Resident Perceptions Research Articles

Can ecosystem services supply match local residents' perception: Linking macro-ESs and micro-individual perceptions in the Yellow River Basin.

Residents' satisfaction perceptions of ecosystem services (ESs) are essential for the ecological protection and high-quality development of the Yellow River Basin (YRB). Existing studies lacks large-scale survey of local residents' satisfaction perception at urban scale within river basins, and has not effectively explored the matching relationship between the ESs supply and the perceptions of local residents. To address this gap, this study develops a database on nine ESs supply and individual perceptions of the YRB, constructs a comprehensive framework to quantify the matching of ESs supply and local residents' satisfaction perceptions, and proposes targeted strategy. The results reveal that: (1) Provisioning services are higher in cities along the river, while regulating services are higher in the south and west, both showing spatial clustering (p<0.05). Cultural services are unevenly distributed, with higher quality of life and leisure tourism in the east and south. Provisioning and regulating services exhibit a spatial clustering (p<0.05). (2) Residents' perceptions of provisioning services are the highest [3.86, 4.28], followed by cultural services [3.85, 3.98], and regulating services are lowest [3.53, 3.69]. Only provisioning services show significant spatial correlation (p<0.05). (3) There are trade-offs and synergies in the ESs supply, but no significant correlation between the supply and perceptions. (4) A significant mismatch between ESs supply and local residents' perceptions in 15-24 cities, with 33.33%-71.79% of cities showing underestimation or overestimation of ESs supply. These findings provide feasible references for formulating and implementing tailored strategies for coordinated human and nature development.

The Many Faces of Good Operating Room Supervision: Supervisors' and Residents' Perspectives After Operating Together.

Effective operating room (OR) learning requires surgical and surgical-educational skills. Current insights into educational skills of surgical educators are derived from general perceptions of supervisors and residents via survey and interview studies. This study aims to provide insight into what educators and residents perceive as good OR supervision behavior based on actual day-to-day collaboration. Additionally, it seeks to explore the underlying goals of good OR supervision and to identify relations between good OR supervision behavior and underlying goals DESIGN: 16 supervisor-resident dyads performing a procedure were video recorded. Directly after the procedure educators and residents independently identified 3 moments of what they perceived as good supervision. During subsequent video-stimulated interviews, they elaborated on why they selected those moments. Thereafter, a qualitative thematic analysis was performed. Four common surgical procedures performed by a resident under supervision of a general or orthopedic surgeon in 6 different teaching hospitals in the Netherlands. 16 unique supervisor-resident dyads were included in a convenient sample. Analysis yielded 13 different codes identifying supervisor behaviors and 6 underlying goals of good OR supervision. Which strategy surgical educators use to achieve one of the underlying goals is situation-dependent. Good supervision is situated and needs to be updated as procedures progress. There is no one-on-one relation between types of good supervision behavior and the underlying goals. As such, a fixed template for effective OR supervision does not exist.

P-978. Internal Medicine Resident Perceptions of the Barriers to and Facilitators of Optimal Inpatient Care of Persons who Inject Drugs: A Mixed Methods Study

Abstract Background Harm reduction counseling and HIV pre- and post-exposure prophylaxis (PrEP and PEP) can prevent infectious complications among persons who inject drugs (PWID). Hospitalizations are opportunities to provide these services, though these interventions occur infrequently for PWID admitted to our hospital. Little is known about internal medicine resident (IMR) perceptions of these interventions in the inpatient setting despite their frontline role in patient care in our institution. Methods In our mixed methods study we describe IMR perceptions of HIV prevention interventions and harm reduction counseling among PWID admitted to the University of Wisconsin Hospital. We conducted a survey examining current practices and perceptions. We explored the barriers and facilitators to optimizing these practices through semi-structured interviews. Transcripts were analyzed via consensus coding using the Systems Engineering Initiative for Patient Safety (SEIPS) model as a guiding conceptual framework. This framework describes the interactions of five components of complex work systems and their individual and overlapping influence on patient outcomes: 1) organization, 2) person, 3) physical environment, 4) task, and 5) technology and tools. Results 59 IMRs responded to the survey (58% response rate). Residents report offering HIV-PrEP or HIV-PEP to PWID at low frequency; 56% never offer PrEP and 64% never offer PEP. 20% or fewer IMRs report offering PrEP or PEP at least some of the time. IMRs report a high degree of importance and appropriateness of HIV prevention interventions; however, the majority lack comfort, familiarity, or competence in how to counsel patients or prescribe PrEP or PEP (Table 1). 15 residents participated in interviews, all of whom identified barriers and facilitators to these interventions relevant to each component of the work system (Figure 1). Conclusion Despite recognizing the importance of HIV prevention services, including PrEP, PEP and harm reduction counseling, IMRs lack knowledge and comfort to do so. Barriers to optimal care span all components of the work system. Facilitators to optimal care and next steps include educational initiatives and EMR-based interventions with assessment of impact. Disclosures Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support

