While the rate of return (51%) was disappointing, it is comparable to other studies of this type [20
]. More than two-thirds of responders (67%) to the survey were in first or second year of training. Thus, the results are more representative of residents who are less experienced in their training. Less experience might lead to increased stress. This possible response bias may have lead to an increased reporting of stress. However, residents that are more senior in training have other stresses that may be equally concerning (e.g. final examinations, higher expectations). The number of hours worked per week (75 ±16) was consistent with previous surveys of the PARA membership. In addition, since the survey was performed over a period of six months (January to June, 2004) it is possible that responses were biased based on the higher prevalence of stressors, such as depressed mood during the winter months.
Compared to previous Canadian studies of resident stress in which self-reported stress was not stated as a concern [14
], residents in the study reported most days of their life as stressful (34%). Similar to the research done by Toews and associates [14
], we also found that females reported a higher degree of stress than males (40% vs. 27%, p < 0.02). This may be due to stresses that are unique to the female gender [21
]. One must also wonder whether the results are due to a reporting bias, in that females tend to be more open about their stress than their male counterparts.
Unfortunately, residents also had difficulties dealing with stress and resorted to more troublesome behaviors. A significant amount of residents reported often turning to alcohol to deal with stress and just less than 5% reported using drugs or medication to feel better (sometimes or often). These numbers are not significantly different than the population, but are quite concerning when considering the responsibilities of this group of professionals [8
A large portion of the residents surveyed would consider changing their programs if given the opportunity. This speaks to the need for post-graduate medical education to ensure there is increased flexibility in residency, by taking measures such as increasing the amount of re-entry positions. Even more concerning was that over one fifth of residents reported that they would pursue another career if they had it to do all over again. Clearly, this speaks to the need to improving resident well-being in training.
Many residents reported experiencing intimidation and harassment. This result is consistent with the studies examining resident bullying [20
]. The main form of this intimidation and harassment was in inappropriate verbal comments (66%). These results seem quite different from a previous study of psychiatry residents in Edmonton, Alberta, which concluded that intimidation in the psychiatric educational environment was not a significant issue [23
]. However, due to the setup of our study we did not choose to stratify results from individual programs and therefore cannot directly comment on the psychiatry residents results. The primary basis reported for the intimidation and harassment was gender (12% of males and 38% of females), a difference that did not attain statistical significance, possibly because of the small sample size. However, it is quite possible that intimidation and harassment is one of the reasons that females in our survey reported more stress. This difference is consistent with recent publications that revealed increased female reporting of resident bullying [22
]. Intimidation and harassment occurred often multiple times (more than once in 52% of those responding to the study) in both genders. Over half of the residents felt that the process to deal with it was not adequate, fair and independent. This speaks to the need for further educating all individuals in the healthcare system on resident well-being.
It appears that although the majority of residents are quite resilient to all of life's stresses during training. However, there is a significant group that seems to be having difficulty with their own well-being during this period of their lives (i.e. fair or poor life satisfaction and rated mental health), possibly to an extent below the levels in the general population.
Due to our study's design, we cannot predict what proportion of individuals had a mental illness, nor compare rates to the normal population in the province or country. However, ratings obtained with the CCHS screening questions did not suggest a higher prevalence of disorders. It would not be surprising if the prevalence of specific disorders were lower in this highly selected professional group than in the general population. The results suggest, however, that non-illness-related issues represent the main difference between residents and the general population. Another well-being concern was that many residents still do not have a family physician and a significant amount did not use them (no appointment in the twelve months prior to being surveyed). With all the stresses or residency and the potential for decreased physical health and well-being, the need for more residents to acquire a family physician to be available for dealing with such issues is crucial [25
]. The Canadian Psychiatric association has position statements both on the treatment of mentally ill physicians and on trainee safety [25
]. Some of the recommendations include: 1) that any physician with a possible psychiatric illness should receive an assessment quickly, ideally by a psychiatrist who is not a colleague or friend; 2) that the treating psychiatrist must urge the physician-patient to obtain a family physician as soon as possible and aid in this process as necessary; and 3) all provinces should have psychiatrists who serve on, or consult to, their physician well-being committees. In addition, the trainee safety position statement recommends that minimum standards exist for resident safety and that there should not be any coercion of trainees to see potentially violent patients.
Based on the wide variation of awareness of many well-being resources more education should be applied to this area. Resident career and financial counseling were the highest ranked well-being resource. This was likely rooted in the fact, that many residents's reported high reported stress due to financial situation and the dissatisfaction with residency training and the medical profession. Resident colleagues, program directors and psychiatrist/psychologist(s), were the top resources residents preferred in times of emotional or mental health need. There is a definite need to properly train and educate program directors and all residents in how to deal with well-being concerns. Adequate psychiatric/psychological aid to residents in the province must be an important priority [25
]. The majority of residents reported that they would intervene to aid a colleague having emotional difficulties. Most often by suggesting they go for help (85%) or by offering to go with them for help (76%). Only a small portion of the residents would inform any medical organization. This may suggest that while residents want to help their peers, they prefer to do so in ways that do don't involve notifying external guarding bodies.