Exploring the major difficulties perceived by residents in training: a pilot study.

To assess residents' difficulties during the first year of residency. In contrast to previous studies that mainly used structured questionnaires, a qualitative procedure was applied. Twenty-four consecutive first-year residents in internal medicine were asked to "Please identify two to three major difficulties or concerns related to your practice of medicine within this hospital". The answers were submitted to content analysis performed by three independent researchers. Inter-rater agreement was high (kappa coefficient = 0.92). Disagreements were solved by consensus. Physicians' characteristics: female 37%, mean age 28 +/- 2.2 years, mean duration of postgraduate training 2.5 +/- 1.3 years. Total number of answers: 122, average answers/resident 5.1 +/- 1.3. Nine categories were extracted from content analysis: communication problems at the workplace, feelings of not being respected, constraints of collaborative work, experiencing the gap between medical school and clinical care, work overload, responsibility towards and emotional investment in patients, worries about career plans, and lack of theoretical knowledge. Residents expressed major difficulties in communicating with and being respected by seniors and peers in particular, and hospital staff in general. They also voiced problems in coping with emotions, either their own or those of their patients. The residents' responses stressed the complexity of blending the requirements of the physician's role when instrumental/cognitive knowledge is not sufficient to deal with problems requiring personal and relational dimensions. Learning to combine medical knowledge and practice necessitates helping students/residents identify and deal with the constraints of these requirements