P-1140. Antimicrobial Stewardship Curriculum Development for Pediatric Residents

Abstract Background Although both the Centers for Disease Control and Prevention and the World Health Organization identify education as a core component of antimicrobial stewardship (AS) programs, there is little data to inform AS curriculum development for pediatric residents. Demographics of Resident Survey Respondents. Resident respondents are categorized by their year in training, their prior educational experiences, and their number of prior educational experiences. PGY: post-graduate year, ID: infectious diseases, AS: antimicrobial stewardship Methods Pediatric residents at a single academic tertiary-care children’s hospital were surveyed to identify prior AS educational experiences and usefulness of additional education on different AS domains, among other topics. Content experts (pediatric infectious diseases [ID] faculty, fellows, advanced practice providers, and pharmacists) at the same institution were surveyed to determine what material should be included in an AS curriculum for pediatric residents. A topic was considered to have achieved consensus if ≥80% of respondents identified having knowledge of this topic as “very” or “extremely” important for graduating pediatric residents. The difference in satisfaction in AS education since starting residency training between those who had completed an ID/AS rotation and those who had not was statistically significant (OR 6.1, 95% CI 1.2-52.6, p=0.03). There was no statistically significant difference in MS AS education when comparing those who completed a rotation in medical school to those who did not (OR 3.3, 95% CI 0.34-102.8, p=0.3). MS: medical school, AS: antimicrobial stewardship, ID: infectious diseases Results 33/110 (30%) of pediatric residents responded to the resident survey. The domains on which most residents identified that additional education would be “very” or “extremely” useful were spectrum of activity (97%), duration of therapy (94%), and empiric therapy (94%). Respondents who had completed an ID or AS rotation as a medical student or resident were more likely to identify additional education on antimicrobial resistance (AMR) as “very” or “extremely” useful than those who had never completed an ID or AS rotation (87% versus 40%, OR 8.90, 95% CI 1.61-63.0, p=0.01). 26/26 (100%) of content experts responded to the content expert survey. Overall, 39 of 105 topics (37%) met the threshold for consensus. Domains with the greatest level of consensus were empiric therapy (11/13 topics, 85%) and duration of therapy (5/8, 63%), whereas the domains with the fewest topics achieving consensus were diagnostics (2/14, 14%) and AMR (1/18, 6%). "Any prior rotation" refers to a respondent who had completed an ID or AS rotation in either medical school or residency. "No prior rotation" refers to a respondent who never completed either an ID or AS rotation at any point in training. Respondents who had previously completed an ID/AS rotation were more likely to rate additional education on AMR as “very” or extremely” useful than those who reported no prior experiences (87% versus 40%, OR 8.90, 95% CI 1.61-63.0, p=0.01). There were no other statistically significant differences in responses when comparing prior experiences or year in training for other domains. ID: infectious diseases, AS: antimicrobial stewardship, AMR: antimicrobial resistance Conclusion An AS curriculum for pediatric residents focused on empiric therapy and duration of therapy is most likely to meet the needs of both pediatric residents and content experts. Incorporating content expert opinions may lead to a more focused curriculum than surveying residents alone. Formal ID or AS experiences during training may improve pediatric resident perception of the usefulness of additional education on AMR. Topics Achieving Consensus on Content Expert Survey Topics are categorized by domain. Consensus was defined as ≥80% of respondents identifying a topic as "very" or "extremely" important for a graduate of a pediatric residency program to be knowledgeable on. Each header identifies the number of topics within each domain that achieved consensus, as well as the number of possible topics within each domain and the percentage of topics that achieved consensus. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Comparative Analysis of Regional Economic Conditions in South Texas, Including Business Manager, Local Resident, and University Student Perceptions

This report focuses on comprehensive documentation concerning regional economic indicators for Kleberg County, Texas, located in the Coastal Bend Region along the Gulf of Mexico. It is compared to two other South Texas counties, Texas, and United States for perspectives. The benchmark counties were chosen on the basis of their level of tourism, which is a key economic driver in the region. The research is of value to Journal of Applied Business &amp; Economics readers from elsewhere because it is an example of regional economic analysis. Part 1 presents a broad range of demographic data, while Part 2 focuses on economic conditions. Demographic characteristics and economic conditions. Part 3 presents opinions of local business managers, residents and students regarding economic conditions, including preferred government spending. This report builds on the base of economic information is designed to provide decision-makers a valuable economic tool for strategic planning.

