Acad Psychiatry 29:405-407, October 2005 2005
doi: 10.1176/appi.ap.29.4.405
© 2005 Academic Psychiatry
A Day in the Life of a Psychiatry Resident: A Pilot Qualitative Analysis
Donald M. Hilty, M.D.,
Sonya M. Maynes, M.D.,
Maria Kellner, M.D.,
Marilyn S. Clark, B.A.,
James A. Bourgeois, M.D. and
Mark E. Servis, M.D.
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ABSTRACT
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OBJECTIVE: The topic "A Day in the Life of a Psychiatry Resident" is an opportunity to explore residents’ experiences to inform the delivery of education. METHODS: An open-ended, qualitative approach was used in a pilot project to explore contemporary residents’ experiences with education, similar to a patient-centered model of health care. RESULTS: Key themes for residents include balancing multiple roles at work, balancing work and home, identity formation, diversity (gender, ethnic, cultural, learner styles, and other dimensions), and challenges in training with advances in the field (e.g., neuroscience, technology, culture, spirituality). Contemporary residents have some issues as did their predecessors, but they also have unique experiences, issues, talents, and interests. CONCLUSIONS: A larger qualitative analysis of these issues, followed by testing of theories by quantitative methods, is indicated.
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INTRODUCTION
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Residents’ experiences may help faculty and staff in training programs make decisions on education, similar to the integration of patient perspectives into medical decision-making (i.e., a patient-centered model of health care delivery) (1). The topic "A Day in the Life of a Psychiatry Resident" is an opportunity to explore contemporary residents’ experiences, as well as faculty and staff perspectives of these experiences, as residents, faculty, training programs, and hospital settings continue to significantly change. An open-ended, qualitative approach can be used to identify and understand residents’ experiences, but to our knowledge, this approach has not yet been formally applied to residency education.
The exploration of residents’ experiences is particularly critical at this time for several reasons. We need keen awareness of residents’ issues as we move forward from the current apprenticeship model of training to competency-based programs, with emphasis on skill development, evidence-based treatments, and standardized assessment (2). Residents also assess the quality of a program in different terms than administration (3). In addition, they are often in a key phase of life adjustment, where the impact of decisions about work and home (e.g., marriage and childrearing) is strongly felt, partly due to age and fertility factors (4). Finally, the resident constituency is changing, for example, with the number of women increasing in medical school (4.5% in 1929 to 40% in 1991) and residency (4).
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Method
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Two female residents (PGY-I and PGY-IV), the psychiatric administrator (female), and the training director (male) were interviewed for 1 hour each. Qualitative interviewing was used based on grounded theory analysis (5, 6). The purposes of qualitative research are to explore a topic of interest, to understand perspectives of participants in situations, to capture "natural language," to build a theory and to create hypothesis for testing. Theory methods consist of flexible strategies for focusing and expediting qualitative data collection and analysis. These methods provide a set of inductive steps and successfully lead the researcher from studying concrete realities to rendering a conceptual understanding of them.
The initial question was "What comes to mind regarding ‘A Day in the Life of a Psychiatry Resident’?" Other questions explored and clarified responses. The interviewer (DMH), previously trained in qualitative methodology, spoke from an objective point of view rather than his own, maintained awareness of the participant potentially giving answers to "please" the interviewer, and avoided interpreting the interview data from his understandings. The interviews were transcribed verbatim, reviewed by 3 reviewers individually, and reviewed by all reviewers together. Themes were harvested and described below. Because of the small sample size, statistical analysis was not performed.
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Results
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Several themes from the first part of the interview were elucidated from the transcripts by all three reviewers independently. One theme was the challenge of occupying multiple roles, mainly as a trainee and employee, but also as a person, team member, learner, teacher, and as a peer to students, other residents, faculty and staff. These roles are sometimes in conflict, particularly the tension between residency as a career or a job. Some expressed concern about this: "... we are already halfway down that slope as a profession, that is, to a job instead of a profession. There are pros ... to being a professional ... [our] identity and commitment to patients. It is a developmental process ... to realize that this is not just a job, but a profession."
A juxtaposed theme is the challenge of balancing work and home life, which was identified as the number one challenge for residents, particularly for female residents. Residents’ lives carry on with family, marriage, children, losses, and hobbies. Pregnancy may be exciting for a resident and colleagues but also raises concerns about others being burdened with extra work. It is also believed that residents aim for a higher personal quality of life. "We are more goal-directed toward lifestyle, practical living issues, and advocating for ourselves as persons and trainees. A key part of this is financial and involves moonlighting." "It is more expensive to get a medical education ... [We have] concerns about income later and worry about debt. Yet, there is more sacrifice [in psychiatry] since it is not as lucrative ... People may be more genuine in terms of their intentions and wanting to contribute to society, rather than wanting the prestige."
A third theme identified was the process of professional growth and identity development as a psychiatrist. Early on in residency, residents feel incompetent and are pulled in a number of different directions by their roles and responsibilities. For example, they struggle to "know what to do" to help patients and then may realize, "I can help even if it is only by listening, which is healing." Adverse situations can produce good outcomes (e.g., mean patients and/or inability to help some patients simulate reflection). Residents look for role models and seek advice from peers about what to do in situations.
