DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201520
ISSN: 1981-8963
Bolzan MEO, Guido LA, Lopes LFD et al.
Stress and coping between medical residents.
ORIGINAL ARTICLE
STRESS AND COPING BETWEEN MEDICAL RESIDENTS
ESTRESSE E COPING ENTRE RESIDENTES MÉDICOS
ESTRÉS Y COPING ENTRE MÉDICOS RESIDENTES
Maria Elaine de Oliveira Bolzan1, Laura de Azevedo Guido2, Luis Felipe Dias Lopes3, Rodrigo Marques da Silva4
ABSTRACT
Objective: to check stress and coping strategies in medical residents. Method: Cross-sectional, descriptive
and quantitative study of 112 residents in a University of Rio Grande do Sul, with professional and sociodemographic data form used from the Scale Work Stress and Coping Strategies Inventory. The data were
organized and stored in a spreadsheet in Excel 2003 (Office XP) program and statistically analyzed with the
Statistical Analysis System (SAS) software, version 9.02. The project was approved by the Research Ethics
Committee, CAEE 23081.020160/2010-06. Results: 59.82% of the subjects had high stress. The causes with
high average were "Working during straight hours " and "Feeling annoyed with disabilities in professional
training." Strategies for Coping of Factor Problem Solving and Social Support were the most used. Conclusion:
residents identify the demands of the job as stressful and use strategies of coping centered in problem and
emotion. Descriptors: Psychological stress; Internship and Residency; Nursing.
RESUMO
Objetivo: verificar estresse e estratégias de Coping em residentes médicos. Método: estudo transversal,
descritivo e quantitativo realizado com 112 residentes médicos de uma universidade do Rio Grande do Sul,
com emprego do formulário de dados sociodemográficos e profissionais, da Escala de Estresse no Trabalho e
do Inventário de Estratégias de Coping. Os dados foram organizados e armazenados em uma planilha
eletrônica no programa EXCEL 2003 (Office XP) e analisados estatisticamente com o software Statistical
Analisys System (SAS), versão 9,02. O projeto recebeu a aprovação no Comitê de Ética em Pesquisa, CAEE
23081.020160/2010-06. Resultados: 59,82% dos sujeitos apresentaram alto estresse. Os estressores de maior
média foram “Trabalhar durante horas seguidas” e “Sentir-se incomodado com a deficiência nos treinamentos
para capacitação profissional”. As estratégias de Coping do Fator Resolução de Problemas e Suporte Social
foram as mais utilizadas. Conclusão: os residentes identificam as demandas do trabalho como estressoras e
utilizam estratégias de Coping centradas no problema e emoção. Descritores: Estresse Psicológico; Internato
e Residência; Enfermagem.
RESUMEN
Objetivo: verificar estrés y estrategias de Coping en residentes médicos. Método: estudio transversal,
descriptivo y cuantitativo realizado con 112 residentes médicos de una universidad de Rio Grande do Sul, con
el uso de formulario de datos socio-demográficos y profesionales, de la Escala de Estrés en el Trabajo y del
Inventario de Estrategias de Coping. Los datos fueron organizados y almacenados en una planilla electrónica
en el programa EXCEL 2003 (Office XP) y analizados estadísticamente con el software Statistical Analisys
System (SAS), versión 9,02. El proyecto recibió la aprobación en el Comité de Ética en Investigación, CAEE
23081.020160/2010-06. Resultados: 59,82% de los sujetos presentaron alto estrés. Los motivos de estrés de
mayor media fueron “Trabajar durante horas seguidas” y “Sentirse incomodado con la deficiencia en los
entrenamientos para capacitación profesional”. Las estrategias de Coping del Factor Resolución de Problemas
y Soporte Social fueron las más utilizadas. Conclusión: los residentes identifican las demandas del trabajo
como estresantes y utilizan estrategias de Coping centradas en el problema y emoción. Descriptores: Estrés
Psicológico; Internado y Residencia; Enfermería.
