Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Benjamin Doolittle

Abstract

Objectives: The specific aims of this study were as follows: (1) To identify which factors contribute to a subjective sense of thriving among resident physicians. (2) To propose a conceptual model of resident physician thriving. (3) To understand what effect the COVID-19 pandemic has had on the residency experience. And (4) To determine if and to what extent perspectives on the residency experience have changed over time throughout the course of the COVID-19 pandemic. Methods: In this qualitative study, we conducted in-depth interviews from May 2020 through February 2021 with resident physicians in the internal medicine, pediatrics, and combined internal medicine-pediatrics residency programs at a single university-affiliated hospital to determine what factors have contributed to their sense of thriving in residency as well as the effect of the COVID-19 pandemic on their residency experience. We used a snowball sampling technique to recruit participants. Validated instruments were used to quantify the participant’s subjective level of job and life satisfaction as well as their level of career burnout. To derive our conclusions, we employed thematic content analysis using a grounded theory-based approach.Results: 56 resident physicians were invited to participate in our study. We ultimately interviewed 37 residents. The first 15 interviews were completed between May 2020 and July 2020 (early COVID-19), with the remaining 22 interviews completed between December 2020 and February 2021 (late COVID- 19). Resident Thriving: Of the 37 total participants, 24 interviewees met criteria for life, career, and residency satisfaction while also not meeting criteria for burnout. Based on the statements from these 24 ‘thriving’ residents, we discovered six key themes contributing to resident thriving: (1) program leadership, (2) learning climate, (3) connectedness, (4) joy in medicine, (5) life balance, and (6) intrinsic factors. COVID-19 and the Residency Experience: Residents interviewed during the late COVID-19 block were less likely to meet criteria for satisfaction (p<0.01) and thriving (p<0.05) and were more likely to endorse feeling burned out (p<0.002) compared to their peers in the early COVID-19 cohort. Four key themes emerged relating to the impact of the COVID-19 pandemic on the residency experience: (1) changes to training and education, (2) changes to well-being, (3) changes to the practice of medicine, and (4) changes to perspectives on residency. Conclusions: The persistence of the COVID-19 pandemic has contributed to a subjective decline over time in residents’ perceptions of their well-being as well as their clinical education and training. Despite these circumstances, we found that nearly two-thirds of the residents we interviewed met criteria for thriving. As such, we believe that utilizing a theoretical model of resident thriving centered on flourishing has the potential to inform residency program structure, culture, and values even in the midst of a global pandemic.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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