The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Medical Resident Perceptions of Distress during Training

Authors: Simone A. Bernstein, MD, MHPE, Janice L. Hanson, PhD, EdS, MH, Emily A. Slat, MD, PhD, Jennifer G. Duncan, MD

Abstract

Objectives: This study used a qualitative research approach to grounded theory to identify factors that contributed to resident distress during 2021–2022 in multiple different specialties and at different postgraduate years of residency. By better understanding these contributors to distress, the aim was to inform the design of optimal interventions to reduce burnout and other emotional distress.

Methods: The residents enrolled in this study completed a demographic survey and semistructured interview. Interviews were recorded and transcribed. Data analysis included developing codes inductively, grouping codes into categories, and describing themes. Recruitment continued until data analysis indicated theoretical saturation/sufficiency had been reached. A qualitative research approach to grounded theory was used to identify themes and relationships among themes to better understand how the sources of distress affected the trainees of various specialties and postgraduate levels of training.

Results: Thirty-three participants (15 medical-based, 9 hospital-based, and 9 surgical-based residents) participated in interviews between 2021 and 2022. Seven themes described sources of distress and potential ameliorating factors: workload, support and community, culture, resident outlook, institutional resources, work-life balance, and coronavirus disease 2019. The grounded theory highlights that these factors can collectively influence work-life balance and distress.

Conclusions: The findings of the grounded theory qualitative analysis were used to examine ways to better mitigate the sources of distress that the residents enrolled in this study described. As institutions strive to diminish distress among residents, they can consider opportunities to assess environmental factors and design targeted interventions for their institutions or programs.

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References

1. Burnout-Among-Health-Care-Professionals-A-Call-to-Explore-and-Address-ThisUnderrecognized-Threat.pdf. https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/. Updated July 17, 2017. Accessed January 6, 2024.
 
2. Dyrbye LN, Satele D, Sloan J, et al. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med 2013;28:421–427.
 
3. Dyrbye LN, Schwartz A, Downing SM, et al. Efficacy of a brief screening tool to identify medical students in distress. Acad Med 2011;86:907–914.
 
4. Murray E, Krahé C, Goodsman D. Are medical students in prehospital care at risk of moral injury? Emerg Med J 2018;35:590–594.
 
5. Rosen IM, Gimotty PA, Shea JA, et al. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med 2006;81:82–85.
 
6. Burn-out an “occupational phenomenon”: International Classification of Diseases. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases. Updated May 28, 2019. Accessed January 8, 2024.
 
7. Rathert C, Williams ES, Linhart H. Evidence for the quadruple aim. Med Care 2018;56: 976-984.
 
8. van der Heijden F, Dillingh G, Bakker A, et al. Suicidal thoughts among medical residents with burnout. Arch Suicide Res 2008;12:344-346.
 
9. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 2016; 91:422–431.
 
10. Sinsky CA, Dyrbye LN, West CP, et al. Professional satisfaction and the career plans of US physicians. Mayo Clin Proc 2017;92:1625–1635.
 
11. Finn KM, O’Connor AB, McGarry K, et al. Prevalence and sources of mistreatment experienced by internal medicine residents. JAMA Intern Med 2022;182:448–450.
 
12. Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 2019;381:1741–1752.
 
13. Guille C, Speller H, Laff R, et al. Utilization and barriers to mental health services among depressed medical interns: a prospective multisite study. J Grad Med Educ 2010;2:210-214.
 
14. ACGME Common Program Requirements. https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf. Published 2023. Accessed November 16, 2023.
 
15. National Academy of Medicine. Systems approaches to improve patient care by supporting professional well-being. https://www.nationalacademies.org/our-work/systems-approaches-to-improve-patient-care-by-supporting-clinician-well-being. Published 2019. Accessed January 23, 2024.
 
16. Sinsky CA, Biddison LD, Mallick A, et al. Organizational evidence-based and promising practices for improving clinician well-being. NAM Perspect 2020;2020:10.31478/202011a.
 
17. Benson NM, Chaukos D, Vestal H, et al. A qualitative analysis of stress and relaxation themes contributing to burnout in first-year psychiatry and medicine residents. Acad Psychiatry 2018;42:630–635.
 
18. Hurst C, Kahan D, Ruetalo M, et al. Ayear in transition: a qualitative study examining the trajectory of first year residents’ well-being. BMC Med Educ 2013;13:96.
 
19. Ismail MNBM, Lindstrom Johnson S, Weaver SJ, et al. Factors influencing burn-out among resident physicians and the solutions they recommend. Postgrad Med J 2018;94:540–542.
 
20. Strauss A, Corbin JM. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: SAGE Publications; 1998.
 
21. Burnard P. Book review: Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Nurse Res 2006;13:84.  
22. 2021–2022 ACGME Databook Document. https://www.acgme.org/globalassets/pfassets/publicationsbooks/2021-2022_acgme__databook_document.pdf. Updated 2022. Accessed December 1, 2023.
 
23. O’Brien BC, Harris IB, Beckman TJ, et al. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014;89:1245–1251.
 
24. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017; 92:129–146.
 
25. Thomas LR, Ripp JA, Duncan JG. Graduate medical education well-being directors in the United States: who are they, and what does the role entail? BMC Med Educ 2024;24:254.
 
26. Willett LL, Wellons MF, Hartig JR, et al. Do women residents delay childbearing due to perceived career threats? Acad Med 2010;85:640–646.
 
27. Pham DT, Stephens EH, Antonoff MB, et al. Birth trends and factors affecting childbearing among thoracic surgeons. Ann Thorac Surg 2014;98:890–895.
 
28. Shapiro J, Galowitz P. Peer support for clinicians: a programmatic approach. Acad Med 2016;91:1200–1204.
 
29. Evans TR, Burns C, Essex R, et al. A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers. Front Psychiatry 2023;14:1078797.
 
30. Young A, Gilotra K, Jin MX, et al. A review of COVID-19’s impact on radiology residents’ academics and wellness in North America. J Am Coll Radiol 2023;20:1135–1145.
 
31. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 2020;323:2133–2134.
 
32. Agarwal A, Sangha H, Deutsch A, et al. Emergency medicine resident perspectives on well-being during COVID-19: a qualitative study. Emerg Med J 2023;40:92–95.
 
33. Sanghavi PB, Au Yeung K, Sosa CE,et al. Effect of the coronavirus disease 2019 (COVID-19) pandemic on pediatric resident well-being. J Med Educ Curric Dev 2020;7: 2382120520947062.
 
34. Burnet G, Platnick C, Krishnan P, et al. Muffins and meditation: combating burnout in surgical residents. J Surg Educ 2023;80:185–193.
 
35. Ey S, Moffit M, Kinzie JM, et al. “If you build it, they will come”: attitudes of medical residents and fellows about seeking services ina resident wellness program. J Grad Med Educ 2013;5:486–492.
 
36. Ey S, Soller M, Moffit M. Protecting the well-being of medical residents and faculty physicians during the COVID-19 pandemic: making the case for accessible, comprehensive wellness resources. Glob Adv Health Med 2020;9:2164956120973981.
 
37. American Medical Association. Wellness-centered leadership playbook. https://www.ama-assn.org/practice-management/ama-steps-forward/wellness-centered-leadership-playbook. Updated June 28, 2024. Accessed July 14, 2024.
 
38. Rehder K, Adair KC, Sexton JB. The science of health care worker burnout: assessing and improving health care worker well-being. Arch Pathol Lab Med 2021;145:1095–1109.
 
39. Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9–18.