Theodore W. Whitley

A study of occupational stress and depression among emergency physicians

OBJECTIVE To determine the level of stress and depression among emergency physicians and whether these variables were related to the emergency physicians decision to leave the specialty. STUDY DESIGN AND TYPE OF PARTICIPANTS: The study involved a random sample of 1,350 emergency physicians who received a questionnaire containing scales on depression and occupational stress as well as questions about their future plans for remaining in the specialty. RESULTS Seven hundred sixty-three usable surveys (56.5%) were returned. Mean scores for the locus of control, Work-Related Strain Inventory, and the Center for Epidemiologic Studies--Depression Scale (CES-D) were within normal ranges. However, a disproportionate number, ie, more than 2.5% of the sample, scored more than two standard deviations from the mean. With the exception of the work satisfaction scale, there were no significant differences between the scores of fellows and nonfellows on measures of locus of control, stress, or depression. Of the population, 12.4% indicated that they were somewhat likely to very likely to leave the clinical practice of emergency medicine within the next year; 26.7% planned on leaving in the next five years, and less than half (42.9%) planned on seeing patients ten years from now. Older men, women, and those with high levels of stress and low job satisfaction were more likely to leave the specialty over the next ten years. CONCLUSION While the vast majority of emergency physicians reported normal levels of stress, a disproportionate number reported high levels of stress and depression and plan on leaving the specialty of emergency medicine. The number of individuals planning to leave appeared to be greater than the number that will be replaced through residency training.

Is Ambulance Transport Time With Lights and Siren Faster Than That Without

STUDY OBJECTIVE To determine whether ambulance transport time from the scene to the emergency department is faster with warning lights and siren than that without. DESIGN In a convenience sample, transport times and routes of ambulances using lights and sirens were recorded by an observer. The time also was recorded by a paramedic who drove an ambulance without lights and siren over identical routes during simulated transports at the same time of day and on the same day of the week as the corresponding lights-and-siren transport. SETTING An emergency medical service system in a city with a population of 46,000. PARTICIPANTS Emergency medical technicians and paramedics. RESULTS Fifty transport times with lights and siren averaged 43.5 seconds faster than the transport times without lights and siren [t = 4.21, P = .0001]. CONCLUSION In this setting, the 43.5-second mean time savings does not warrant the use of lights and siren during ambulance transport, except in rare situations or clinical circumstances.

What predicts medical student career choice

The literature on medical student career choice has identified several influences that can be categorized as student demographics, medical school characteristics, students’ perceptions of specialty characteristics, and student-held values. A logistic regression model that included demographics, medical school, and student-rated influences as a proxy for perceptions and values was used to determine their relative contribution to student career choice for three consecutive cohorts of senior medical students attending two schools (n=649). This model identified a positive relation between choice of primary care career and both student-rated influences and one student demographic characteristic, but not between career choice and school attended. Variables positively correlated with primary care career choice were related to working with people and marital status. Negatively correlated variables were related to income and prestige.

Organizational Characteristics, Perceived Work Stress, and Depression in Emergency Medicine Residents

Abstract A structural equation analysis of data collected from 484 members of the Emergency Medicine Residents Association was used to test a model in which peer support and work-group cohesiveness predicted role ambiguity. Role ambiguity was then specified as a predictor of work-related stress. Stress was hypothesized to affect depression and work satisfaction. The analysis confirmed the direct relationship between stress and depression and indicated that support from peers and the work group reduces stress. This impact is influenced by the amount of role ambiguity perceived by residents. Peer support, role ambiguity, and stress explain 52% of the variance in depression reported by residents. Residents are more satisfied with their work when their peers are supportive and when levels of occupational stress and role ambiguity are not high. The model accounted for 47% of the variance in reported work satisfaction. The results suggest that role ambiguity leads to perceptions of stress. This perceived stress...

Factors associated with stress among emergency medicine residents.

A survey of members of the Emergency Medicine Residents Association was conducted to investigate the occupational stress and depression experienced by this group. The 488 respondents provided demographic information and completed measures of stress and depression. Multivariate analysis of variance revealed statistically significant differences in stress and depression by year of training (P less than .001), gender (P less than .01), and marital status (P less than .01). Univariate analyses of variance revealed overall differences in both stress and depression. Mean levels of stress and depression were higher for women residents, and unmarried residents reported more depressive symptomatology. The results indicate that women emergency medicine residents experience more stress and depression than men and that spouses can buffer some of the stress of residency training for men and women residents. No significant differences in stress or depression by year in training were revealed by univariate analysis of variance, which suggests that residents experience stress throughout the course of training. The similarities and differences in the occupational stress and depression experienced by emergency medicine residents in comparison with residents from other specialties suggest that additional study in emergency medicine is warranted.

