Prevalence of stress and its determinants among residents enrolled in China Standardized Training Program for Resident Doctor (C-STRD) program: A cross-sectional study
Authors: Yan-Jun Guan
Da-Wei Dai
Ying Jiang
Zhen-Yu Huang
Wei Huang
Journal: PLoS ONE (2019)
Discipline: Multidisciplinary
Keywords: China Standardized Training for Resident Doctor (C-STRD); stress; financial income; workload; stress management
Affiliations: Department of Medicine, New Jersey Medical School Affiliated to Rutgers University, Rutgers University, Newark, New Jersey, United States., Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, Shanghai, PR China.

Abstract:  Background: It has been widely understood that well-trained doctors are crucial for a high-quality public health system and safe patient care. Thus, in 2011, China initiated its first national residency training program, called the China Standardized Training for Resident Doctor (C-STRD), for medical graduates to prepare qualified doctors for the medical care system with increasing demands. So far, no studies have specifically address the prevalence of stress and its determinants among residents enrolled in the C-STRD. Participants and methods: The research is performed in two stages. In stage I, the authors conducted a pilot study and met 112 C-STRD residents in person. Based on the preliminary data, a revised questionnaire was adopted in stage II, during which the authors conducted a multi-institutional, cross-sectional survey of 340 participants from 11 hospitals in Shanghai in a self-administered manner. Results: The results showed that C-STRD residents were overall under severe stress as their mean PSS score was 27.5 ± 4.9, which was higher than the threshold of high stress (PSS = 20). Specifically, the PSS score for the residents with Bachelor (MB), Master (MM) and Doctoral of Medicine (MD) educational degree were 26.6 ± 4.1, 27.8 ± 3.5 and 27.1 ± 5.2, respectively (P&gt;0.05). Their stress was mainly associated with their financial income status and workload, as these two factors caused more severe burden than other listed stressors (P&lt;0.05). Specially, the residents indicated that their montly payroll amout were as low as $590.2 ± 127 while no benefit package and allowance were given. Surprisingly, wage arrears up to 5.3 month were reported by 36 (10%) participants. Workload survey showed the residents has high work intensity and inadequate rest. Since no stress management program was provided, the majority of residents tended to cope their stress with unhealthy strategies, such as mesmerizing in TV/computer (88.2%) and overeating (59.7%). Conclusion: The C-STRD residents are at high risk of perceived stress. Although there was a difference in perception of stress for workload and career future among different educational degree owners, low financial income is the major stressor among all C-STRD residents. Unhealthy stress management strategies were adopted by all residents due to lack of appropriate stress-relieving intervention. 

Retracted: Yes

PubPeer comments:
 2019 retraction. https: journals.plos.org plosone article?id=10.1371 journal.pone.0219653 Following publication of this [1] article, concerns were noted about the enrolment of participants and the level of ethical oversight for this research. The article states u201cThe current study has been approved by the ethics committee of Shanghai Chang Zheng Hospital,u201d however the authors were unable to provide ethics approval documentation or any confirmation from their institution to support this statement. The authors have explained that they did not seek written informed consent from study participants due to associated costs but that participation was voluntary. Furthermore, the affiliation listed for the corresponding author on the published article is incorrect. The corresponding author is affiliated with Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University. The author explained that they were affiliated to Rutgers University from January-August 2016, during preparation of this manuscript. Owing to unresolved concerns about whether this work received the necessary ethical approval prior to its initiation, the PLOS ONE Editors retract this article. The authors did not respond to the retraction decision. Reference 1. Jiang Y, Guan Y-J, Dai D-W, Huang W, Huang Z-Y (2019) Prevalence of stress and its determinants among residents enrolled in China Standardized Training Program for Resident Doctor (C-STRD) program: A cross-sectional study. PLoS ONE 14(1): e0207258. https: doi.org 10.1371 journal.pone.0207258 pmid:30615626 ,