The COMET Study: a Prospective COhort of MEdical residenTs to Assess Professional, Personal and Psychological Trajectories of Residents in General Internal Medicine (COMET)
2026年7月15日 更新者：Marco Mancinetti、University of Fribourg
Introduction.
Switzerland, like most Western countries, faces a paradox: an ageing, multimorbid population needs general internal medicine (GIM) physicians more than ever, yet fewer young doctors choose - and stay in - the specialty. Career decisions during residency are intertwined with well-being, mental and physical health, and work-life balance, and distress in training has been associated with depression, burnout, attrition and poorer patient care. Longitudinal data following GIM residents across these domains, and linking them to actual career trajectories, are lacking. The COMET study establishes a multicentre prospective cohort of GIM residents to fill this gap.
Methods and analysis.
COMET is a prospective, open, multicentre cohort conducted in the departments of (general) internal medicine of Fribourg Hospital (HFR, four sites), Bern University Hospital (Inselspital) and Lausanne University Hospital (CHUV). All GIM residents providing direct patient care are eligible (≈334 residents; expected enrolment ≥267, assuming 80% participation). Participants complete an annual online survey (REDCap; French or German) at baseline and for at least four years, covering sociodemographics; job characteristics; career intentions and 24 factors for or against a GIM career; well-being (Physician Well-Being Index, Professional Fulfillment Index, quality of life, work-life balance); mental health (CES-D, Perceived Stress Scale, Maslach Burnout Inventory, Questionnaire of Cognitive and Affective Empathy); and physical health (step counts, physical activity, fatigue, sleep, healthcare utilisation). Primary endpoints are the longitudinal course of well-being and distress (PWBI, PFI, CES-D) and residents' career trajectory. Analyses combine descriptive statistics, mixed-effects and regression models, and comparisons with the population-based CoLaus|PsyCoLaus cohort.
調査の概要
研究の種類
観察的
入学 (推定)
800
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究連絡先
- 名前：Marco Mancinetti, MD
- 電話番号：0041263062360
- メール：marco.mancinetti@unifr.ch
研究場所
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-
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Bern、スイス
- 募集
- Inselspital - University Hospital
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コンタクト：
- Stefanie Mosimann
- 電話番号：0041316322111
- メール：stefanie.mosimann@insel.ch
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Fribourg、スイス、1700
- 募集
- HFR - Hôpital cantonal
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コンタクト：
- Marco Mancinetti, MD
- 電話番号：0041263062360
- メール：marco.mancinetti@unifr.ch
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Lausanne、スイス
- 募集
- CHUV - University Hospital
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コンタクト：
- Vanessa Kraege
- 電話番号：004121 314 11 11
- メール：vanessa.kraege@chuv.ch
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-
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
- 子
- 大人
- 高齢者
健康ボランティアの受け入れ
はい
サンプリング方法
非確率サンプル
調査対象母集団
resident physicians in general internal medicine at approximately 22 Swiss hospital and ambulatory centres (~1,300 eligible)
説明
Inclusion Criteria:
Resident physician in general internal medicine employed at a participating study site or annex centre during the recruitment period Written informed consent
Exclusion Criteria:
Not providing direct patient care Severe mental or physical condition precluding informed consent or compliance with the protocol
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
|---|
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Residents in General Internal Medicine (GIM)
All residents in GIM in the participating centers in Switzerland
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Change from baseline in psychological distress measured by the Physician Well-Being Index (PWBI)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The Physician Well-Being Index (resident version) comprises 7 yes/no items referring to the past month.
Total score ranges from 0 to 7; higher scores indicate greater distress (worse outcome).
A score of 3 or higher identifies residents at risk of distress
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in professional fulfilment measured by the Professional Fulfillment Index (PFI) - professional fulfilment subscale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The professional fulfilment subscale of the Professional Fulfillment Index comprises 6 items scored 0-4 on 5-point scales (past two weeks); the subscale score is the item mean, ranging from 0 to 4. Higher scores indicate greater professional fulfilment (better outcome); scores of 3.0 or higher indicate professional fulfilment
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in burnout measured by the Professional Fulfillment Index (PFI) - burnout composite
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The burnout composite of the Professional Fulfillment Index comprises 10 items (4 work-exhaustion and 6 interpersonal-disengagement items) scored 0-4 on 5-point scales (past two weeks); the composite score is the item mean, ranging from 0 to 4. Higher scores indicate more severe burnout (worse outcome); scores of 1.33 or higher indicate burnout
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in depressive symptoms measured by the Center for Epidemiologic Studies-Depression scale (CES-D)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The Center for Epidemiologic Studies-Depression scale comprises 20 items scored 0-3 by symptom frequency over the past week.
Total score ranges from 0 to 60; higher scores indicate more depressive symptoms (worse outcome).
A score of 16 or higher indicates clinically relevant depressive symptoms.
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Baseline and annually at years 1, 2, 3, 4 and 5
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Percentage of participants remaining in general internal medicine training or practice
時間枠：Annually at years 1, 2, 3, 4 and 5
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Proportion (%) of participants who, at each annual follow-up survey, report continuing postgraduate training or clinical activity in general internal medicine, versus having switched to another specialty or having left clinical medicine, assessed by structured self-report items (current work position and current specialty goal) of the annual COMET online survey
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Annually at years 1, 2, 3, 4 and 5
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Intention to leave direct patient care, measured on a single-item 5-point scale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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Single self-report item of the annual COMET survey rating the likelihood of leaving direct patient care within five years, from 1 (none) to 5 (high).
Higher scores indicate a stronger intention to quit (worse outcome)
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Baseline and annually at years 1, 2, 3, 4 and 5
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Change from baseline in self-rated work-life balance (single-item 5-point scale)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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Single self-report item rating the current balance between personal and professional life on a 5-point scale from 1 (very good) to 5 (very bad), as used by Keeton et al.
Higher scores indicate a worse perceived work-life balance.
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in perceived stress measured by the Perceived Stress Scale (PSS-10)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The 10-item Perceived Stress Scale, referring to the past month, with items scored 0-4.
Total score ranges from 0 to 40; higher scores indicate greater perceived stress (worse outcome)
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in work exhaustion measured by the Professional Fulfillment Index (PFI) - work-exhaustion subscale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The work-exhaustion subscale of the Professional Fulfillment Index comprises 4 items scored 0-4 (past two weeks); the subscale score is the item mean, ranging from 0 to 4. Higher scores indicate greater work exhaustion (worse outcome).
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in interpersonal disengagement measured by the Professional Fulfillment Index (PFI) - interpersonal-disengagement subscale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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he interpersonal-disengagement subscale of the Professional Fulfillment Index comprises 6 items scored 0-4 (past two weeks); the subscale score is the item mean, ranging from 0 to 4. Higher scores indicate greater interpersonal disengagement (worse outcome)
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Baseline and annually at years 1, 2, 3, 4 and 5
|
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Change from baseline in cognitive empathy measured by the Questionnaire of Cognitive and Affective Empathy (QCAE) - cognitive empathy subscale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The cognitive empathy subscale of the QCAE comprises 19 items rated on 4-point agreement scales (1-4).
Total score ranges from 19 to 76; higher scores indicate greater cognitive empathy (better outcome)
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Baseline and annually at years 1, 2, 3, 4 and 5
|
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Change from baseline in affective empathy measured by the Questionnaire of Cognitive and Affective Empathy (QCAE) - affective empathy subscale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The affective empathy subscale of the QCAE comprises 12 items rated on 4-point agreement scales (1-4).
Total score ranges from 12 to 48; higher scores indicate greater affective empathy.
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Baseline and annually at years 1, 2, 3, 4 and 5
|
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Change from baseline in daily step count (smartphone-derived)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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Average number of steps per day, reported by participants from the default health application of their smartphone as monthly averages for the current month and the two previous months (unit: steps/day).
Higher values indicate more physical activity
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in self-reported physical activity measured by the International Physical Activity Questionnaire - short form (IPAQ-SF)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The IPAQ short form comprises 7 items covering vigorous activity, moderate activity, walking and sitting time over the past 7 days; responses are converted to metabolic equivalent of task (MET)-minutes per week according to the IPAQ scoring protocol.
Higher values indicate more physical activity
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in fatigue measured by the Chalder Fatigue Scale
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The Chalder Fatigue Scale comprises 11 items scored 0-3 (Likert scoring).
Total score ranges from 0 to 33; higher scores indicate more severe fatigue (worse outcome).
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Baseline and annually at years 1, 2, 3, 4 and 5
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Change from baseline in insomnia severity measured by the Insomnia Severity Index (ISI)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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The Insomnia Severity Index comprises 7 items scored 0-4, referring to sleep problems over the past two weeks.
Total score ranges from 0 to 28; higher scores indicate more severe insomnia (worse outcome)
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Baseline and annually at years 1, 2, 3, 4 and 5
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Mean rating of each of 31 career pull and push factors (adapted Hauer questionnaire)
時間枠：Baseline and annually at years 1, 2, 3, 4 and 5
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Each of 31 factors potentially influencing a career in internal medicine is rated on a 5-point bipolar scale from 1 (very pushed away) to 5 (very attracted toward), adapted from Hauer et al.
Mean scores per factor (range 1-5) describe the relative weight of attracting and repelling factors; higher scores indicate a more attracting influence.
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Baseline and annually at years 1, 2, 3, 4 and 5
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Difference in CES-D depressive-symptom score between residents and age-matched general-population participants (CoLaus|PsyCoLaus)
時間枠：Baseline
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Difference in mean Center for Epidemiologic Studies-Depression scale score (20 items, total 0-60; higher = more depressive symptoms) between COMET participants and participants aged 18-35 of the population-based CoLaus|PsyCoLaus cohort, using the identical instrument (unit: score points)
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Baseline
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Difference in QCAE empathy scores between residents and Swiss medical students
時間枠：Baseline and year 5
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Difference in mean QCAE cognitive (19-76) and affective (12-48) empathy subscale scores between COMET participants and published values from a national cohort of Swiss medical students, using the identical instrument (unit: score points; higher = greater empathy)
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Baseline and year 5
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ここでは、この調査に関係する人々や組織を見つけることができます。
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始 (実際)
2025年8月1日
一次修了 (推定)
2026年12月31日
研究の完了 (推定)
2031年12月31日
試験登録日
最初に提出
2026年7月9日
QC基準を満たした最初の提出物
2026年7月15日
最初の投稿 (実際)
2026年7月16日
学習記録の更新
投稿された最後の更新 (実際)
2026年7月16日
QC基準を満たした最後の更新が送信されました
2026年7月15日
最終確認日
2026年7月1日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- CERV-VD Project-ID 2024-00444
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
未定
IPD プランの説明
Depends on the demand - as noted on the Research Project Collaboration Guidelines
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
いいえ
米国FDA規制機器製品の研究
いいえ
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