The ‘July Effect’ in supervisory residents: assessing the emotions of rising internal medicine PGY2 residents and the impact of an orientation retreat

Abstract

2020) The 'July Effect' in supervisory residents: assessing the emotions of rising internal medicine PGY2 residents and the impact of an orientation retreat, Medical Education Online, 25:1, 1728168, ABSTRACT Background: The arrival of new residents brings challenges for residency programs and residents. Many residency programs conduct orientation sessions to help transition rising supervisory residents into their new roles, but no evaluation of their impact on residents' emotional well-being has been performed.Objective: This study assesses the impact of a half-day orientation retreat on rising internal medicine post-graduate year (PGY) 2 residents' emotions toward PGY2 year and their selfconfidence in fulfilling the supervisory resident role. Design: A survey was administered to a class of rising supervisory residents immediately before and after an orientation retreat in May 2017. The survey provided participants an open-ended prompt to describe their emotions toward PGY2 year and a 5-point Likert scale to rate their confidence in fulfilling supervisory resident roles. Differences were assessed using McNemar's exact and Wilcoxon signed-rank tests, respectively. Results: Forty-four of 50 (88%) eligible participants completed pre-and post-intervention Likert scales and 40 of 50 (80%) eligible participants completed corresponding emotion sections. Pre-intervention the most common emotions were anxiety (n = 33, 82.5%) and excitement (n = 32, 80.0%). Post-intervention, participants' fear was reduced (45.0% vs 12.0%; p < 0.001). Participants reported greater confidence that internship prepared them for PGY2 year and understanding of triaging and admitting principles (agree or strongly agree from 65.9% to 84.0% and from 25.0% to 68.2%, respectively; p < 0.005 for improvement by Wilcoxon signed-rank for both). Conclusions: Orientation retreats may be an effective way to reduce fear and demystify the supervisory resident role. ARTICLE HISTORY

From doing to leading: PGY‐1 to PGY‐2 transition

“…PGY-2 year and reported that the most common emotions expressed were anxiety and excitement. 3 However, these emotions or factors that elicited them were not further explored in detail. In a study by Fraser et al, they reported that 80% of their residents desired formal leadership training.…”

“…These new roles are often assumed with little more than brief resident-as-teacher and leadership workshops and retreats. [3][4][5][6][7] The progression from undergraduate medical education to graduate medical education has been the subject of several research studies. [8][9][10][11][12][13] In contrast, transitions during residency have been less well investigated, [3][4][5]7,14 particularly in-depth explorations of trainee perspectives and emotions during this transition.…”

“…The entire team is overseen by faculty consultants. These new roles are often assumed with little more than brief resident‐as‐teacher and leadership workshops and retreats 3–7 . The progression from undergraduate medical education to graduate medical education has been the subject of several research studies 8–13 .…”

Training junior doctors to lead rapid responses

“…Junior doctors (residents) develop patient management skills primarily through an apprenticeship model of on‐the‐job learning. For residents in North America and elsewhere, the transition from postgraduate year (PGY) 1 to 2 is a particularly challenging and stressful time 2 . While as PGY‐1s, trainees handle day‐to‐day tasks of patient care with ample guidance from supervisors, as senior residents (PGY‐2s and higher), they supervise and teach near peers, lead ward rounds, engage in interprofessional teamwork and manage safe patient care.…”

“…While as PGY‐1s, trainees handle day‐to‐day tasks of patient care with ample guidance from supervisors, as senior residents (PGY‐2s and higher), they supervise and teach near peers, lead ward rounds, engage in interprofessional teamwork and manage safe patient care. There is wide variability in how programmes prepare their residents for the oncoming transition 2 . Thus, residents often rely on observation of senior role models and/or acquire these skills through trial and error.…”