RESUMO

Objective: To study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout. Methods: Cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the Perceived Stress Scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21). Results: 78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands. In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 psychological demands dimensions (ß = 0.393; p < 0.003) and stress scores (ß = 0.451; p < 0.001) significantly predict emotional exhaustion (r2 = 0.443). Finally, 38% of junior doctors experienced a threat/aggression during their work in the emergency ward urgencies. Conclusion: Junior doctors develop its professional activity under adverse circumstances probably due to the high psychosocial risk associated to the job. Psychological demands are suggested as the main predicting factor of burnout. These results indicate the need of psychological and structural interventions in order to improve the professional performance of junior doctors at the emergency ward.

Objetivo: Evaluar el estrés, los riesgos psicosociales asociados al puesto de trabajo y el burnout en un grupo de residentes en el servicio de urgencias; y analizar qué variables se relacionan y predicen mejor el burnout. Método: Estudio analítico y trans- versal en el que han participado 42 médicos internos residentes que hacen guardias en el servicio de urgencias del Hospital Universitario San Cecilio, Granada. Se han utilizado la versión adaptada al español de la Perceived Stress Scale para evaluar el estrés, el Maslach Burnout Inventory (MBI) para valorar el desgaste profesional, y el cuestionario adaptado y baremado para la autoevaluación de riesgos psicosociales en el trabajo (CopSoQ-ISTAS21). Resultados: El 78% de los residentes evaluados se encuentra en la categoría desfavorable o intermedia en todas las dimensiones del CopSoQ-ISTAS21, y destaca que el 90% presenta una puntuación desfavorable en exigencias psicológicas. Además, en el MBI el 45% presenta conjuntamente un alto agotamiento emocional y una elevada despersonalización. La dimensión de exigencias psicológicas del ISTAS21 (ß = 0.393; p < 0.003) y las puntuaciones de estrés (ß = 0.451; p < 0.001) predicen significativamente el agotamiento emocional (r2 = 0.443). Por último, el 38% ha sufrido una amenaza/agresión en el servicio de urgencias. Conclusión: La situación de los residentes parece perjudicial para su desempeño profesional debido a los altos riesgos psicosociales asociados al puesto de trabajo. Las exigencias psicológicas se proponen como un importante predictor del burnout. Se recomiendan intervenciones psicológicas y estructurales con las que mejorar la situación de los residentes que realizan guardias en el servicio de urgencias.

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RESUMO

The aim of this study was to analyze Internal Medicine as a subject and its requirement in each of the Universities curriculum in Mexico that offers a degree in General Medicine. By the end of the first quarter of 2014, the research was closed and 81 campuses were studied. This research was quantitative, using an analytical technique, written discourse, exploratory and purposive sampling not random and homogeneous type. The Likert questionnaire was used in this study to analyse the following variables: the record of Internal Medicine as a subject, the burden of credit, and the location of the program. The procedure consisted of three phases. First obtaining an official list of all the Universities in the Mexican Association of Colleges and Schools of Medicine. Second, obtaining an analysis of each of the Universities' curriculums, and lastly gathering each variable of the study. The results of the Universities were 63% were public and 37% private. Internal Medicine as a subject in the curriculum was 37.1%, and 20% of the universities include it for six months and 9% offer it the whole year. However, the undergraduate internship in Internal Medicine offers it 100%. In conclusion, Internal Medicine as a subject could disappear from the curriculum in General Medicine before coming to the undergraduate internship, even though the latter is declared required in hospital shifts.

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