A Targeted Feedback Framework to Move the Needle on Operative Feedback.

Actionable and impactful feedback remains a perpetual challenge in medical education despite extensive efforts to improve the feedback process. A feedback framework was adapted from a validated model and tailored to a single residency program. The purpose of this study was to evaluate the impact of the new feedback framework on the quantity and quality of perioperative feedback amongst surgical residents. A nonrandomized interventional study was conducted in a general surgery residency program at a single academic institution over a 6-month study period. The new 'Brainstorm', 'Focus', and 'Recap' (BFR) feedback framework was introduced to surgical faculty and residents on 2 surgical services. Posters of the framework were displayed in the operating rooms and scrub sinks. Regular reminder emails were sent, and competitions were held to encourage engagement. Pre and postintervention surveys were distributed electronically to all participants. Brigham and Women's Hospital Department of Surgery in Boston, MA. A total of 19 faculty and 56 residents inclusive of 2 general surgery services (trauma and acute care surgery; minimally invasive and bariatric surgery). Faculty reported giving more frequent and higher quality feedback than residents reported receiving, before and after the intervention. There was increased satisfaction with technical feedback following the intervention, which was reported by both faculty (27.3%-73.3%, p = 0.01) and upper-level residents (17.7%-54.6%, p = 0.02). Faculty and residents mutually indicated improved overall feedback breadth (faculty 58.2%-78.7%, p = 0.01; residents 41.6%-54.3%, p = 0.03). The introduction of a tailor-made framework that utilizes a structured, shared mental model to promote goal-oriented feedback improved faculty and resident practices and perceptions of perioperative feedback. Nevertheless, a disparity between faculty and resident perceptions persists. More work is needed to overcome the complexities of the surgical learning environment and better align faculty and resident perceptions.

The measurement of multiple influence paths of residents' positive perception in ethnic minority village tourism destinations: a case study of Ping'an Zhuang Village in Longsheng County

Ethnic tourism is a delightful activity for tourists to visit ethnic minority gathering areas to fulfill their aesthetic demands by observing and experiencing the cultures of ethnic minorities. Based on the grounded theory, quantitative analysis and fuzzy set qualitative comparative analysis, this paper delves into the measurement of the positive perception of residents in ethnic minority villages and the multiple paths of its influencing factors, aiming to offer policy notions for promoting the dynamic protection of ethnic minority culture and rural revitalization. The findings revealed that: (1) The positive perception of residents in tourist destinations can be classified into three dimensions: “positive perception in economy,” “positive perception in social and cultural aspects,” and “positive perception in environment,” and the localized scale encompasses nine items; (2) The influencing factors consist of three elements: place belonging, perceived power, and residents' participation. The enhancement of residents' positive perception demands a combination of these factors rather than relying solely on any single one; (3) Regarding the perception of residents in any dimension, the direct impact of perceived power on the positive perception of residents in ethnic villages is weak. Place belonging and residents' participation are the core conditions for the formation of the positive perception of residents in ethnic villages. Strengthening the emotional connection and participation mechanism of residents is an effective means to boost their positive perception.

Survey on Perceptions of Residents around a Solid Waste Incinerator

Survey on Perceptions of Residents around a Solid Waste Incinerator

Avaliação do Sistema Wood Frame em HIS plurifamiliar no Paraná

This article presents a study of multi-story buildings in the Wood Frame construction system, implemented in the state of Paraná. The objective is to evaluate the referred construction system from the point of view of the user in multifamily social interest housing. The study started from two methodological approaches: Literature review and the case study through post-occupancy evaluation – POE. The POE was applied in two buildings located in the Metropolitan Region of Curitiba, using the following tools: interviews with intervening agents and questionnaires applied to users, aiming to characterize the object, understand its operation and recognize the residents perception of quality and performance of their housing unit. The requirements were: luminous comfort, thermal comfort, acoustic comfort, maintenance and spatial analysis of the apartments. The results demonstrate that the performance in use of multifamily buildings in Wood Frame is satisfactory, although there are non-conformities recurring, reported by users, with regard to acoustic, thermal and maintenance performance.

