Perceptions of Health and Wellness Impacts on Residents in their Certification Exam Year
Pardhan, Kaif; Snelgrove, Natasha; Onlock, Michelle; Nasser, Laila; Riddell, Tara
Introduction: Residency training in Canada includes a certification exam administered by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada during residents’ final year. Residents continue to work clinically while studying. As such, studying for this exam may impact residents’ health and wellness.
Objectives: Objectives of this study were to explore (a) the residents’ certification exam year experiences, (b) residents’ strategies for managing personal wellness and educational value of their exam year, (c) retrospective perceptions of faculty on their certification exam year, and (d) faculty perceptions of certification exam year experiences of current residents.
Methods: Qualitative description methodology was used. Participants included residents and faculty supervisors from McMaster University and the University of Toronto. In depth, semi-structured one-on-one interviews were conducted by one of the investigators. Each interview was transcribed, reviewed, and coded using content analysis by two members of the investigating team.
Results: Based on the data obtained thus far, residents identified impacts on their personal and professional lives including significant stress pertaining to finances, career planning, and relationships. Health impacts identified included heightened anxiety, loss of interest, weight gain, and poor eating habits. Negative impacts were exacerbated by observing predecessors’ stress, the high stakes nature of the examination, and competing training demands including a perceived expectation of peak clinical performance while studying. Residents used supportive personal and professional networks, norming of the examination as creating a knowledge foundation for practice, and a shared community goal of resident success to mitigate stress.
Conclusion: This study has begun to identify unique challenges that residents face in their exam year. A focus on mitigating factors will be helpful to ensure physician wellness during transition to practice. This will be particularly important as competency-based medical education shifts the timing of the final exam a year earlier for residents in all specialties except family medicine. This may provide an opportunity both to determine if the wellness impacts of the exam shift with this timing change, as well as to implement needed support and resources for residents to help mitigate the stressors and challenges associated with the exam year.
Resident wellness on call: a quality improvement perspective in emergency psychiatry at McMaster University
Riddell, Tara; Westcott, Sandra; Clarkstone, Christopher
Introduction: Concerns from multiple educational stakeholders at McMaster University in 2019 regarding the local Psychiatric Emergency Services (PES) led to a reappraisal of the service infrastructure and role of psychiatry residents. Although a valuable learning environment and a required training experience, working in PES can also be inherently stressful. A group of residents sought to understand, through a quality improvement lens, factors impacting resident wellness related to PES during this transformation, and to identify areas for ongoing improvement.
Methods: Utilizing a process map, a working model of factors that may impact resident well-being in PES before, during, and post-call was developed. This was translated into a mixed methods survey that was distributed to PGY2-5 residents in October 2019. Results were analyzed for themes, which were then compared with data from various education committee meetings and additional wellness surveys. From this, a list of recommendations that could be tested was generated within each theme and distributed to residents, who rated the perceived impact of each intervention with regards to restoring and promoting their well-being.
Results: Five major themes - the 5C’s - impacting resident wellness related to PES were identified: competing demands, communication, comfort and environment, care management, and connectedness. It was further recognized that for meaningful change to occur, courage to listen to the needs of learners and staff, as well as courage to embrace and incite change is paramount. This further informed specific recommendations that are to be implemented with sequential PDSA cycles.
Conclusion: The results of this quality improvement initiative will help inform hospital, department, and educational leadership as changes in PES continue to unfold. Although McMaster psychiatry residents’ experience in PES was the primary focus, the 5C model of understanding resident well-being on call may be generalizable to learners in other settings, including but not limited to emergency psychiatry. Through sharing of the proposed recommendations and interventions related to each theme, it is the hope that participants can apply this model to their own settings, which may aid in building clinical and training environments which are sustainable, humanistic, and foster professional fulfillment and well-being.