Speaking Up: A qualitative review of residents’ perceptions of training

Introduction : In 2013, the Accreditation Council for Graduate Medical Education (ACGME) invited all trainees at ACGME approved programs to complete an optional, anonymous well-being survey; 22, 476 trainees responded, with 1,782 respondents detailing more personal experiences in the open comments section of the survey. We believe this to be the largest sample ever subjected to systematic analysis aimed at identifying both known and unknown sources of issues unique to the training environment of US residents. Methods : We performed a retrospective, qualitative review of 1,200 of the 1,782 comments written by trainees; the comments were analyzed independently by three coders. Each coder reviewed all entries and separately characterized concepts. These three coders then met periodically and used an iterative process to reach consensus and content reliability on over-reaching concepts and themes; individual raters identified various quotes that exemplified each of the themes. Results : Overall, the comments analyzed encompassed all medical specialties and some subspecialties. Respondents who provided comments had a similar demographic profile to the larger residency population as a whole. Six major concepts were identified: children at home, satisfaction with the program, unprofessional behaviors/mistreatment, slavery, financial pressures, and duty hours. The overarching theme of all the comments was disconnect between expectation and reality. Conclusion : Our analysis highlights six major concepts and one overarching theme related to medical training from the perspective of medical residents. These valuable insights can potentially be a focus for creating more innovative, supportive graduate training programs in the future. Moving forward, the novel concepts discovered from analysis of these comments should be recognized as essential components of well-being and should become a focus for future research.