A fourth theme appeared with regard to resident learning, in terms of the process and challenges therein. Residents are excited about learning from and helping patients, as well as new developments in the field. Residents learn from didactics, individual supervision, group formats (experiential group, didactics, sharing stories), teaching, adverse situations (mean patients, inability to help some patients, and interruptions "... make me prioritize"), and technology (literature searches, electronic medical records, personal digital assistants). Challenges include: frustration with "gray" issues, interruptions, a steep learning curve, prioritization and organization; sensitivity to feedback, inadequate time for reading, feeling incompetent, and assimilation of the plethora of knowledge. Still, some state, "I love it when residents tell me ‘I learned, I grew, and I loved it.’"
An additional theme related to people and their many differences, including: learner styles, trainee level, gender, ethnic and cultural diversity, and varying degrees of interest (e.g., work versus personal life).
Additional themes emerged from more detailed questions to the interviewees. One theme was the importance of peer interaction for learning and support. Residents learn a great deal from each other, socialize in and out of work, and go to peers first when problems occur. Authority figures (e.g., chief resident, faculty) are not the first choice for problem-solving. Interviewees also commented on a tension between learning more and the amount of time for learning. This was seen as a major contemporary challenge, with new emphasis on topics like neuroscience, culture, spirituality, and information technology.
Interviewees were asked how education and residents have changed over the past two decades. In addition to the themes of balancing work/home and diversity of learners mentioned above, interviewees reported that residents: work fewer hours; have more demands and higher expectations as consumers in terms of salaries and work hours; are more information-savvy, creative, and able to multitask; may be better at self-directed learning; are not as good at psychotherapy; and perhaps are less intellectually thirsty ("as the culture does not support the liberal arts education as much as before and the focus is more pragmatic"). Comments about technology abounded and interviewees were asked "What impact, if any, has technology had on residency training?" They noted it is far easier to acquire information using the Internet. They noted that communication is facilitated by e-mail and it gives "increased, timely access to faculty and the residency training director." Still, residents realized the benefit of "two-way connection [by phone], which makes it easier to problem-solve and is more immediately gratifying." Personal digital assistants provide tremendous information without "carrying medicine manuals."
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Discussion
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This initial qualitative project suggests that contemporary experiences for residents include: 1) previously identified, largely unchanged issues like identity formation and balancing multiple roles; 2) previously identified but evolving issues like balancing work and home and how to learn so many things (e.g., "usual" topics plus neuroscience, culture, spiritual, and information technology topics); and 3) relatively newly identified issues related to sociodemographic (gender, ethnic, cultural) and learning style diversity, as well as higher expectations as consumers in terms of salaries and work hours.
It appears that identity formation, role clarity, and work/home balance may be challenges experienced, discussed, and (hopefully) conquered over time. Ideally, residents will develop a sense of "ownership" of the role of a physician and of the profession. Pregnancy and childrearing may ultimately mean as much to the development as a physician as does training (7) although conflict about workload does occur (7–8). Clinical experience, relationships with others, peer support, supervision, role-modeling, mentoring, and other intangible events shape these challenges more than didactics.
Limitations of this pilot project include small sample size and heterogeneity of the interviewees, as well as the possibility that results do not generalize to other institutions. A larger, multisite qualitative analysis of these issues would be helpful to see if the trends in themes persist, as well as to identify others. Themes could be used to generate hypotheses based on theories and tested by additional studies using qualitative and/or quantitative methods.
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ACKNOWLEDGMENTS
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Dr. Hilty is Associate Professor of Clinical Psychiatry, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California. Dr. Maynes is Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California. Dr. Kellner is Resident, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California. Ms. Clark is Administrative Specialist, Resident Training, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California. Dr. Bourgeois is Associate Professor of Clinical Psychiatry and Director, Psychosomatic Medicine Service, University of California, Davis, Sacramento, California. Dr. Servis is Professor of Clinical Psychiatry, Vice-Chair of Education and Residency Training Director, University of California, Davis, Sacramento, California. Address correspondence to Dr. Hilty, University of California, Davis, 2230 Stockton Blvd., Sacramento, CA 95817; dmhity@ucdavis.edu (E-mail). Copyright © 2005 Academic Psychiatry.
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REFERENCES
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- Lane C, Davidoff F: Patient-centered medicine: a professional evolution. JAMA 1996; 275–276
- Martin L, Saperson, Maddigan B: Residency training: challenges and opportunities preparing trainees for the 21st century. Can J Psychiatry 2003; 48:225–231[Medline]
- Yudkowsky R, Elliot R, Schwartz A: Two perspectives on the indicators of quality in psychiatry residents. Acad Med 2002; 72:57–64
- Young-Shumate L, Kramer T, Beresin E: Pregnancy during graduate medical training. Acad Med 1993; 68:792–799[Medline]
- Charmaz K: Qualitative interviewing and grounded theory analysis, in Handbook of Interview Research. Edited by Gubrium JF, Holstein JA. Thousand Oaks, Calif, Sage Publications, 2001, pp 675–694
- Glaser BG, Strauss AL: The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine, 1967
- Tinsley JA: Pregnancy of the early-career psychiatrist. Psychiatr Serv 2000; 51:105–110[Abstract/Free Full Text]
- Rodgers C, Kunkel ES, Field HL: Impact of pregnancy during training on a psychiatry resident cohort. J Am Med Women’s Assoc 1994; 49:49–52
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Editorial Leadership of Academic Psychiatry
Acad Psychiatry,
September 1, 2009;
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353 - 357.
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C. Horn, B. Plazas Snyder, J. H. Coverdale, A. K. Louie, and L. W. Roberts
Educational Research Questions and Study Design
Acad Psychiatry,
May 1, 2009;
33(3):
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ABSTRACT
INTRODUCTION
