Spanish medical graduates who apply for a medical specialty training position (MIR) must take an examination that will shape their future personal and professional lives. Preparation for the test represents an important stressor that persists for several months. The aim of this study was to elucidate the stress pattern of this group and evaluate possible changes in the circadian rhythm of cortisol release in medical graduates preparing for this test. A repeated-measures longitudinal study was performed, measuring the salivary cortisol concentrations in 36 medical graduates (13 males and 23 females; mean age of 24.2 years) on five sampling days. Five cortisol samples were collected from 07:00 to 21:00 h in order to monitor changes in the circadian rhythm. On all sampling days (except on the day of the official examination), anxiety and psychological stress were evaluated with the Spanish versions of the State-Trait Anxiety Inventory (STAI) and the Perceived Stress Scale (PSS). During the study period, participants showed higher levels of anxiety than the Spanish reference population as well as a progressive increase in self-perceived stress. A significant increase in salivary cortisol concentration was observed in both chronic (study and examination preparation) and acute (examinations) situations. Our results suggest that the cortisol awakening response (CAR) may be a good indicator of anticipatory stress but is unaffected by long-term examination preparation. Comparison of results between the official examination day and the mock examination days yielded evidence that learning may modulate the behavior of the hypothalamic-pituitary-adrenal axis.

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Objective:The objective of the study was to study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout. Methods: A cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the perceived stress scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21). Results: About 78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands (PD). In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 PD dimensions (β = 0.393; p < 0.003) and stress scores (β = 0.451; p < 0.001) significantly predict emotional exhaustion (r2 = 0.443). Finally, 38% of junior doctors experienced a threat/aggression during their work in the emergency ward urgencies. Conclusion: Junior doctors develop its professional activity under adverse circumstances probably due to the high psychosocial risk associated to the job. PD are suggested as the main predicting factor of burnout. These results indicate the need for psychological and structural interventions to improve the professional performance of junior doctors at the emergency ward.

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