Zink Korie, Clugston Cory, Regan Linda
Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA.
AEM Educ Train. 2022 Jun 23;6(3):e10764. doi: 10.1002/aet2.10764. eCollection 2022 Jun.
Most emergency medicine (EM) residency programs have orientation curricula to guide interns through the transition from medical school to residency, although no standard components are required. This transition is recognized as a challenging time for young physician learners; however, there is no current understanding of the perspective of incoming interns as they enter residency. We sought to identify themes, examine the current literature, and reflect on the experiences of our residency leadership to inform the creation of orientation activities that foster positive experiences, as well as directly address intern fears and anxieties.
This qualitative study collected free text responses on the first day of EM orientation regarding areas of high excitement and high fear as interns entered residency. Data were collected from 2011 to 2019 in a 4-year EM residency program and a 6-year combined EM-Anesthesia residency program in the Mid-Atlantic. An inductive approach was used to code intern responses and develop themes within each category, and a frequency analysis was performed.
A total of 112 interns participated. Thematic analysis of coded responses yielded 11 themes around "most excited" and 13 themes around "most scared." The most frequent themes for "most excited" were: (1) Forming new relationships, (2) Building and applying knowledge, and (3) Being responsible for the care and education of others. For "most scared," the most frequent themes were: (1) work-life balance and burnout, (2) making harmful mistakes, and (3) knowledge wealth and retention.
We identified themes of high excitement and high fear for interns entering residency orientation. Based on the themes developed and current literature, recommendations for residency programs regarding intern orientation are provided, specifically that programs intentionally address opportunities for professional identity formation, building relationships with new people/places, emphasizing wellness, and mitigating burnout.
大多数急诊医学（EM）住院医师培训项目都有入职培训课程，以指导实习生从医学院过渡到住院医师培训阶段，不过对于课程所需的标准组成部分并无要求。人们认为这段过渡时期对年轻的医师学员而言颇具挑战性；然而，目前对于即将进入住院医师培训阶段的实习生的看法尚无了解。我们试图确定主题、审视当前的文献，并反思我们住院医师培训领导层的经验，以为创建能带来积极体验、直接解决实习生恐惧与焦虑的入职培训活动提供信息。
这项定性研究在急诊医学入职培训的第一天收集了关于实习生进入住院医师培训阶段时高度兴奋和高度恐惧领域的自由文本回复。数据于2011年至2019年在大西洋中部地区一个为期4年的急诊医学住院医师培训项目和一个为期6年的急诊医学与麻醉联合住院医师培训项目中收集。采用归纳法对实习生的回复进行编码，并在每个类别中确定主题，同时进行频率分析。
共有112名实习生参与。对编码回复的主题分析得出了围绕“最兴奋”的11个主题和围绕“最害怕”的13个主题。“最兴奋”的最常见主题为：（1）建立新关系；（2）积累和应用知识；（3）负责他人的护理和教育。对于“最害怕”，最常见的主题为：（1）工作与生活的平衡及职业倦怠；（2）犯下有害错误；（3）知识储备与记忆。
我们确定了进入住院医师培训入职阶段的实习生高度兴奋和高度恐惧的主题。基于所确定的主题和当前的文献，针对住院医师培训项目的实习生入职培训提出了建议，具体而言，项目应特意提供形成职业身份认同的机会、与新的人/场所建立关系、强调健康并缓解职业倦怠。
