Abstract
BackgroundAlthough program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training. Most program evaluation consists of numerical rating scales from which it is often difficult to pinpoint exact sources of dissatisfaction.MethodsOur goal in this work is to evaluate the utility of focus group methodology to uncover in detail the reasons for residents’ deteriorating morale in an IM residency program, as well as to solicit suggestions for correction. This study employed focus groups (FG) in a qualitative research design, in which descriptive statistics from a resident program evaluation survey served to guide an intensive focus group process. Participants were 40 of 45 2nd and 3rd year internal medicine residents enrolled in the IM residency training program. Five chief residents were trained to conduct 5 focus groups with 8 residents in each group. The focus groups examined possible issues contributing to the deterioration of morale noted in the quantitative survey.ResultsMany unexpected themes were uncovered by the FGs. Residents identified the following factors as the major contributors to deteriorating morale: 1) Pace of change 2) Process of change 3) The role of chief residents in change 4) Fear of intimidation and retaliation. Groups also suggested practical recommendations for improving the culture of the residency.ConclusionIntroducing change in residency training is a challenging process. Respectful attention to resident frustrations and solution-focused discussions are necessary to understand and improve morale. Focus groups proved to be a useful tool in revealing the precise source of pervasive resident concerns as well as providing potential solutions. In addition, FGs methodology can be adapted in a practical manner to residency evaluation.
Highlights
Program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training
focus groups (FG) participants attributed some of the deterioration of morale to the many changes that had occurred over a short period of time, leaving them feeling helpless and out of control
As a result of the FG process, we developed crucial insights into what had gone wrong with a process of change that the administration believed to be inclusive and transparent
Summary
Program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training. Program evaluation is intended to support the goal of the Alliance for Academic Internal Medicine Education Redesign Task Force tool precludes such deep understanding of residents’ concerns. The study was triggered by an annual written resident survey that uncovered new resident dissatisfaction and a lower overall level of morale compared to prior years. Resident evaluations of program leadership, fairness of evaluations, and educational quality declined compared to the two previous years, as did resident personal and professional morale (see Table 1). Because we could not determine from our standard survey the specific nature and sources of this dissatisfaction, we conducted a series of focus groups (FGs) to gain a more explicit understanding of residents’ concerns. At first glance FGs might not seem ideally suited to the exploration of sensitive topics, research suggests that they can reveal data that other methodologies do not [12]
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