• S Williams, J Dale, E Glucksman, and A Wellesley.
• Department of General Practice and Primary Care, King's College School of Medicine and Dentistry, London.
• BMJ. 1997 Mar 8;314(7082):713-8.

ObjectiveTo investigate the relation between accident and emergency senior house officers' psychological distress and confidence in performing clinical tasks and to describe work related stressors.DesignQuestionnaire survey with data collected at four points during senior house officers' six month attachment to accident and emergency departments.Subjects171 newly appointed accident and emergency senior house officers from 27 hospitals in the South Thames region.Main Outcome MeasuresPsychological 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.ResultsOverall 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).ConclusionsPsychological 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.

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