Law Marcus, Lam Michelle, Wu Diana, Veinot Paula, Mylopoulos Maria
M. Law is associate professor of family medicine and director of Foundations, MD Program, University of Toronto, as well as director of medical education, Michael Garron Hospital, Toronto, Ontario, Canada. M. Lam is a family physician, Hamilton, Ontario, Canada. D. Wu is a family physician, Toronto, Ontario, Canada. P. Veinot is an independent research consultant, Toronto, Ontario, Canada. M. Mylopoulos is assistant professor, Faculty of Medicine, and scientist, Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
Acad Med. 2017 Nov;92(11):1601-1606. doi: 10.1097/ACM.0000000000001711.
Residency poses challenges for residents' personal relationships. Research suggests residents rely on family and friends for support during their training. The authors explored the impact of residency demands on residents' personal relationships and the effects changes in those relationships could have on their wellness.
The authors used a constructivist grounded theory approach. In 2012-2014, they conducted semistructured interviews with a purposive and theoretical sample of 16 Canadian residents from various specialties and training levels. Data analysis occurred concurrently with data collection, allowing authors to use a constant comparative approach to explore emergent themes. Transcripts were coded; codes were organized into categories and then themes to develop a substantive theory.
Residents perceived their relationships to be influenced by their evolving professional identity: Although personal relationships were important, being a doctor superseded them. Participants suggested they were forced to adapt their personal relationships, which resulted in the evolution of a hierarchy of relationships that was reinforced by the work-life imbalance imposed by their training. This poor work-life balance seemed to result in relationship issues and diminish residents' wellness. Participants applied coping mechanisms to manage the conflict arising from the adaptation and protect their relationships. To minimize the effects of identity dissonance, some gravitated toward relationships with others who shared their professional identity or sought social comparison as affirmation.
Erosion of personal relationships could affect resident wellness and lead to burnout. Educators must consider how educational programs impact relationships and the subsequent effects on resident wellness.
住院医师培训给住院医师的个人关系带来了挑战。研究表明，住院医师在培训期间依赖家人和朋友的支持。作者探讨了住院医师培训要求对住院医师个人关系的影响，以及这些关系的变化对他们健康状况的影响。
作者采用建构主义扎根理论方法。在2012年至2014年期间，他们对来自不同专业和培训水平的16名加拿大住院医师进行了有目的的理论抽样半结构化访谈。数据分析与数据收集同时进行，使作者能够采用持续比较法来探索新出现的主题。对访谈记录进行编码；将代码组织成类别，然后形成主题，以发展出一个实质性理论。
住院医师认为他们的关系受到其不断演变的职业身份的影响：尽管个人关系很重要，但成为一名医生的身份更为重要。参与者表示，他们被迫调整自己的个人关系，这导致了关系层次结构的演变，而培训带来的工作与生活的失衡强化了这种层次结构。这种糟糕的工作与生活平衡似乎导致了关系问题，并降低了住院医师的健康水平。参与者应用应对机制来管理因适应而产生的冲突，并保护他们的关系。为了尽量减少身份认同冲突的影响，一些人倾向于与具有相同职业身份的人建立关系，或者寻求社会比较来获得肯定。
个人关系的侵蚀可能会影响住院医师的健康，并导致职业倦怠。教育工作者必须考虑教育项目如何影响人际关系以及对住院医师健康的后续影响。
