Qualitative Analysis of Well-being Preparedness at an Emergency Medicine Residency Program

Abstract

IntroductionThere is significant variability in the preparedness of incoming interns at the start of residency training with regard to medical knowledge, procedural skills, and attitudes. Specialty-specific preparatory courses aimed at improving clinical skills exist; however, no preparatory courses targeting wellness promotion or burnout prevention have previously been described. Resident well-being has gained increasing attention from the Accreditation Council for Graduate Medical Education, and numerous studies have demonstrated high levels of burnout among resident physicians. The American Medical Association (AMA) divides resident well-being into the following six categories: nutrition, fitness, emotional health, financial health, preventative care, and mindset and behavioral adaptability. Using the AMA’s conceptual framework for well-being in residency, we performed a targeted needs assessment to support the development of a “pre-residency” well-being curriculum. Our aim was to discover what current residents and faculty felt were the perceived areas of under-preparedness, in relation to resident well-being, for incoming interns at the start of their residency training.MethodsUsing a grounded theory approach, we conducted a series of semi-structured, focus group interviews. Focus groups consisted of junior residents (postgraduate years [PGY] 1-3), senior residents (PGY-4), and current faculty members. A standardized interview guide was used to prompt discussion and themes were identified from audio recording. We modified theories based on latent and manifest content analysis, and we performed member checking and an external audit to improve validity.ResultsParticipants noted variable exposure to both formal and informal well-being training prior to residency. Regardless, participants uniformly agreed that their past experiences did not adequately prepare them for the challenges, specific to burnout prevention, faced during residency training. Of the six domains of resident well-being described by the AMA, emotional health, mindset and behavioral adaptability, and financial health were the domains most cited for interns to be underprepared for at the start of residency training.ConclusionDespite variability in prior medical school and life experiences, incoming interns were underprepared in several domains of well-being, including emotional health, mindset and behavioral adaptability, and financial health. Targeted interventions toward these areas of well-being should be piloted and studied further for their potential to mitigate effects of burnout among resident physicians.

Using Focus Groups to Explore Evolving Perceptions of Student Pharmacists’ Curricular Experiences

“…To preserve student confidentiality and promote comfort in disclosing information, focus groups were not recorded and verbatim transcriptions were not taken; instead, detailed facilitator notes were documented and, at times, included descriptive phrases from students. 40 For a variety of reasons pertinent to particular studies, the use of non-verbatim transcripts has been an approach selected by scholars conducting qualitative research. [37][38][39][40][41] As is often the case in qualitative research, in this study the researchers were the "tools" used to analyze data.…”

“…40 For a variety of reasons pertinent to particular studies, the use of non-verbatim transcripts has been an approach selected by scholars conducting qualitative research. [37][38][39][40][41] As is often the case in qualitative research, in this study the researchers were the "tools" used to analyze data. We were therefore aware of the potential for preconceptions to be introduced during data analysis.…”

Loneliness and sleep under real-world stress: An intensive longitudinal daily diary and behavioral biomarker study

“…For this study, we used questionnaire data collected before (t0) and during internship (t1) as well as diary-and wearable-based data collected during the internship (t1). We decided to focus on time point t1 as this may constitute a peak period of stress during the internship given the greater independence and responsibility students have to assume [e.g., 34,35].…”