1
Nurse, Master degree in Nursing, University Hospital of Santa Maria/HUSM. Santa Maria (RS), Brazil. E-mail:
mariaelaine.bolzan@bol.com.br; 2Nurse, PhD Professor in Nursing, Federal University of Santa Maria/UFSM. Santa Maria (RS), Brazil. Email: lguido344@gmail.com; 3PhD Professor in Production Engineering, Administration Department, Federal University of Santa
Maria/UFSM. Santa Maria (RS), Brazil. E-mail: lflopes67@yahoo.com.br; 4Nurse, Master Professor in Nursing, Vale do Juruena College
(AJES). Santa Maria (RS), Brazil. Email: marques-sm@hotmail.com
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INTRODUCTION
The globalized development guides to
specialization, technology, robotics and the
dehumanization of interpersonal relationships
in produtive environments.1 At the same time,
there is an increase in cases of diseases by
exercise or work activities and a requirement
for health services containing more effective
policy action on health and safety at work.2
It is observed that the emerging diseases,
such as stress, depression and anxiety, as well
as the situations of violence at work,
harassment and intimidation are responsible
for 18% of the health problems associated
with work. Furthermore, a fourth part of this
portion involves two weeks or longer without
working.3
This reality is a result of the changes
occurring in the workplace and in
organizations, with the superposition of new
technologies and management strategies
against old patterns. This facilitates the
intensification
of
work,
employment
instability modifying the profile of health
workers, as evidenced by the emergence of
other forms of diseases and manifestations of
suffering related to the work process.4 In this
circumstance,
there
are
the
health
professionals,
in
multi-professional
interaction, inserted in the social and
technological organizational context of the
work process. These include medical
residents, may be subject to diseases related
to changes made to the working environment.
The doctor does his profession generally in
accordance with the specialty of his training
at post-graduate, as is the case of the Medical
Residency, established by Decree No. 80,281
of September 5, 1977. Moreover, the same
decree established the National Commission of
Medical
Residency
(CNRM),
which
is
responsible for the accreditation and
recognition of residency programs.5
In training scenarios, medical residents
assume in front of patients, families and
society, the everyday of art and science of
medicine, under the supervision and support
of preceptors from different specialties.
Inserting them in the organizational context of
care and educational institutions, the
conquest and the solidification of spaces
within healthcare teams and the acquisition of
trust and credibility by the patients and
families are challenges for them.
Medical residents in daily work and a caring
institution, face discomforting situations,
sometimes challenging, due to internal and
external pressures. Among them, there are
the
administration
of
professional
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DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201520
Stress and coping between medical residents.
responsibility, dealing with seriously ill
patients, fear of making mistakes, demand
management of knowledge in the area and the
establishment of boundaries between personal
and professional identity.6-7 We highlight some
training characteristics, such as sleep
deprivation, fatigue, excessive care burden,
excessive administrative work, problems
concerning the quality of teaching and
learning environment, lack of time and
dedication required, anxiety about the quality
and difficulty of the material to study and the
evaluation system.6,8 Individual characteristics
and personal situations such as gender,
personality and psychological vulnerabilities
can also be stressful.6 Therefore, being though
a personal development, the period of
residence may be reported as stressful by the
resident.6
Stress
is
characterized
by
a
psychophysiological process involved the
causes of stress, the evaluation of the subject
in such a situation and the body´s reaction. In
this sense, the evaluation of the stressful
event will depend on the individual, their
experiences and possible resources for
coping.9 In addition to this, there are
strategies for Coping, used by individuals as a
way to cope with this causes of stress that in
the cognitive perspective, can be focused on
emotion and/or problem.9
With all this, the following questions were
formulated:
Do the medical resident identify job
demands as stressful? What are the coping
strategies used by these professionals? To
answer them the next objective was
determined:
● To check stress and coping strategies in
medical residents.
METHOD
Descriptive,
cross-sectional
and
quantitative study, developed in a federal
university in the interior of Rio Grande do Sul
(RS)/Brazil. The study population consisted of
121 medical residents in 17 specialties and 8
Areas of Expertise.
