Changes in residents' attitudes in response to residency program modifications: a prospective study.

Interventions to modify stress during residency training have rarely been formally analyzed for effectiveness. Using a 33-item, closed-ended questionnaire based on factors previously reported to cause residency stress, we studied how program modifications affected the attitudes of residents in a university-affiliated community internal medicine residency training program. Training program modifications, targeting specific questions, were prospectively introduced, and questionnaire responses were compared from year to year and by resident year of training. Between 1988 and 1989, the noon conferences and ward rotations were modified. Between 1989 and 1990, a "night float" was introduced. Residents' responses varied little by year of training, but the mean responses to seven of the fourteen "targeted" questions showed significant changes over time. In particular, the introduction of a night float resulted in markedly improved attitudes regarding time demands. This study demonstrates that residents' attitudes can be objectively measured, and that residents accurately perceive and respond to program modifications. Efforts should be made to standardize, validate, and develop attitudinal scales from such questionnaires to aid in the assessment of the numerous changes in residency programs currently being considered or implemented nationwide.