title: Using focus groups to understand causes for morale decline after introducing change in an IM residency program.
abstract: BACKGROUND
  Although program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training. Most program evaluation consists of numerical rating scales from which it is often difficult to pinpoint exact sources of dissatisfaction.
  
  
  METHODS
  Our goal in this work is to evaluate the utility of focus group methodology to uncover in detail the reasons for residents' deteriorating morale in an IM residency program, as well as to solicit suggestions for correction. This study employed focus groups (FG) in a qualitative research design, in which descriptive statistics from a resident program evaluation survey served to guide an intensive focus group process. Participants were 40 of 45 2nd and 3rd year internal medicine residents enrolled in the IM residency training program. Five chief residents were trained to conduct 5 focus groups with 8 residents in each group. The focus groups examined possible issues contributing to the deterioration of morale noted in the quantitative survey.
  
  
  RESULTS
  Many unexpected themes were uncovered by the FGs. Residents identified the following factors as the major contributors to deteriorating morale: 1) Pace of change 2) Process of change 3) The role of chief residents in change 4) Fear of intimidation and retaliation. Groups also suggested practical recommendations for improving the culture of the residency.
  
  
  CONCLUSIONS
  Introducing change in residency training is a challenging process. Respectful attention to resident frustrations and solution-focused discussions are necessary to understand and improve morale. Focus groups proved to be a useful tool in revealing the precise source of pervasive resident concerns as well as providing potential solutions. In addition, FGs methodology can be adapted in a practical manner to residency evaluation.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Rucker
authors.affiliation: Department of Family Medicine, University of California, Irvine School of Medicine, 101 The City Drive South, Rte 81, Bldg 200, Ste 835, Orange, CA 92868, USA. jfshapir@uci.edu.
authors.forename: Johanna
authors.initials: J
authors.lastname: Shapiro
authors.forename: Cliff
authors.initials: C
authors.lastname: Fornwalt
authors.forename: Keenu
authors.initials: K
authors.lastname: Hundal
authors.forename: Swapna
authors.initials: S
authors.lastname: Reddy
authors.forename: Zarema
authors.initials: Z
authors.lastname: Singson
authors.forename: Khanh
authors.initials: K
authors.lastname: Trieu
mesh_terms: D002055:Burnout, Professional / Q000209:etiology / Q000523:psychology; D017144:Focus Groups / Q000379:methods; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods / Q000458:organization & administration*; D009013:Morale; D009936:Organizational Innovation; D015397:Program Evaluation