Data collection was conducted from
February 15 to April 30, 2011 through a form
of professionals and socio-demographic data
of the Work Stress Scale (WSS), and the
Coping Strategies Inventory (IEC).10-1 These
instruments were applied to subjects invited
and accepted to voluntarily participate in the
study after being informed of the objectives
and characteristics of the study. The approach
to the subject was taken, in most cases,
individually and sometimes in groups. Thus, it
was made personal contact with medical
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residents in their areas of action in the
institution. At first contact, the researcher
introduced himself, said the topic and
objectives of the study and invited them to
participate. When accepted, they combined
an appropriate time and made clarifications
according to the availability of the
participant. The collective approach of
residents occurred in the breaks in doctor´s
living rooms and the procedure was as in the
individual approach. When returning the
protocols, data were checked and for those
missing, the fulfillment of the form was
asked.
The WSS, built and validated in 200410,
consists of 23 items arranged in a Likert type
scale of five points. 1 - Totally disagree. 2 –
Disagree. 3 - Partly agree. 4 – Agree. 5 –
Totally agree. The IEC, translated, adapted
and validated for portuguese11, consists of 66
items showing thoughts and actions that
people use to cope with internal and external
demands of a given stress cause. The items
are arranged on a Likert scale of 4 points,
where zero – “I do not use the strategy”, 1 – “I
slightly used it”, 2 – “I used it a lot” and 3 – “I
use used it aplenty”.11
The data were organized and stored in a
spreadsheet in Excel 2003 (Office XP) program
and statistically analyzed with the Statistical
Analysis System (SAS) software, version 9.02.
The internal consistency of the instruments
was evaluated by Cronbach Alpha Coefficient.
Qualitative variables were presented in
absolute (n) and relative (%). Quantitative
variables were described in descriptive
measures: average, standard deviation,
minimum and maximum values.
For analysis of WSS, there was the
population
average,
and
from
this
measurement,
the
responses
were
dichotomized into "high" and "low" stress. In
addition, there was the average population
per item of WSS, identifying the stress cause
and the emotional reaction according to
greater and lesser stress on resident
responses. For Inventory Coping strategies
used by participants, eight proposed
classification factors were respected. Factor 1
– Confrontation. Factor 2 – Removal. Factor 3 –
Self-control. Factor 4 - Social Support. Factor
5 - Acceptance of Responsibility. Factor 6 Escape / Evasion. Factor 7 – Problem Solving.
Factor 8 – Positive Reevaluation.11 Thus, there
was the sum of scores determined in every
item of the same factor, divided by the total
number of items. This allowed us to identify
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DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201520
Stress and coping between medical residents.
the strategies most used by multidisciplinary
residents to face stress in the workplace.
It was available to those who agreed to
participate in the research, the Free Informed
Consent - FIC, with information relating to the
research, signing two copies (one for
participant and one for the researcher) and
authorizes voluntary participation in the
research. It is declared that there is no
conflict of interest.
This study is part of Stress, Coping,
Burnout, and Depressive Symptoms in Medical
Resident and multidisciplinary project,
approved by the Ethics Committee in Research
of the Federal University of Santa Maria/UFSM
under CAEE number 23081.020160/2010-06.
RESULTS
In the analysis of the internal consistency
of the WSS and IEC items, it was obtained
respectively a Cronbach's Alpha of 0.92 and
0.91.
The Factor Coping of Self-control had a
lower Alpha of 0.40 and the exclusion of any
item did not increase this value. Therefore, it
was eliminated from the analysis for this
research. Other factors obtained values of
Alpha from 0.48 to 0.72. According to authors,
these values are enough to show satisfactory
internal reliability of the instrument.12
From the population of the study, 92.56%
of residents met the eligibility criteria and
were part of this research, since two of them
left the program, two refused to participate
and five did not return the instruments.
Regarding
to
socio-demographic
characteristics of residents, there was a
predominance of male (52.68%), single
(52.68%), between 26 to 30 years old, without
children (91.96%), living with their family
(5.54%), practice sports (58.93%), have leisure
activities (75.00%) and are satisfied with the
residence (94.64%).
