Importance Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency. Objective To explore factors associated with symptoms of burnout and career choice regret during residency. Design, Setting, and Participants Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016. Exposures Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school. Main Outcomes and Measures Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again). Results Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.24 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.17 [95% CI, 1.07 to 1.28]; risk difference [RD], 7.2% [95% CI, 3.1% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.11]; RD, 1.8% per 1-point increase [95% CI, 1.6% to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 0.99]; RD, −0.5% per 1-point increase [95% CI, −0.6% to −0.3%]). Reported symptoms of burnout (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret. Conclusions and Relevance Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.

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美国住院医师职业倦怠症状与职业选择后悔的临床专业关联

医生的职业倦怠很常见，并且与医疗错误和专业性失误有关。目前尚不清楚住院医师职业倦怠症状的比率是否因临床专业而异，以及在医学院期间测量的个体因素是否与住院期间职业倦怠的风险和职业选择后悔有关。目的探讨住院期间倦怠症状和职业选择后悔的相关因素。设计、设置和参与者 4732 名美国住院医师的前瞻性队列研究。2010 年 10 月至 2011 年 1 月期间招收了一年级医学生并完成了基线问卷。参与者被邀请回答 2 份问卷；一个在医学院的第 4 年（2014 年 1 月至 3 月）和另一个在住院医师的第二年（2016 年春季）。最后一次随访时间为 2016 年 7 月 31 日。暴露临床专业、人口特征、教育债务、美国医学执照考试 Step 1 分数，以及报告的医学院期间的焦虑、同理心和社会支持水平。主要结果和措施 居住第二年报告的职业倦怠症状的患病率，通过 2 个单项措施（改编自 Maslach 职业倦怠量表）和一个评估职业选择后悔的附加项目（定义为是否能够重新审视职业选择） ，居民会选择再次成为一名医生）。结果 在4696名住院医师中，3588人（76.4%）在住院第二年完成了问卷（2016年中位年龄29[四分位距，28.0-31.0]岁；女性1822人[50.9%]）。3574 名住院医师中有 1615 名报告了倦怠症状（45.2%；95% CI，43.6% 至 46.8%）。3571 名住院医师中有 502 名报告了职业选择后悔（14.1%；95% CI，12.9% 至 15.2%）。在多变量分析中，与内科培训相比，泌尿科、神经病学、急诊医学和普通外科培训与报告的倦怠症状（RR 范围，1.24 至 1.48）的较高相对风险 (RR) 相关。与报告的倦怠症状较高风险相关的特征包括女性（RR，1.17 [95% CI，1.07 至 1.28]；风险差 [RD]，7.2% [95% CI，3.1% 至 11.3%]）和更高的报告医学院期间的焦虑水平（RR，每增加 1 点增加 1.08 [95% CI，1.06 至 1.11]；RD，每增加 1 点增加 1.8% [95% CI，1.6% 至 2.0%]）。医学院期间较高的同理心报告水平与住院期间报告的倦怠症状的风险较低相关（RR，每增加 1 分 0.99 [95% CI，0.99 至 0.99]；RD，每 1 分增加 -0.5%增加 [95% CI，-0.6% 至 -0.3%]）。报告的倦怠症状（RR，3.20 [95% CI，2.58 至 3.82]；RD，15.0% [95% CI，12.8% 至 17.3%]）和临床专业（RR 范围，1.66 至 2.60）均显着相关带着职业选择的遗憾。结论和相关性 在美国住院医师中，职业倦怠和职业选择后悔的症状很普遍，但因临床专业而异。需要进一步研究以更好地了解这些差异并解决这些问题。99 到 0.99]；RD，-0.5% 每增加 1 个点 [95% CI，-0.6% 至 -0.3%]）。报告的倦怠症状（RR，3.20 [95% CI，2.58 至 3.82]；RD，15.0% [95% CI，12.8% 至 17.3%]）和临床专业（RR 范围，1.66 至 2.60）均显着相关带着职业选择的遗憾。结论和相关性 在美国住院医师中，职业倦怠和职业选择后悔的症状很普遍，但因临床专业而异。需要进一步研究以更好地了解这些差异并解决这些问题。99 到 0.99]；RD，-0.5% 每增加 1 个点 [95% CI，-0.6% 至 -0.3%]）。报告的倦怠症状（RR，3.20 [95% CI，2.58 至 3.82]；RD，15.0% [95% CI，12.8% 至 17.3%]）和临床专业（RR 范围，1.66 至 2.60）均显着相关带着职业选择的遗憾。结论和相关性 在美国住院医师中，职业倦怠和职业选择后悔的症状很普遍，但因临床专业而异。需要进一步研究以更好地了解这些差异并解决这些问题。结论和相关性 在美国住院医师中，职业倦怠和职业选择后悔的症状很普遍，但因临床专业而异。需要进一步研究以更好地了解这些差异并解决这些问题。结论和相关性 在美国住院医师中，职业倦怠和职业选择后悔的症状很普遍，但因临床专业而异。需要进一步研究以更好地了解这些差异并解决这些问题。