Stress during internship at three Johannesburg hospitals

Abstract

Background: There has been much recent attention paid to the excessive hours worked by interns, with a commitment by the health department to address this issue. However, there is still limited recognition of other stressors that influence the well-being and performance of interns.

Methods: Cross-sectional study at three hospitals within the academic complex of the University of Witwatersrand, Johannesburg. Interns were randomly selected as respondents for an anonymous, self-administered, confidential questionnaire.

Results: One hundred and ten questionnaires were distributed; 68 (62%) were returned and analysed. Twenty-seven participants (40%) rated internship as being “significantly” or “overwhelmingly” stressful. While the main stressors related to heavy workloads and excessive working hours, the risk of acquiring HIV and the frustration of working in inadequately resourced environments were the next most important stressors. Over two-thirds (69%) of responding interns had experienced accidental occupational exposure to HIV. Somatic manifestations of stress were universal with all interns reporting one or more stress-associated symptoms. More than one-half (54%) of interns admitted to being depressed, with over a third suffering from insomnia or appetite loss. Female interns were significantly more likely to report weight changes (OR 5.7 [95% CI 1.2-29.8], p=0.01) and crying (OR 3.8 [95% CI 1.1-14.4, p=0.02). Vacations and the support of family and friends served as the major stress relievers. Despite 93% of interns rating their stress to be “moderate” to “significant”, an overwhelming majority (91%) claimed to be coping with their internship.

Conclusions: Internship in South Africa remains a stressful experience. HIV emerged as a significant stressor. Positively, and despite widespread somatic complaints, most interns believed they were coping. There is still inadequate acknowledgement of the extent of intern stress, and few systematic attempts by the health system to help interns cope and to alleviate the primary stressors.