As to Work Stress Scale, the average was of
2.20 (± 0.66) where the minimum value was
1.00 and the maximum value was 4.08. On the
classification of the severity of stress of
medical residents, it was found that 59.82% of
them had high stress and 40.18% had low
stress. Table 1 shows the descriptive measures
for situations of higher and lower average,
i.e., representing respectively the highest and
lowest stress for medical residents.
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Bolzan MEO, Guido LA, Lopes LFD et al.
Stress and coping between medical residents.
Tabela 1. Descriptive measures for situations of higher and low
arevage of WSS. Santa Maria, Rio Grande do Sul, 2013.
WSS Situations
Average
SD*
Min.
Max.
“I'm in a bad mood working for long
hours” (10)
3,32
1,35
01
05
“I felt bothered with lack
professional training” (13)
of
3,05
1,20
01
05
“I'm bothered by my superior
avoiding
me
from
important
responsibilities” (23)
1,62
0,66
01
04
“The low perspective of improving
my career makes me distressed”
(16)
1,64
0,87
01
05
Higher stress
Lower stress
As for the IEC, the factors with the highest
average, i.e., mostly used by medical
residents facing stress are: Problem Solving
and Social Support. The least factor used by
residents is the confrontation (Table 2).
Tabela 2. Medidas descritivas dos Fatores de Coping entre
os residentes médicos. Santa Maria, Rio Grande do Sul,
2013.
Fatores de Coping
Média SD* Mín. Max.
F1-Confrontation
0,82 0,46
0
2
F2-Removal
0,92
0,43
0,14
2,57
F4–Social Support
1,66
0,56
0,33
2,83
1,63
0,49
0
2,71
1,26
0,94
0
3
F7–Problem Solving
1,98
0,50
3
0,50
F8–Positive Reevaluation
1,43
0,51
0
2,26
F5-Acceptance
Responsibility
F6–Escape-Evasion
of
*SD= Standard Deviation
In the Factor Problem Solving, the most
used strategy by the medical residents was “I
know what should be done, so I doubled my
efforts to do whatever was necessary", it was
the strategy most used by residents (  =2,24).
DISCUSSION
Medical residents are in a peculiar context,
since they are exposed to situations of the
work and the teaching-learning process,
concomitantly, that can be evaluated as
stressful for them. In this sense, it was found
that 59.82% of residents have high stress and
40.18% have low stress. In a research of
medical residents, 79.6% of them considered
their work stressful.13 In a research with
doctors of a public hospital in South Africa,
27% of these professionals in high stress were
identified.14
It is noteworthy that the residency is
characterized as a stressful phase, especially
in the first year, being a period of immersion
in the profession, with working hours
dedicated to patient care in complex
situations and difficult to handle. This
difficulty may be related to the severity of
clinical manifestations, the institutional lack
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and limitations
organization
of
compromises the
professionals and
provided to service
and/or the improper
the
training.15
This
quality of life of these
consequently the care
users.16
The situations of increased stress for
residents were "working for long hours" and
"feeling bothered with the lack of professional
training."
About the workload, in a research with
medical residents, it was identified an
average workload of 66 hours without
computing work and extracurricular shift.7
Even, when analyzing a medical residency
program in pediatrics, a group of researchers
found that, for residents the workload was
considered heavy and there was not enough
free time to study and/or for research. In this
context, it is noteworthy that the Medical
Residency Programs have minimum workload
of 60 hours/week, with 24 hours on duty per
week.17 In addition, 80 to 90% of the workload
is developed by in-service training, being 10
to
20%
for
theoretical-complementary
activities.18 It is observed that the profession
has long working hours and this fact can
constitute one of the main causes of stress for
these professionals.19
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In the lack of professional training, a study
highlights that the dissatisfaction of residents
may be due to the general conditions of
training and lack of pedagogical structure.7
Thus, the resident feels unsatisfied and has
the feel of "stolen time" when is in the
activities of residence.7 Since the professional
training is one of the main activities in most
organizations, public and private, to invest in
training is a fundamental need in all levels of
the organization, providing competitive
advantage by spreading knowledge.20
The causes of stress of lowest average are
job demands of lower stress. For medical
residents, “the superior avoiding me from
important responsibilities” and “The low
perspective of improving in the career” are
among the minor causes of stress.
