Presenting Author:

Katherine O'Brien, M.D.

Principal Investigator:

DeWitt Baldwin Jr. , M.D.

Department:

Education

Keywords:

ACGME, Well-Being, Qualitative Review, Children at home, Financial pressures, Unprofessional behaviors

Location:

Third Floor, Feinberg Pavilion, Northwestern Memorial Hospital

E1 - Education

A qualitative review of graduate medical trainees’ perceptions of training

Background: In 2013, the Accreditation Council for Graduate Medical Education (ACGME) invited all residents and fellows at ACGME approved programs to complete an optional, anonymous well-being survey. 22,500 trainees responded (out of a possible 120,000), and of these, 1,910 respondents detailed more personal experiences in the open comments section at the end of the survey. While there have been smaller scale survey studies looking at various individual aspects of well-being, this study analyzed in-depth, personal trainee feedback and is the first study of this magnitude to assess graduate medical trainees’ comments and concerns about their training in relation to well-being. Objective: To identify overarching themes related to well-being of graduate medical trainees. Methods: We performed a retrospective, qualitative review of 1910 comments written by trainees. Comments were excluded if they did not include information related to training or were less than two words. Comments were analyzed using a grounded theory, line-by-line coding process to generate themes. Results: Overall, the comments analyzed encompassed all medical specialties and some subspecialties. Respondents who provided comments had a similar demographic profile to those who responded to the quantitative survey. The overall tone of the comments was varied; 57% of comments had an overall negative tone, 31% had a neutral tone, and 12% of comments had a positive tone. The positive comments received were also less robust than the negative comments. Overall, there were three concepts that emerged as the most striking: children at home, financial pressures, and unprofessional behaviors. Many trainees described the complexity added to medical training due to pregnancy and raising children. Financial indebtedness was commonly cited as leading to an uncertain future, a disillusionment with the profession, and a feeling of being trapped in medicine, described as indentured servitude. Finally, the existence of unprofessional behavior and the continued experience of mistreatment, humiliation and retaliation were identified. Significance: The overarching theme that emerged from the review of the comments was the complex and challenging nature of training. Through the analysis of these comments from trainees, valuable insight can be gleaned into topics that can serve as a focus for creating more innovative, supportive graduate training programs. Moving forward, the novel concepts discovered from analysis of these comments should be recognized as essential components to well-being, and should become a focus for future research. In addition, there is a need for more illustrative positive comments about training programs, in order to glean exactly what elements of a training program create a high-quality experience. This can help to shape change, as the ultimate goal is to produce healthy, well-adjusted physicians who can provide the best possible care for patients throughout t