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BACKGROUND: Interns are vulnerable to emotional distress and burnout. Little is known about the extent to which interns' well-being can be influenced by peer support provided by their senior residents. OBJECTIVE: To elucidate contributors to interns' emotional distress and ways that peer support from senior residents may impact intern well-being. DESIGN: Qualitative study using semi-structured interviews conducted December 2017-March 2018. PARTICIPANTS: Second year residents (n = 11) in internal medicine at a major academic medical center during the data collection period. APPROACH: Constructivist grounded theory approach in which transcripts were analyzed in an iterative fashion using constant comparison to identify themes and to create a conceptual model. KEY RESULTS: The investigators identified three themes around emotional distress and two themes around resident peer support. Distress was a pervasive experience among participants, caused by a combination of contextual factors that decreased emotional resilience (e.g., sleep deprivation) and acute triggers (e.g., patient death) that led to an abrupt increase in distress. Participants grappled with identity reconciliation throughout internship. Reaching clinical competency reinforced self-efficacy for participants. With regard to peer support, participants recalled that resident support was ad hoc, primarily involving task support and debriefing traumatic events. Participants reflected that their intern experiences shaped their supervisory support style once they became senior residents; they did not perceive any formalized, systematic approach to supporting interns. CONCLUSIONS: We propose a model illustrating key points at which near-peers can make an impact in reducing interns' distress and suggest strategies they can use. Given the substantial role peer learning plays in intern development, senior residents can impact their interns by normalizing emotions, allowing vulnerability, and highlighting the importance of self-care. A formalized peer support skill-building curriculum for senior residents may empower them to provide more effective support as part of their supervisory efforts.

Across 7 experiments (N = 3883), we demonstrate that communicators and targets make egocentric moral judgments of deception. Specifically, communicators focus more on the costs of deception to them-for example, the guilt they feel when they break a moral rule-whereas targets focus more on whether deception helps or harms them. As a result, communicators and targets make asymmetric judgments of prosocial lies of commission and omission: Communicators often believe that omitting information is more ethical than telling a prosocial lie, whereas targets often believe the opposite. We document these effects within the context of health care discussions, employee layoffs, and economic games, among both clinical populations (i.e., oncologists and cancer patients) and lay people. We identify moderators and downstream consequences of this asymmetry. We conclude by discussing psychological and practical implications for medicine, management, behavioral ethics, and human communication. (PsycINFO Database Record

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Background Genital, anal and oral injuries sustained from sexual intercourse may explain HIV transmission among women. We determined the variability in genitoanal injury frequency and prevalence in women following consensual sexual intercourse, exploring the role of menstrual phase and hormonal birth control. Methods We used a longitudinal, observational design with a convenience sample of 393 women aged 21 and older. Participants had a baseline interview with gynecologic examination, followed by consensual sexual intercourse with a male partner and a second gynecologic examination. We analyzed injury prevalence with logistic regression and injury frequency with negative binomial regression among women who were: a) menstrual, not using hormonal birth control, b) menstrual, using hormonal birth control, or c) menopausal. We also compared injury among menstrual women in the follicular, ovulatory and luteal phases. Findings Women using hormonal birth control had 38% more external genitalia injuries (adjusted rate ratio [ARR] = 1.38, p = 0.030) and more than twice the anal injuries (ARR = 2.67, p = 0.005) as the non-hormonal birth control menstruating group. Menopausal women had more than three times the anal injuries (ARR = 3.36, p = 0.020) than those in the non-hormonal menstrual group. Among menstrual women, those in the follicular phase had a greater prevalence and frequency of external genitalia injuries than those in other phases. Interpretation Increased rates of post-coital genitoanal injuries are noted among women using hormonal birth control and/or in the follicular phase of menstruation. Biological factors that influence women's risk for HIV warrant further investigation.