In this sense, the relationship of trust
between the supervisor and the resident is an
important
factor
in
interpersonal
relationships. This may be linked to the
performance of supervisors and their
classification.
For students of general health and in
particular, for medicine students, the first
contacts with patients raise fears arising from
their personal insecurities. Thus, the presence
of the supervisor is important in these early
stages. Moreover, it helps to form and
determine the professional identity of future
doctors and it facilitates the transition
between the resident and their professional
practice. However, the image from the tutor
for the resident can be positive or negative,
depending on their impression.21-2
The few perspectives for career growth
were evaluated as the lowest average cause of
stress. This expresses that, for residents, the
issue of career and professional perspectives
are among the smaller causes of stress. This
may mean that they believe in the hypothesis
be a promising career. However, the idealized
vision of the importance of the medical and
the student associated with a promising
career may not materialize, during the course
and the residence, and be a cause of distress
for some residents.23
Once the causes of stress are known,
strategies for coping can be elaborated. The
possibility of discussion of causes of stress
among the group of residents can be a
strategy to mitigate the problems, support
and relief from stress and reduce feelings of
social isolation.23
Coping strategies from the Problem Solving
factor were prevalent among residents, who
by identifying the demands of the
environment, they move to cope the stressful
situation. In this factor, the most used
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Stress and coping between medical residents.
strategy was "I know what should be done, so I
doubled my efforts to do what was necessary."
In a study among nurses in the surgery
room, problem solving as a coping factor
prevalent among these professionals were
identified.24 In a research with a nurse in the
intensive care unit with kidney problems
patients, there was coping focused in the
problem between nurses.25 In this sense, it is
observed that for the nurses as well as
medical residents, the Problem Solving factor
was the most used, being a form of coping
centered on the problem. This confirms the
importance of the integration of the
multidisciplinary team in the process of work
of health institutions.
In problem solving, it is necessary to define
the problem, list the alternatives and
compare them with the possible desired
results and to select and establish a proper
action plan. Individuals who use these
strategies
are
able
to
modify
the
environmental pressures, minimizing the
causes of stress and make significant changes
in the stress evaluation process.9
Coping strategies as the social support
factor had the second highest average, and
the coping strategy most used by the study
subjects was "talked to someone else about
the problem, seeking more information about
the situation." In this sense, it is emphasized
that social support involves those strategies in
which the individual search for the people in
their social environment, such as family,
friends, doctors or coworkers in an attempt to
obtain cooperation and assistance to solve
their problem.26
Comparing investigations with medical
residents, a study with Dutch residents found
that lack of social support has shown a direct
effect
on
emotional
exhaustion
and
depersonalization, two of the burnout
indicators.27 Other research emphasized the
importance of social support in coping with
causes of stress to deal with the difficulties
associated with medical residents from other
cities.28 This study highlights that moving to
an unfamiliar environment, with new
responsibilities and less social support leads to
potential difficulty in adapting to a new life.28
With this strategy, the individual does not
seek to solve the cause of stress, but minimize
its effects, distorting the reality or not. In this
sense, less effective strategies for coping are
better than those centered on the problem.
Therefore, the prevalence of high stress
among residents of this study may be related
to the use of strategies of Social Support
Factor, a way of coping focused on emotion
obtaining the second highest average.
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It was found that the confrontation was the
factor less used by medical residents and the
strategy less used this factor was "tried to run
away from people in general." A similar result
was found in the surgical nurses´ area study in
which the Confrontation and Acceptance of
Responsibility factors were the less used by
researchers.24 The confrontation refers to
strategies that include the challenge view and
attention to one aspect of the situation,
involving memories of past experiences and
the evaluation of possible actions and their
consequences.26
Reactions, coping processes and adaptation
of a situation are unique to each individual, as
well as the perception, identification and
evaluation of a cause of stress differing from
one person to another. Thus, developing
coping strategies to the problems may help
decreasing the negative consequences of
stress among medicine students.29
CONCLUSION
Studies on the population of medical
resident in Brazil are from mid-90s, with
difficulties in addressing issues such as care,
chemical dependency, depression, emotional
difficulties, stress and Burnout. The main
indicated cause of stress that hinder the
performance of functions and professional
achievement, refer to the relationship with
patients, working conditions, remuneration,
hours of work, ethical dilemmas, professional
responsibility, among others.