Knowledge, Attitude, and Perception Toward Evaluation of Acute Heart Failure Among Emergency Medicine Residents in Riyadh, Saudi Arabia.

Acute heart failure (AHF) poses significant challenges in clinical practice due to its varied clinical presentations and complex management strategies. Adequate confidence levels among medical residents in diagnosing and managing AHF are crucial for timely and effective patient care. This cross-sectional study aimed to assess medical residents' knowledge, attitude, and perception levels in diagnosing and managing AHF and explore factors influencing their confidence levels. A total of 52 medical residents from various specialties participated in the study. Based on different clinical parameters, participants completed a questionnaire assessing their confidence levels in diagnosing AHF. Descriptive statistics were used to summarize confidence levels, while chi-square tests explored associations between demographic/clinical factors and confidence levels. The majority of residents exhibited high confidence levels in diagnosing heart failure (HF) based on history and physical examination findings alone (22 (42.3%) and 16 (30.8%), respectively). However, confidence levels were lower when relying solely on laboratory tests and imaging modalities for diagnosis (17 (32.7%) and 18 (34.6%), respectively). Factors such as symptoms (e.g., dizziness) and availability of ultrasound equipment were associated with higher confidence levels (p < 0.05). However, demographic factors such as age, gender, and residency year did not significantly influence confidence levels (p > 0.05). Our study highlights variations in confidence levels among medical residents in diagnosing and managing AHF. While clinical assessment remains paramount, targeted educational interventions focusing on interpreting diagnostic tests and imaging findings are warranted to enhance residents' confidence levels and improve patient care.

Urban Walkability in a Megacity Context: An Examination of Johar Block-13, Karachi

This study examines the walkability perceptions of residents in Johar Block-13, Karachi, focusing on pedestrian satisfaction and infrastructure needs. Using surveys and field observations, the research identifies key concerns, including poor sidewalk maintenance, limited crossing accessibility, inadequate lighting, and safety issues, with 76% of respondents feeling unsafe while walking. Additionally, noise pollution, vehicle congestion, and the lack of pedestrian-friendly amenities detract from the overall walkability experience. Results indicate significant dissatisfaction with the current infrastructure, especially regarding accessibility for vulnerable groups, including the elderly and disabled. The findings underscore a need for targeted improvements to foster a safer, more accessible environment, enhancing pedestrian activity and quality of life in Johar Block-13. The study's findings may help policymakers and urban planners design a city that can promote walking.

Sustainability and Sociability: Shared Practices and Community Cohesion in U.S. Cohousing

This study argues that environmental-sustainability and adjacent practices and identities are conducive to community cohesion in cohousing in the U.S. The theoretical framework draws from cohousing research based on social practice theory and on degrowth concepts. Data came from a Cohousing Research Network combined individual resident- and community-level survey data set (level-1 N = 272, level-2 N = 39). Two multi-level models of community connection among residents included individual-level factors measuring participation in cohousing practices, community-level measures of green identity, and an individual-level attitudinal indicator of potential discord stemming from perceptions of other residents’ insufficient or excessive commitment to sustainability. Keeping in mind data constraints, results from multilevel linear regression analysis were tentatively supportive. The findings suggest that residents indeed connected to their communities through participation in shared practices and through shared green identities. Further confirmatory and exploratory research is needed.

Перцептивный портрет Беловежской пущи в региональном языковом сознании

The article presents the results of an experimental study on the perceptual embodiment of the BELOVEZHSKAYA PUSHCHA concept as a fragment of regional worldview. The research aimed to characterize the way this concept is expressed in the linguistic consciousness of residents of the Brest region by modelling and analysing its perceptual component. The main research method applied in the paper is the anthropometric method, combined with statistical and contextual analysis techniques. The material consists of associative reactions to the stimulus phrase Belovezhskaya Pushcha, obtained by processing 300 respondent questionnaires. All the participants in the experiment are residents of the Brest region and represent three age groups: schoolchildren, students, and the working population. The perceptual features are arranged from the most to the least frequent. As a result of quantitative processing of the reactions, the following images of the concept were identified: chromatological, auditory, and olfactory. In each of these images, dominant and peripheral units were recorded. The analysis established that the boundaries between the modes are unclear. In a number of cases, to describe Belovezhskaya Pushcha respondents used a symbiosis of several modes, based on which tactile-visual, gustatory-olfactory, and visual-auditory images were recorded. The phenomenon of synaesthesia serves as a means of conveying one’s emotions and impressions in connection with the visit to Belovezhskaya Pushcha. The analysis of the data obtained showed that the BELOVEZHSKAYA PUSHCHA concept is communicatively relevant in the perception of residents of the Brest region: in the regional worldview, not only the conceptual component is updated, but also a multi-level perceptual image filled with unique connotations is modelled.