Work-related stress and depression among practicing emergency physicians: An International study

STUDY OBJECTIVE To compare the levels of work-related stress and depression reported by practicing emergency physicians in three survey sites and to determine the effects of gender and marital status on the stress and depression experienced by these physicians. DESIGN Cross-sectional mail surveys. SETTING AND PARTICIPANTS Seven hundred sixty-four practicing emergency physicians from the United States, 91 fellows in full-time practice from Australasia, and 154 consultants and 47 senior registrars from the United Kingdom. INTERVENTION Administration of questionnaires requesting demographic information and including an inventory to assess work-related stress and a scale to measure depressive symptomatology. MEASUREMENTS AND MAIN RESULTS A 3 x 2 x 2 multivariate analysis of variance performed to compare scores on the stress inventory and depression scale simultaneously by survey site, gender, and marital status revealed significant differences in stress and depression by survey site and marital status. Univariate analyses of variance revealed significant differences in both stress and depression among the three survey sites and in depression by marital status. Adjusted means indicated that physicians from the United Kingdom reported higher levels of stress and depression than physicians from the United States and Australasia. Physicians from the United States and Australasia did not differ with respect to stress or depression. Physicians who were not married reported higher levels of depression than married physicians. No large mean differences, actual or adjusted, were found for any of the grouping factors. CONCLUSION Statistical differences among practicing emergency physicians from the United States, Australasia, and the United Kingdom were observed, but the actual levels of work-related stress and depression were similar and did not appear severe. Marriage was associated with lower levels of depressive symptomatology.

Reliability and Validity of the Work-Related Strain Inventory among Health Professionals

This article provides evidence from five samples of different health professionals (family physicians, emergency medical technicians, hospital nurses, flight nurses, and emergency medicine residents) for the reliability and validity of the Work-Related Strain Inventory (WRSI). The inventory consists of 18 items and was designed to measure perceptions of strain in occupational settings. Internal consistency reliability ranged from .85 to .90 and, as predicted, was correlated with the Maslach Burnout Inventory and measures of depression, role ambiguity, job satisfaction, and work-group functioning. When compared with different measures of depression symptoms (eg, Zung Self-Rating of Depression Scale, Center for Epidemiologic Studies Depression Scale), the Work-Related Strain Inventory was found to measure a different and independent construct. This inventory, a short, easily administered measure with good reliability, may be useful for appraising levels of work-related strain in behavioral and organizational models of the consequences of stress in different work environments.

Prehospital care by EMTs and EMT-is in a rural setting: Prolongation of scene times by ALS procedures

Because the initiation of IV lines by emergency medical technicians-Intermediates (EMT-Is) appeared to delay the patients transport to the hospital, we undertook a retrospective study of 370 patients to compare prehospital care rendered by EMTs (EMT-A equivalent) and EMT-Is in a rural setting. Our study was limited to acute medical conditions in which protocols called for IV lines (124 patients with chest pain, 122 with acute respiratory distress, 99 with seizures, and only 25 with cardiac arrest) (the cardiac arrest cases were too few for statistical significance). We found that the difference in scene times for EMTs and EMT-Is not attempting IV lines was 6.1 and 6.9 minutes, respectively. The average scene time of EMT-Is attempting an IV line was 19.6 minutes (P less than .001) compared with EMT times, or times for EMT-Is not attempting an IV line. One hundred twenty-eight of 370 patients received IV medication within ten minutes of arrival in the emergency department, and ten of these patients had their IV lines initiated successfully in the field. Thirty-nine percent of patients with ED IV lines received IV medication within ten minutes of arrival, while only 21% of patients with a field IV line received medication in this period (P less than .05). We conclude that initiating a field IV line in this specific patient population significantly increased scene time and did not improve the chances of these patients receiving IV medication within ten minutes of arrival in the emergency department.

Work-related stress and depression among physicians pursuing postgraduate training in emergency medicine: An international study

STUDY OBJECTIVE To compare the levels of work-related stress and depression reported by physicians-in-training in emergency medicine in three survey sites and to determine the effects of gender and marital status on stress and depression among these physicians. DESIGN Cross-sectional mail surveys. SETTING AND TYPE OF PARTICIPANTS Physicians-in-training in the United States, United Kingdom, and Australasia. INTERVENTION Questionnaires requesting demographic information and including scales assessing work-related stress and depression were administered. MEASUREMENTS AND RESULTS A 3 x 2 x 2 multivariate analysis of variance in which survey site, gender, and marital status were independent variables and stress and depression scale scores were dependent variables revealed significant differences when stress and depression were analyzed simultaneously. Univariate analyses of variance revealed significant differences in stress by survey site and gender and in depression for all three independent variables. Comparison of adjusted means revealed that respondents from the United Kingdom reported significantly higher levels of stress than did respondents from the United States and that women reported significantly higher levels than men. Respondents from the United States reported significantly higher levels of depression than did respondents from the other countries, women reported higher levels than men, and unmarried respondents reported higher levels than married respondents. CONCLUSION Despite limitations resulting from self-report bias, cross-sectional survey methodology, sampling error, and differences in training among the three survey sites, the respondents experienced similar levels of stress and depression attributable to anticipated sources.

Bicycle accidents and injuries: A pilot study comparing hospital- and police-reported data

Bicycle accident and injury data collected by two different samples of North Carolina hospital emergency rooms during the summers of 1985 and 1986 are examined and compared with state police-reported bicycle accident data for the same time periods. Of the 649 emergency room treated bicyclists, 62% were children aged 5-14 and 70% were male. Nineteen percent of the riders suffered moderate or worse injuries (AIS greater than or equal to 2), and 6% were hospitalized. In contrast, less than half of the police-reported accidents involved riders under 15 years of age, 85% of the riders were male, and two-thirds suffered moderate or worse injury. Whereas virtually all of the police-reported accidents involved a motor vehicle, less than a fifth of the emergency room cases did. Only 10% of the emergency room cases were duplicated on the state accident files. It is estimated that 800 children ages 0-19 are hospitalized annually in North Carolina for bicycle-related injuries, and an additional 13,300 children receive emergency room treatment.