The Factors That Most Greatly Influence Resident Satisfaction

Ryan Syrek, MA

Disclosures

June 07, 2018

Although a precise formula for resident happiness is probably impossible, a new systematic review published in the Journal of General Internal Medicine has identified key factors that may increase resident satisfaction during outpatient ambulatory training.

As Stepcyznski and colleagues acknowledge, residents are known to be frustrated by "the tension between simultaneous and conflicting inpatient and outpatient responsibilities." Young doctors also face challenges due to the clinic schedule and a higher prevalence of significant comorbidities among patients followed within a residency continuity clinic. This prompted researchers to identify and review 357 applicable studies, from which 11 papers were selected for inclusion in the final review. Seven of these studies emphasized organizational elements as affecting resident satisfaction, whereas four studies focused on the role and relationship of dedicated faculty.

The studies primarily focused on internal medicine residency programs, which accounted for nine of the 11 papers. The remaining two studies were from pediatrics and family medicine, respectively. Stepcyznski and colleagues broadly divided the 11 studies into two categories: interventional studies focused on clinic reorganization and cross-sectional studies that explored specific factors associated with resident satisfaction.

The models used in the seven interventional studies varied widely, from "traditional" half-day per week clinical models to "long-block" approaches that last 12 months, during which residents had no inpatient responsibilities. Although the approaches were different, the interventions all resulted in an increased perception of resident/patient continuity, which was thus isolated by Stepcyznski and colleagues as one of the key factors to overall resident satisfaction.

Three of the four cross-sectional studies analyzed factors that correlated with resident satisfaction, residents' views of the continuity experience, and the likelihood of choosing internal medicine as a career. The remaining study explored satisfaction with patient interactions using a postvisit questionnaire. The key elements identified in this group of studies as having the greatest significance were the resident's perception of their preceptor as a role model, as well as patient/resident continuity, which mirrored the interventional study findings.

The systematic review thus concluded that viewing preceptors as role models and organizational factors that promote patient/resident continuity and separation of inpatient and outpatient responsibilities were the major factors for resident satisfaction. Stepcyznski and colleagues recommend that ambulatory training programs should be organized in such a way that competition between inpatient and outpatient responsibilities are minimized while continuity with patients is maximized. They also recommend investment in faculty who serve as mentors and role models as a means to both improve the ambulatory clinic experience overall and influence more residents to pursue primary care as their career.

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