhibited significantly higher burnout at T3 than at T1, and in both internal and surgical specialties, female R1s reported significantly higher burnout than males. Additionally, regardless of specialty grouping, for every 1-point increase in work stress, burnout increased by 0.25–0.38 points. However, the interaction effect between work stress and burnout change rates over time was not significant.This study finds that work stress consistently predicts burnout levels in R1s during training, yet its impact does not significantly intensify or diminish over time. Factors such as specialty-specific work characteristics, gender differences, work environment, and individual adaptation rates may contribute to varying degrees and patterns of burnout. Furthermore, even as R1s adjust to their work environment, burnout may not necessarily improve. This study enhances understanding of burnout dynamics during R1 training, urging training institutions to pay close attention to stress levels in the early stages of residency and monitor long-term burnout trends. Future research should explore the effects of different stressors on various types of burnout to further improve residents’ mental health and well-being.