Enhancing resident perceptions of autonomy, education, and psychological safety: effects of implementing a senior resident-led team-based service model on a trauma and acute care surgery rotation

Enhancing resident perceptions of autonomy, education, and psychological safety: effects of implementing a senior resident-led team-based service model on a trauma and acute care surgery rotation

Continuity of supervision: Balancing continuous and episodic relationships for assessment and learning.

Meaningful supervisor-resident relationships enhance feedback and learning, yet not all relationships reach this potential. While there is increasing interest in continuity of supervision (CoS) to build relationships that support feedback and promote learning, there remains a limited understanding of how relationships develop and influence assessment over time. The aim of this study was to explore how supervisors and learners in postgraduate medical education perceive CoS relationships and their impact on feedback and assessment. We used constructivist grounded theory informed by the educational alliance to develop insight into how supervisor and resident perceptions of episodic and continuous relationships impact feedback and assessment. We interviewed 22 participants, including 14 family medicine residents and eight faculty advisors. We iteratively analysed the data concurrently with data collection. In episodic relationships, participants accepted superficiality for variety and diversity in feedback. In continuous relationships, we identified four sub-types. Our participants described how each of these relationships impacted their perceptions of the feedback and assessment information given or received and resulted in different steps taken in response to their perceptions: (i) Not developing-tolerate feedback and seek out additional assessors, (ii) deteriorating-avoid feedback and seek out alternative assessors, (iii) developing-value and tailor feedback and (iv) becoming a friendship-question bias in feedback and advocate for more assessors. Episodic and continuous relationships offered feedback and assessment value. However, deeper analysis of the continuous relationships revealed additional complexity. Understanding the nuances of CoS relationships is important for supporting successful relationships and improving feedback and assessment.

Perception of Anambra State Residents Toward Media Campaigns Against the Consumption of Uncertified Herbal Medicine

The study examined the perception of Anambra state residents toward media campaigns against the consumption of uncertified herbal medicine. The essence of the study was to determine the extent of exposure of the residents to media campaigns against the consumption of uncertified herbal medicine. Study adopted two theoretical frameworks, and a survey research method was used. The study found, among others, that a majority of the respondents were moderately exposed to media campaigns against the consumption of uncertified herbal medicine; radio was the medium through which most of the respondents accessed media campaigns against the consumption of uncertified herbal medicine. Further findings revealed that the media campaigns against consumption of uncertified herbal medicine among the residents have not been so effective. The study concluded that the media campaigns against the consumption of uncertified herbal medicine convey uncertainty, a grey area by Anambra state residents. Thus, the study recommended that media should actively shed light on the dangers of consuming uncertified herbal medicine, committing themselves to features, editorials, radio presentations, news programmes, call-in-programs, and documentaries, among others.

Just-in-Time Simulation Training to Augment Overnight ICU Resident Education.

Background Patients who decompensate overnight experience worse outcomes than those who do so during the day. Just-in-time (JIT) simulation could improve on-call resident preparedness but has been minimally evaluated in critical care medicine (CCM) to date. Objective To determine whether JIT training can improve residents' performance in simulation and if those skills would transfer to better clinical management in adult CCM. Methods Second-year medicine residents participated in simulated decompensation events aligned to common medical intensive care unit (MICU) emergencies predicted to occur overnight by their attending intensivist. Simulation faculty scored their performance via critical action checklists. If the event occurred, MICU attendings rated residents' clinical management as well. At the rotation's conclusion, a variant of one previously trained scenario was simulated to assess for performance improvement. Resident perceptions were surveyed before, during, and after completion of the study. Results Twenty-eight residents participated; 22 of 28 (79%) completed the curriculum. Management of simulated decompensations improved following training (initial simulation checklist completion rate 60% vs 80% final simulation, P≤.001, Wilcoxon r=0.5). Predicted events occurred in 27 (45%) of the 60 shifts evaluated, with no observed difference in faculty ratings of overnight performance (median rating 4.5 if trained vs 3.0 if untrained; U=58.50; P=.12; Mann-Whitney r=0.30). Residents' self-reported preparedness to manage MICU emergencies improved significantly following training, from a median of 3.0 to 4.0 (P=.006, Wilcoxon r=0.42). Conclusions JIT simulation training improved residents' performance in simulation.