It is considered that the hospitals are
recognized as stressful environments due to
the rigidity of the labor hierarchy process and
the present and necessary paperwork.
However, such situations often hinder the
speed and effectiveness of procedures
considered urgent. Moreover, there is direct
interaction with patients from different
health needs and the frequent recovery by
effective results by patients, family and
society as a whole.
To cope this situation, medical residents
use Coping Strategies focused on the problem,
i.e., they perform the direct confrontation of
the cause of stress, seeking to resolve the
stressful situation. However, since the
average Social Support Factor, it was observed
that residents also use strategies focused on
emotion. This may explain the high frequency
of stress among residents since this type of
strategy is considered less effective for coping
with causes of stress.
This study allowed the knowledge and
understanding of the causes of stress
identified by medical residents, as well as the
coping strategies used by them, which may
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Stress and coping between medical residents.
facilitate
closer
relations
between
professionals of health teams, within the logic
of multidisciplinary interaction, focusing the
welfare of workers and human care to
patients and families.
It is expected that the results of this study
may contribute to the residency program in
order to provide support for the establishment
of actions to minimize the difficulties and
mitigate the causes of stress experienced in
the residence and pointed out this research.
Also, to contribute with the review of work
processes in hospitals and to create spaces of
support and integration between the
multidisciplinary teams aimed at improving
the quality of life and interpersonal
relationships.
REFERENCES
1. Kirchhof RS, Guido LA, Freitas EO, Benetti
ERR, Lopes LFD. STRESS AMONG EMERGENCY
NURSES. Rev enferm UFPE on line [Internet].
2012 Dec [cited 2013 Feb 27]; 6(12):2927-33.
Available
from:
http://www.revista.ufpe.br/revistaenfermage
m/index.php/revista/article/view/3414/pdf_
1766
DOI:
10.5205/reuol.2265-25464-1LE.0612201208
2. Murofuse NT, Abranches SS, Napoleão AA.
Reflections on stress and Burnout and their
relationship with nursing. Rev Latino-Am
Enfermagem [Internet]. 2005 Mar [cited 2013
Feb
23];13(2):255-61.
Available
from:
http://www.scielo.br/pdf/rlae/v13n2/v13n2a
19.pdf
DOI:
10.1590/S010411692005000200019
3. Comisión De Las Comunidades Europeas.
Como adaptarse a los cambios en la sociedade
y en el mundo del trabajo: una nueva
estrategia comunitaria de salud y seguridad;
2002-2006.
4. Brasil. Ministério da Saúde do Brasil.
Organização Pan-Americana da Saúde/Brasil.
Doenças relacionadas ao trabalho. Manual de
Procedimento para os Serviços de Saúde. Série
A. Normas e Manuais Técnicos; (114). Brasília:
Ministério da Saúde; 2001.
5. Brasil. Ministério da Educação. Residência
Médica. Brasília (DF): Ministério da Educação;
2009.
6. Nogueira-Martins LA. Residência Médica:
estresse e crescimento. Psychiatry on-line
Brazil [Internet]. 1998 Mar [cited 2012 Nov
23];3(10):[About 8 p]. Available from:
http://www.polbr.med.br/ano98/resid2.php
7. Asaiag PE, Perotta B, Martins MA, Tempski
P. Quality of Life, Daytime Sleepiness, and
Burnout in Medical Residents. Rev bras educ
méd [Internet]. 2010 July [cited 2012 Oct
7669
ISSN: 1981-8963
Bolzan MEO, Guido LA, Lopes LFD et al.
23];34(3):422–9.
