1 17–21 Physicians working under acute care conditions, for example, in Emergency Departments (EDs), face a combination of cognitive load, interruptions, communication challenges and time-urgency conditions that are reported to increase the risk of adverse medical events. Physician stress is increasingly recognised as an overlooked yet important indicator of the quality and safety of patient care. 8 Since acute and chronic stress is associated with changes in neurocognitive and psychophysiological systems with implications for cerebral functioning and medical decision-making, there is a need for more detailed studies designed to investigate whether, and by which biological mechanisms, physician stress impacts patient safety.
#Doctors in training step 2 endocrine 8 trial#
10–13 A randomised trial of enhanced working conditions for physicians reported improvement in burn-out and job satisfaction in the intervention, when compared with the control group, with no discernible effects on independently charted clinical performance. 8 9 Studies looking at the impact of physicians’ working conditions on patient safety predominantly focus on either working hours or patient satisfaction. Furthermore, no study has linked objective measures of cognitive load and physiological stress to provider-independent measures of adverse outcomes. 3–7 However, previous studies lack rigour in that they fail to use biological markers of stress and do not consider how sick or injured the patients are, which might be indicators of objective stressor load. 1 2 Importantly, physician stress impacts negatively on patient-perceived quality of care and purportedly increases the risks for adverse medical events. Physician stress has been associated with adverse medical outcomes in a number of studies. The study demonstrated that it is feasible to collect both self-reports and biological data from residents during active duty in a busy Emergency Department setting. Further research is needed as to how near misses relate to adverse medical events, including errors. However, more knowledge is needed about possible differences in rating an event as a near-miss between residents and supervisors. Near misses as an outcome is a novel way to determine performance of medical learners.
Results need to be reproduced in different settings and also comparing with biological data collected from residents when they are not working in order to control for normal circadian variations. Results are based on one emergency medicine department in North America. Therefore, it is not known whether potential differences between participants and non-participants were important. No data were collected on those residents who chose not to respond to study invitations, or who initially agreed to take part and then were unable to attend.
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