Intended for healthcare professionals


Senior house officers' work related stressors, psychological distress, and confidence in performing clinical tasks in accident and emergency: a questionnaire study

BMJ 1997; 314 doi: (Published 08 March 1997) Cite this as: BMJ 1997;314:713
  1. Susan Williams, research fellowa,
  2. Jeremy Dale, senior lecturer in primary carea,
  3. Edward Glucksman, consultantb,
  4. Amanda Wellesley, senior registrarb
  1. a Department of general practice and primary care, King's college school of medicine and dentistry, London SE5 9PJ
  2. b Department of accident and emergency medicine, King's college hospital, London SE5 9RS
  1. correspondence to: Susan Williams
  • Accepted 29 November 1996


Objective: To investigate the relation between accident and emergency senior house officers' psychological distress and confidence in performing clinical tasks and to describe work related stressors.

Design: Questionnaire survey with data collected at four points during senior house officers' six month attachment to accident and emergency departments.

Subjects: 171 newly appointed accident and emergency senior house officers from 27 hospitals in the South Thames region.

Main outcome measures: Psychological distress measured with a 25 item questionnaire; confidence in performing a range of 35 clinical and practical activities (visual analogue scales); reported consultation stress factors, other work related stressors, and personal stressors.

Results: Overall confidence scores in carrying out a range of clinical and practical activities increased significantly between the end of the first and the end of the fourth month (Z=-6.05, P<0.001). Senior house officers with higher psychological distress scores at the end of their first and fourth month had significantly lower confidence scores (Z=-3.20, P<0.001; Z=-1.90, P<0.05). Senior house officers with lower increases in confidence between the first and fourth month had significantly higher distress than those with greater increases (Z=-2.62, P<0.001). Factors identified as causing stress during consultations included difficulties with communication, certain clinical presentations, and department organisational factors (particularly the intensity of workload).

Conclusions: Psychological distress is linked to confidence in senior house officers. This supports the need to monitor and build confidence in senior house officers and to address work related stressors. Additional communication skills training needs to be considered.

Key messages

  • The importance of dealing with stress in junior doctors has been emphasised since excessive levels of stress may lead to dissatisfaction, lower morale, and poorer work performance

  • Senior house officers' psychological distress levels is inversely related to their confidence in carrying out a range of clinical tasks in accident and emergency

  • Intensity of workload, communication difficulties, and feeling concerned about incorrect or missed diagnoses were common stress factors

  • Senior house officers may benefit from training in communication skills

  • There remains a need to reduce high work intensity and provide greater support


    • Accepted 29 November 1996
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