Available
from:
http://www.scielo.br/pdf/rbem/v34n3/12.pd
f DOI: 10.1590/S0100-55022010000300012.
8. Loureiro EMF, McIntyre TM, Mota-Cardoso
R, Ferreira MA. An Inventory of Sources of
Stress During Medical Education (IASSME). Rev
bras educ méd [Internet]. 2009 Apr [cited
2012 Oct 24]; 33(2): 191-7. Available from:
http://www.scielo.br/pdf/rbem/v33n2/05.pd
f DOI:10.1590/S0100-55022009000200005
9. Lazarus RS, Folkman S. Stress, appraisal,
and coping. New York: Springer Publishing
Company; 1984.
10. Paschoal T, Tamayo A. Validação da escala
de estresse no trabalho. Estud psicol
(Campinas)[Internet]. 2004 Apr [cited 2012
Nov
12];9(1):45-52.
Available
from:
http://redalyc.uaemex.mx/src/inicio/ArtPdfR
ed.jsp?iCve=26190106
11. Savóia MG, Santana PR, Mejias NP.
Adaptação do inventário de estratégias de
coping de Folkman e Lazarus para o
português. Psicol USP[Internet].1996 Dec
[cited 2012 Oct 23];7(1/2):183-201. Available
from:
http://www.revistas.usp.br/psicousp/article/
view/34538/37276
12. Bailar J, Mosteller F. Medical users of
statistics. Boston: Nejm Books; 1992.
13. Campos Velho MTA, Santos FG, Silva LC,
Zanardo CP. A residência médica no Hospital
Universitário de Santa Maria: o real e a
perspectiva através da visão dos residentes.
47º Congresso Brasileiro de Educação Médica.
Curitiba (PR): Editora; 2009.
14. Govender I, Mutunzi E, Okonta HI. Stress
among medical doctors working in public
hospitals of the Ngaka Modiri Molema district
(Mafikeng health region), North West
province, South Africa. S Afr J Psychiatr
[Internet]. 2010 May [cited 2012 Dec
12];18(2):42-6.
Available
from:
http://www.ajol.info/index.php/sajpsyc/arti
cle/view/82276/72435
15. Nogueira-Martins LA. Qualidade de vida
dos médicos residentes: revisão de estudos
brasileiros. Cad ABEM. 2010; 6(s.n):12-8.
16. Lourenção LG, Moscadine AC, Soler ZASG.
Health and quality of life of medical
residents. Rev Assoc Med Bras(1992)[Internet].
2010[cited
2012
Dec
13];56(1):81-91.
Available
from:
http://www.scielo.br/pdf/ramb/v56n1/en_21
.pdf DOI: 10.1590/S0104-42302010000100021
17- Koch VHK, Filho UD, Bollela VR.
Assessment of the Medical Residency Programs
of the Paediatrics Department of the
University of São Paulo Medical School in light
of the Professional Profiles of the Graduates.
English/Portuguese
J Nurs UFPE on line., Recife, 9(Suppl. 3):7664-71, Apr., 2015
DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201520
Stress and coping between medical residents.
Rev bras educ méd [Internet]. 2011 Dec [cited
2012 Dec 12];35(4):454–9. Available from:
http://www.scielo.br/pdf/rbem/v35n4/a03v3
5n4.pdf
DOI:
10.1590/S010055022011000400003
18. Brasil. Resolução nº 004/2003[8]. Dispõe
sobre os Programas de Residência Médica
credenciáveis pela Comissão Nacional de
Residência Médica. Brasília (DF); 2003.
19. Nogueira-Martins LA, Jorge MR. Stress
nature and magnitude during Medical
Residency
training.
Rev
Assoc
Med
Bras(1992)[Internet]. 1998 Jan [cited 2012 Dec
12];4(1):28-34.
Available
from:
http://www.scielo.br/pdf/ramb/v44n1/2005.
pdf DOI: 10.1590/S0104-42301998000100006
20. Spector PE. Psicologia nas organizações.
São Paulo: Saraiva; 2002.
21. Silva GCC, Souza EG, Koch HA. Atributos
de preceptores de programa de Residência
Médica. Rev bras educ méd[Internet]. 2008
July [cited 2012 Nov 23]; 32(3)(Suppl 2):37.
Available
from:
http://www.educacaomedica.org.br/edicoes/
numero_int.php?numero=57
22. Silva GCC, Koch HÁ, Sousa EG, GasparettoI
E, Buys RC. Anxiety and depression among
medical residents in Radiology and Diagnostic
Imaging. Rev bras educ méd [Internet]. 2010
Apr [2012 Oct 21]; 34 (2): 199-206. Available
from:
http://www.scielo.br/pdf/rbem/v34n2/a03v3
4n2.pdf
DOI:10.1590/S010055022010000200003
23. Sass N, Silveira MRF, Della Nina M.
Estresse
na
residência
médica
de
tocoginecologia: uma experiência de suporte
psicoeducacional.
Diagn
tratamento
[Internet]. 2011 Apr [cited 2012 Oct 21];
13(2):6(2):14-6.
Available
from:
http://coral.ufsm.br/ppgenf/DISSERTACAO%2
0MARIA_ELAINE.pdf.
24. Guido LA, Silva RM, Goulart CT, Kleinübing
RE, Umann J. Stress and coping among
surgical unit nurses of a teaching hospital. Rev
Rene [Internet]. 2012[cited 2012 Oct 21];
13(2):
428-36.
Available
from:
http://www.revistarene.ufc.br/revista/index.
php/revista/article/view/226/pdf
25. Britto SE, Carvalho, AMP. Stress, coping
(enfrentamento)
e
saúde
geral
dos
enfermeiros que atuam em unidades de
terapia intensiva e problemas renais. Enferm
glob [Internet]. 2004 May [cited 2012 Nov 21];
3(1):1-10.
Available
from:
http://revistas.um.es/eglobal/article/view/5
89
26. Folkman S, Lazarus RS. If it changes it
must be a process: a study of emotion and
7670
ISSN: 1981-8963
Bolzan MEO, Guido LA, Lopes LFD et al.
DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201520
Stress and coping between medical residents.
coping during three stages of a college
examination. J pers soc psychol - Psychol
health med [Internet]. 1985 Jan [cited 2012
Nov 22]; 48(1):150-70. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/29802
81
27.
Prins
JT,
Hoekstra-Weebers
JE,
Gazendam-Donofrio SM, Van De Wiel HB,
Sprangers F, Jaspers FC, Van Der Heijden FM.
The role of social support in burnout among
Dutch medical residents. Psychol health med
[Internet]. 2007 Jan [cited 2012 Nov
22];12(1):1-6.
Available
from:
http://www.ncbi.nlm.nih.gov/pubmed/17129
928
28. Marco MA, Cítero VA, Nogueira-Martins
MCF, Yazigi L, Wissow LS, Nogueira-Martins LA
et al. Medical residency: factors relating to
"difficulty in helping" in the resident
physician-patient relationship. São Paulo med
j [Internet]. 2011 Jan [cited 2012 Nov 22];
129(1):5-10.
Available
from:
http://www.scielo.br/pdf/spmj/v129n1/v129
n1a02.pdf
DOI:
10.1590/S151631802011000100002
29. Gonçalves MB, Benevides-Pereira AMT.
Considerations on medical education and its
affective and emotional impact on medical
students
in
Brazil.
Rev
bras
educ
méd[Internet]. 2009 July [cited 2012 Oct
22];33(3):493-504.
Available
from:
http://www.scielo.br/pdf/rbem/v33n3/20.pd
f
Submission: 2013/02/27
Accepted: 2014/07/04
Publishing: 2015/04/15
Corresponding Address
Laura de Azevedo Guido
Universidade Federal de Santa Maria
Departamento de Enfermagem
Rua Fioravante Antonio Spiazzi, 78 / Cerrito /
Km 03
CEP 97095-180 — Santa Maria (RS), Brazil
English/Portuguese
J Nurs UFPE on line., Recife, 9(Suppl. 3):7664-71, Apr., 2015
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