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Transition to residency is tough everywhere

A series of studies presented at the 2014 International Conference on Physician Health (ICPH) have documented just how stressful the transition from medical student to resident can be, no matter which health care system is involved.

With ‘Milestones and Transitions — Maintaining the Balance’ the theme of this year’s ICPH meeting, the data suggested the student resident transition could be the most challenging in the spectrum of medical education and practice.

Four presentations on this particular transition came from Canada, the United States, United Kingdom and Spain.

“It’s really raw, I experienced it myself,” said Canadian Medical Association President Chris Simpson, who was attending the session. Simpson is now chairman of the cardiology department at Queen’s University (Kingston, ON).

He said graduating from medical school to residency training continues to cause anxiety for those involved.

The Canadian data, published last year and presented during the session, was based on in-depth interviews with 17 PGY 1 residents at the University of Toronto.

Dr. Susan Edwards, speaking on behalf of lead author Christopher Hurst, said the degree of stress experienced by first year residents is clearly seen at the University of Toronto. The PGY 1s comprise the main group seeking assistance at the Office of Resident Wellness, where she is director.

Edwards said the study showed large upswings and downswings in the state of well-being that residents reported as they passed through monthly rotations of their year-old residency.

“I can’t stress enough the importance of humanity,” Edwards said, discussing how to improve the experience. She also noted that feeling part of a team was a positive experience for these residents.

Encouraging a sense of teamwork was a point also made by Dr. Vikas Acharya in his presentation on how the transition to residency has been improved at Luton and Dunstable Hospital, NHS Trust, Luton, UK.

“It’s a survival experience,” Acharya said of the transition period. He noted that the high levels of stress and anxiety felt by those moving from the nurturing environment of medical school – and having to work in a demanding hospital environment with fewer supports – can have a negative impact on patient care as well as the individual’s own well-being.

Dr. Amir Reyahi who worked with Acharya on the study, said one of the most positive steps to improve the residents’ experience is to make them feel part of the team by holding the team dinner at the beginning of the rotation rather than at the end.

The high levels of stress and anxiety experienced by new residents were confirmed by research studies from a national mental health survey conducted with medical students and physicians in Australia and residents and young doctors in Catalonia.

Dr. Michael Bonning, who presented the Australian data, said the best way to improve the transition from medical school to residency is to change the culture of medicine.

Anna Mitjans, who presented the Spanish research on behalf of the Galatea Foundation, said residents also reported “a sweet moment” when they first started their residency.

Edwards and others confirmed that while many residents reported they had “anxious anticipation” upon starting residency, this feeling was quickly overcome by the anxieties experienced with the new role. Mitjans speculated the Spanish residents felt more positive because they knew they had four or five years of employment ahead of them, whereas it was uncertain whether they would have a job when they entered practice.

Simpson said program leaders can help lessen transition stress – and the expectations involved – by taking tangible steps to improve the work environment for residents.

Forward any comments about this article to: cmanews@cma.ca.