Background Sickness presenteeism among healthcare professionals can compromise patient safety. To better understand what motivates this phenomenon, especially among trainees, the authors investigated attitudes of medical students, resident physicians, and faculty physicians about working when sick with what might be an infectious condition. Methods In 2012-2013, the authors employed a mixed methods, two-stage, cross-sectional survey at the University of Iowa Hospitals and Clinics of medical students (third-year students in the first survey and fourth-year students in the second survey), resident physicians in Internal Medicine, Pediatrics, and Family Medicine (first-year residents in the first survey and second-year residents in the second survey), and faculty physicians in Internal Medicine, Pediatrics, and Family Medicine. The first survey included one open-ended question querying attitudes about sickness presenteeism, answers to which underwent content analysis that identified 17 codes used to develop 23 additional closed-ended questions for a second survey. Results 127 participants completed the second survey (44% response rate). Sixty percent of these participants felt obligated to work when sick; and 33% felt obligated to work with influenza-like symptoms (fever, myalgias, cough), with residents and students being more likely to do so than faculty (67% vs. 35% vs. 14%, p = 0.001). Most participants (83%) were motivated to work when sick to avoid creating more work for colleagues, and residents and students were more likely than faculty physicians to want to avoid negative repercussions (84% vs 71% vs. 25%, p < 0.001) or appear lazy or weak (89% vs 75% vs. 40%, p < 0.001). Most participants also recognized the need to avoid spreading infections to patients (81%) or colleagues (75%). Conclusions When deciding whether to work when sick, students, residents, and faculty report a mixture of motivations that focus on the interests of patients, colleagues, and themselves. Awareness of these mixed motivations, particularly among trainees, can help inform interventions aimed at limiting instances of sickness presenteeism to support a culture of patient safety and counter any tendencies toward a hidden curriculum of efficiency and achievement.

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在医学培训中对疾病表现主义的态度：是否有隐藏的课程？

背景技术卫生保健专业人员中的疾病表现主义可能会危及患者的安全。为了更好地理解是什么原因导致了这种现象，尤其是在受训者中，作者调查了医学生，住院医师和教职医师在生病时可能患有传染病的态度。方法2012-2013年，作者在爱荷华大学医院和诊所对医学生进行了混合方法，两阶段，横断面调查（第一次调查的第三年级学生和第二次调查的第四年级学生） ），内科，儿科和家庭医学的住院医师（第一次调查的第一年住院医师和第二次调查的第二年住院医师）以及内科，儿科和家庭医学的住院医师。第一次调查包括一个关于疾病表现主义的开放式问题查询态度，对答案进行了内容分析，确定了用于第二次调查的23个封闭式问题的17个代码。结果127名参与者完成了第二次调查（答复率为44％）。这些参与者中有60％感到生病时有义务工作；另有33％的人认为自己有义务应对类似流感的症状（发烧，肌痛，咳嗽），而居民和学生比教师更容易这样做（67％比35％对14％，p = 0.001）。大多数参与者（83％）在生病时会积极工作，以避免为同事创造更多的工作，居民和学生比教师更愿意避免负面影响（84％vs 71％vs. 25％，p <0.001 ）或显得懒惰或虚弱（89％vs 75％vs. 40％，p <0.001）。大多数参与者还认识到有必要避免将感染传播给患者（81％）或同事（75％）。结论在决定是否在病假时工作时，学生，居民和教职员工会汇报各种动机，这些动机着重于患者，同事和他们自己的利益。意识到这些混合动机，尤其是在受训者中，可以帮助采取干预措施，以限制疾病表现主义的出现，从而支持患者安全文化并抵制隐藏于效率和成就的隐性课程中的任何趋势。和教职员工报告的动机混合在一起，着重于患者，同事和他们自己的利益。意识到这些混合动机，尤其是在受训者中，可以帮助采取干预措施，以限制疾病表现主义的出现，从而支持患者安全文化并抵制隐藏于效率和成就的隐性课程中的任何趋势。和教职员工报告的动机混合在一起，着重于患者，同事和他们自己的利益。意识到这些混合动机，尤其是在受训者中，可以帮助采取干预措施，以限制疾病表现主义的出现，从而支持患者安全文化并抵制隐藏于效率和成就的隐性课程中的任何趋势。