title: A year in transition: a qualitative study examining the trajectory of first year residents' well-being.
abstract: BACKGROUND
  It is generally understood that trainees experience periods of heightened stress during first year residency, yet there is little information on variations in stress and well-being over the transition period or those factors that contribute to these variations. This qualitative study explored the trajectory of well-being described by first year residents in the context of challenges, supports and adaptations over time.
  
  
  METHODS
  In-depth interviews were conducted face-to-face with 17 first year residents at the University of Toronto. Participants drew a graph of their well-being over the course of their first year and described critical periods of challenge and adaptation. Interviews were audio-taped and transcribed. Results were organized into a thematic analysis using NVivo software.
  
  
  RESULTS
  Residents described a pattern of well-being that varied in accordance with changes in rotations. Well-being increased when residents perceived high levels of team support, felt competent and experienced valued learning opportunities. Well-being decreased with low team support, heavy work demands, few learning opportunities and poor orientations. Anxiety and excitement in the beginning of the year gave way to heightened confidence but increased fatigue and apathy towards the year's end. Residents used a number of cognitive, behavioural and self-care strategies to cope with transitional challenges.
  
  
  CONCLUSIONS
  Residents experienced a pattern of highly fluctuating well-being that coincided with changes in rotations. Residents' well-being varied according to levels of supervisor and colleague support, learning opportunities, and work demands. Residents' well-being may be improved by program interventions that facilitate better team and supervisory supports, maintain optimal service to learning ratios, establish effective fatigue and risk management systems, offer wellness support services and integrate skills based resiliency training into the curriculum.
authors.affiliation: Postgraduate Medical Education, University of Toronto, 500 University Avenue, Suite 602, Toronto, Ontario M5G 1V7, Canada. christopher.hurst@utoronto.ca
authors.forename: Christopher
authors.initials: C
authors.lastname: Hurst
authors.forename: Deborah
authors.initials: D
authors.lastname: Kahan
authors.forename: Mariela
authors.initials: M
authors.lastname: Ruetalo
authors.forename: Susan
authors.initials: S
authors.lastname: Edwards
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology