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.
研究概览
研究类型
观察性的
注册 (估计的)
800
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习联系方式
- 姓名：Marco Mancinetti, MD
- 电话号码：0041263062360
- 邮箱：marco.mancinetti@unifr.ch
学习地点
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-
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Bern、瑞士
- 招聘中
- Inselspital - University Hospital
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接触：
- Stefanie Mosimann
- 电话号码：0041316322111
- 邮箱：stefanie.mosimann@insel.ch
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Fribourg、瑞士、1700
- 招聘中
- HFR - Hôpital cantonal
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接触：
- Marco Mancinetti, MD
- 电话号码：0041263062360
- 邮箱：marco.mancinetti@unifr.ch
-
Lausanne、瑞士
- 招聘中
- CHUV - University Hospital
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接触：
- Vanessa Kraege
- 电话号码：004121 314 11 11
- 邮箱：vanessa.kraege@chuv.ch
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-
参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
- 孩子
- 成人
- 年长者
接受健康志愿者
是的
取样方法
非概率样本
研究人群
resident physicians in general internal medicine at approximately 22 Swiss hospital and ambulatory centres (~1,300 eligible)
描述
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
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
队列和干预
团体/队列 |
|---|
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Residents in General Internal Medicine (GIM)
All residents in GIM in the participating centers in Switzerland
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Change from baseline in psychological distress measured by the Physician Well-Being Index (PWBI)
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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
|
|
Change from baseline in professional fulfilment measured by the Professional Fulfillment Index (PFI) - professional fulfilment subscale
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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
|
Baseline and annually at years 1, 2, 3, 4 and 5
|
|
Change from baseline in burnout measured by the Professional Fulfillment Index (PFI) - burnout composite
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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)
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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
大体时间：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
大体时间：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
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Change from baseline in self-rated work-life balance (single-item 5-point scale)
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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)
大体时间：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
大体时间：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).
|
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
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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)
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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
|
|
Change from baseline in self-reported physical activity measured by the International Physical Activity Questionnaire - short form (IPAQ-SF)
大体时间：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
|
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
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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).
|
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)
大体时间：Baseline and annually at years 1, 2, 3, 4 and 5
|
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)
大体时间：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)
大体时间：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
大体时间：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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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2025年8月1日
初级完成 (估计的)
2026年12月31日
研究完成 (估计的)
2031年12月31日
研究注册日期
首次提交
2026年7月9日
首先提交符合 QC 标准的
2026年7月15日
首次发布 (实际的)
2026年7月16日
研究记录更新
最后更新发布 (实际的)
2026年7月16日
上次提交的符合 QC 标准的更新
2026年7月15日
最后验证
2026年7月1日
更多信息
与本研究相关的术语
其他研究编号
- CERV-VD Project-ID 2024-00444
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)？
未定
IPD 计划说明
Depends on the demand - as noted on the Research Project Collaboration Guidelines
药物和器械信息、研究文件
研究美国 FDA 监管的药品
不
研究美国 FDA 监管的设备产品
不
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