Decreasing GME training stress to foster residents' professionalism

Acad Med. 2004 Sep;79(9):825-31. doi: 10.1097/00001888-200409000-00003.


The author evaluates current concerns over medical professionalism in residency training. The recent professionalism requirements for residents promulgated by the Accreditation Council for Graduate Medical Education (ACGME) are discussed in relation to the atmosphere of current training. The author first reviews a recent study showing that unprofessional behavior may significantly correlate with burnout, as evaluated by the Maslach Burnout Inventory. Among the elements of that inventory, depersonalization is shown to significantly correspond to unprofessional actions and behavior. Several surveys and studies evaluating residency treatment and stress are reviewed and three sources of training stress are identified: (1) abusive treatment of residents, (2) financial pressures, and (3) pessimism and uncertainty in the medical field. The extent and effects of these stressors are discussed and evaluated in relation to depersonalization, depression, and unprofessional behavior. Each of these pressures is found to correlate with negative effects on residents, such as depersonalization, decreased satisfaction, depression, and burnout. In turn, such effects are found to potentially cause unprofessional behavior among residents. In light of these findings, the author suggests several modifications to the current graduate medical training environment to mitigate such stressors, promote professionalism, and increase morale. Prevention of abusive treatment of residents, alleviation of financial pressure, increased educational opportunities, and role modeling are suggested as beneficial interventions that may foster professionalism and prevent inappropriate behavior. The author indicates that such environmental changes would likely foster professionalism in young physicians more effectively than would ethics seminars or in-class training. Accordingly, the author suggests environmental changes to decrease residency stress as the most effective means of promoting the new ACGME requirements and the ideals of professionalism.

MeSH terms

  • Attitude of Health Personnel*
  • Burnout, Professional / etiology*
  • Burnout, Professional / prevention & control
  • Depression / etiology*
  • Ethics, Medical
  • Humans
  • Internship and Residency / economics
  • Internship and Residency / organization & administration*
  • Job Satisfaction*
  • Quality of Health Care
  • Surveys and Questionnaires