Quality of Life, Job Satisfaction, and Sleep Hygiene Pattern in Medical Residents

⁴ Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

*Corresponding author: Amir Keshavarzi, Department of Psychosomatic Medicine, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: drkeshavarzi@yahoo.com

EXTENDED ABSTRACT

Background

Medical residency is characterized by high physical and psychological demands, including increased responsibility, overnight duties, sleep deprivation, continuous accountability, physical fatigue, and financial pressure. [1] The article describes these conditions as contributors to burnout, psychiatric problems, impaired interpersonal functioning, medical errors, and reduced quality of life. [3, 4, 10] Quality of life reflects an individual's perception of his or her position in life within the relevant cultural and value systems and is influenced by occupational demands and satisfaction. [5, 6] Job satisfaction is important for professional performance, while prior Iranian studies cited by the authors reported low satisfaction among residents in areas such as salary, educational quality, and professional motivation. [7-9] Sleep hygiene comprises behaviors that facilitate healthy sleep and avoidance of behaviors that interfere with normal sleep; residents may be particularly vulnerable to poor sleep because of academic pressure and frequent duties. [13, 16-19] Given the importance of medical residents to healthcare delivery and the limited evidence addressing these dimensions together, this study aimed to determine quality of life, job satisfaction, and sleep hygiene before and six months after the start of residency among residents of different medical specialties working in teaching centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Methods

This cross-sectional descriptive-analytical study used convenience sampling and repeated two-time-point assessment of first-year medical residents entering Shahid Beheshti University of Medical Sciences in 2018. Initially, 194 residents from different specialties agreed to participate and completed the study questionnaires at the beginning of residency. The same residents were invited to complete the questionnaires again six months later. Twenty-eight residents withdrew from continued participation and four transferred, leaving 162 residents with follow-up data. Quality of life, job satisfaction, and sleep hygiene were also examined according to age, sex, residency specialty, and number of monthly shifts. Quality of life was assessed with the 26-item World Health Organization Quality of Life Assessment (WHOQOLA), covering physical health, psychological health, social relationships, and environment. [20, 21] Domain scores were converted to a 0-100 scale; in the present study, Cronbach's alpha was 0.89 for the total scale and 0.83, 0.79, 0.75, and 0.59 for the psychological, physical, social-relationship, and environmental domains, respectively, with test-retest reliability of 0.71. Job satisfaction was assessed with the Brayfield and Rothe Job Satisfaction Questionnaire (JSQ); its reported test-retest reliability and Cronbach's alpha were 0.84 and 0.82, respectively. [22] Sleep hygiene was assessed using the 13-item self-report Sleep Hygiene Index (SHI), scored on a five-point Likert scale; test-retest reliability was 0.76 and Cronbach's alpha was 0.64. [23, 24] Data were analyzed in SPSS version 23 using descriptive statistics, within-subject analysis of variance, multivariate analysis of covariance, and Bonferroni-adjusted follow-up comparisons. For sex-based multivariate comparisons, baseline scores were controlled. Greenhouse-Geisser correction was used for the repeated assessment analyses. Statistical significance was set at P<0.05. The study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.MSP.REC.1397.305), and written informed consent was obtained from all participants before enrollment.

Results

The final sample comprised 162 residents, including 98 women and 64 men. Ninety-nine residents were aged 20-29 years, 55 were aged 30-39 years, and eight were older than 39 years. Pediatrics had the largest number of participants (n=18), whereas dermatology had the smallest (n=3). Eighty-nine residents were in specialties with 10-15 shifts per month, while 15 residents had no shifts. Mean quality-of-life score decreased from 87.15±11.74 before residency to 64.156±9.65 at six months; observed scores ranged from 58-134 at baseline and 46-101 at follow-up. The within-subject effect was significant (F[1,161]=438.208, P<0.005), and the Bonferroni comparison showed a mean difference of -22.994 (standard error [SE], 1.098; P=0.000; 95% confidence interval [CI], -25.163 to -20.825). Mean job-satisfaction score decreased from 57.92±5.11 to 55.56±4.48, with score ranges of 45-95 and 43-68, respectively (F[1,161]=22.702, P<0.005); the mean difference was -2.364 (SE, 0.496; P=0.000; 95% CI, -3.344 to -1.384). The mean SHI score increased from 29.74±4.60 to 33.41±9.81, with corresponding score ranges of 13-55 and 21-74 (F[1,161]=19.97, P<0.005); the mean difference was 3.673 (SE, 0.822; P=0.000; 95% CI, 2.050 to 5.296). The authors interpreted the overall change as a significant deterioration in sleep hygiene after six months of residency.

Table 2. Bonferroni-adjusted comparison of mean quality-of-life, job-satisfaction, and sleep-hygiene scores before residency and six months after residency began.

Multivariate analysis showed a significant overall sex effect (Pillai's trace=0.430, F=38.91, P=0.0001; reported effect size=0.30). Bonferroni follow-up analysis indicated that only quality of life differed significantly by sex: men had lower quality-of-life scores than women six months after residency began (P=0.0001), whereas job satisfaction (P=0.554) and sleep hygiene (P=0.952) did not differ significantly. No significant differences across residency specialties were detected for quality of life (P=0.765), job satisfaction (P=0.975), or sleep hygiene (P=0.547). The number of monthly shifts was significantly associated with quality of life (F=2.057, P=0.016), job satisfaction (F=3.39, P=0.02), and sleep hygiene (F=3.98, P=0.009). The authors additionally reported that more than 15 shifts per month was associated with a marked reduction in quality of life (P=0.01). Overall analyses did not show significant differences by age for quality of life (P=0.51), job satisfaction (P=0.79), or sleep hygiene (P=0.31).

Conclusion

Six months after the start of residency, medical residents showed a substantial reduction in quality of life, a smaller but statistically significant reduction in job satisfaction, and a significant adverse change in the sleep-hygiene measure. Male residents had lower quality of life than female residents, while the number of monthly shifts was associated with all three measured outcomes; the article specifically identifies more than 15 shifts per month as related to a marked decline in quality of life. Residency specialty was not associated with significant differences in these outcomes. The authors conclude that medical universities should implement measures to improve residents' quality of life, job satisfaction, and sleep hygiene during training. They specifically propose moderating workload by reducing time spent in the hospital and addressing economic burden through improved compensation. Because all participants were residents from Shahid Beheshti University of Medical Sciences, the authors caution against generalizing the findings to other universities or populations.

Keywords: Job Satisfaction, Quality of Life, Residency, Sleep Hygiene

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