A year in transition: a qualitative study examining the trajectory of first year residents’ well-being

Abstract

BackgroundIt is generally understood that trainees experience periods of heightened stress during first year residency, yet there is little information on variations in stress and well-being over the transition period or those factors that contribute to these variations. This qualitative study explored the trajectory of well-being described by first year residents in the context of challenges, supports and adaptations over time.MethodsIn-depth interviews were conducted face-to-face with 17 first year residents at the University of Toronto. Participants drew a graph of their well-being over the course of their first year and described critical periods of challenge and adaptation. Interviews were audio-taped and transcribed. Results were organized into a thematic analysis using NVivo software.ResultsResidents described a pattern of well-being that varied in accordance with changes in rotations. Well-being increased when residents perceived high levels of team support, felt competent and experienced valued learning opportunities. Well-being decreased with low team support, heavy work demands, few learning opportunities and poor orientations. Anxiety and excitement in the beginning of the year gave way to heightened confidence but increased fatigue and apathy towards the year’s end. Residents used a number of cognitive, behavioural and self-care strategies to cope with transitional challenges.ConclusionsResidents experienced a pattern of highly fluctuating well-being that coincided with changes in rotations. Residents’ well-being varied according to levels of supervisor and colleague support, learning opportunities, and work demands. Residents’ well-being may be improved by program interventions that facilitate better team and supervisory supports, maintain optimal service to learning ratios, establish effective fatigue and risk management systems, offer wellness support services and integrate skills based resiliency training into the curriculum.

Níveis de Ansiedade e Depressão entre Residentes de Pediatria

“…Os níveis de ansiedade e depressão apresentados pelos residentes em Pediatria deste estudo evidenciam que o período de transição aluno-profissional é desgastante, reforçando os resultados de outros estudos com médicos residentes 8,9,12,13,17,19 . Um estudo com residentes canadenses apontou que a presença de transtornos psicológicos é maior no primeiro ano de formação, quando os profissionais estão em fase de adaptação à nova rotina de trabalho e, por conta disso, apresentam maior insegurança 20 .…”

Junior Doctors’ Views of How Their Undergraduate Clinical Electives in Palliative Care Influenced Their Current Practice of Medicine

“…25,36,37 However, there seem to be missed opportunities for junior doctors and medical students to be able to openly discuss the impact of a patient death and debrief within the acute care context. 25 Whilst palliative care attachments provided an open space for debriefing, inside the hospital, the study participants did not seek or find opportunities to discuss these issues with senior medical staff and preferred to talk to their own families.…”

Well-Being in Residency: A Systematic Review

“…Interns identified that lighter rotations and vacations were associated with upswings in their well-being, and long work hours and on call were associated with downswings. 24 Obstetrics-gynecology residents in 1 program rated their lifestyle low, which correlated with lower residency satisfaction. 22 Being in a relationship was studied and found associated with greater well-being.…”

“…Specifically, a sense of control and autonomy, pursuit and achievement of goals, opportunities for learning, increased confidence and sense of increasing mastery, positive feedback, and positive colleague relationships were all associated with greater well-being across 4 studies. [21][22][23][24] A few additional factors were associated with wellbeing. Sleep was found to be important in several studies.…”