Barriers and Perceptions Regarding Research Among Ophthalmology Residents in Thailand: A Descriptive Study

Objective: This study aimed to assess the barriers and perceptions of ophthalmology residents toward research and to discern the differences between residents with and without prior research experience before commencingophthalmology training. Materials and Methods: An online survey using Google Forms was conducted to collect data. The survey comprised three sections: general information, research obstacles, and attitudes. Participants utilized a 5-point Likert scale for reporting agreement. Results: The survey was completed by 122 ophthalmology residents, representing a 51.3% response rate. Among them, 54.1% reported having research experience before residency. The top three obstacles identified were “lack of statistical knowledge” (mean 3.80, standard deviation 1.18), “lack of knowledge and experience in manuscript writing” (mean 3.79, SD 1.21), and “lack of time due to routine workload” (mean 3.75, SD 1.15). Residents without research experience demonstrated significantly greater difficulties in research skills, manuscript preparation, and motivation for research submission. While overall research attitudes were positive (mean 3.20, SD 1.18), residents with prior experience displayed significantly more favorable dispositions across various facets of research. These were preferences, perceived educational and career advantages, potential for income generation, and enhancement of communication skills. Conversely, the non-experienced residents primarily viewed research as a graduation requirement. Conclusion: Ophthalmology residents encountered considerable challenges in conducting research, primarily stemming from limited statistical knowledge and inadequate competency in manuscript writing. Implementingtargeted support measures to address these barriers can foster positive research attitudes and encourage sustained research engagement among residents.

Implementing and Assessing Climate Change Education in a Pediatrics Residency Curriculum.

Background For physicians to effectively combat the growing health crisis that is climate change, they should begin learning during medical training about its health implications. However, there is little data on residents' knowledge of the climate crisis, and even less data regarding the effectiveness and acceptability of climate change education in graduate medical training programs. Objective To incorporate a new educational session on the health implications of climate change into a residency curriculum and evaluate the acceptability of the session and its effects on residents' knowledge, attitudes, and perceptions of the topic. Methods In July 2021, a 90-minute, interactive, small-group format educational session on the health implications of climate change was incorporated into the first-year curriculum of a pediatric residency program. From July 2021 through June 2023, resident participants completed pre- and post-session surveys that assessed their knowledge, attitudes, and perceptions regarding health implications of climate change. Likert scale data were analyzed using Wilcoxon signed-rank tests. Results Of the 109 residents scheduled to participate, 50 (46%) completed both the pre- and post-session surveys. Session participation increased residents' self-reported knowledge of how climate change impacts health and how physicians can act as climate advocates. Ninety-eight percent of all post-session respondents (58 of 59) agreed that they would recommend the session to other residents. With 3 facilitators, the monthly session required ≤4 hours of preparation and ≤12 hours of direct teaching time per facilitator each academic year. Conclusions A single educational session improved residents' self-reported knowledge of the health implications of climate change and was well-received by participants.

Medical Resident Perceptions of Distress during Training.

This study used a qualitative research approach to grounded theory to identify factors that contributed to resident distress during 2021-2022 in multiple different specialties and at different postgraduate years of residency. By better understanding these contributors to distress, the aim was to inform the design of optimal interventions to reduce burnout and other emotional distress. The residents enrolled in this study completed a demographic survey and semistructured interview. Interviews were recorded and transcribed. Data analysis included developing codes inductively, grouping codes into categories, and describing themes. Recruitment continued until data analysis indicated theoretical saturation/sufficiency had been reached. A qualitative research approach to grounded theory was used to identify themes and relationships among themes to better understand how the sources of distress affected the trainees of various specialties and postgraduate levels of training. Thirty-three participants (15 medical-based, 9 hospital-based, and 9 surgical-based residents) participated in interviews between 2021 and 2022. Seven themes described sources of distress and potential ameliorating factors: workload, support and community, culture, resident outlook, institutional resources, work-life balance, and coronavirus disease 2019. The grounded theory highlights that these factors can collectively influence work-life balance and distress. The findings of the grounded theory qualitative analysis were used to examine ways to better mitigate the sources of distress that the residents enrolled in this study described. As institutions strive to diminish distress among residents, they can consider opportunities to assess environmental factors and design targeted interventions for their institutions or programs.