Residents' work-related emotional experiences may be shaped by professional identity development and the demands of training, according to a scoping review. Investigators reported that residents' emotions emerged from the interaction between an evolving sense of self and the challenges of residency, suggesting that burnout alone may not fully capture the range of emotional experiences encountered during training.
To examine how qualitative research characterizes residents' work-related emotions, the investigators reviewed 56 studies conducted in the United States and Canada from 1952 to 2023. The studies were identified through searches of Medline, Embase, Web of Science, and the Cochrane Database. Most of the studies used interviews or focus groups to explore residents' experiences across multiple specialties. Through thematic analysis, the investigators identified recurring themes and developed a conceptual model describing factors associated with residents' emotional experiences.
The investigators identified three major themes: identity and development, interpersonal dynamics, and structural dynamics. Residents' emotions were not described as the consequences of just workload or stressful working conditions. Rather, emotional experiences appeared to arise from the interaction between residency challenges and residents' ongoing development as physicians.
Identity and development emerged as a prominent theme across the literature. Forty-seven of the studies referenced concepts such as identity, development, competence, adequacy, or autonomy. Residents frequently linked emotional experiences to questions about competence, responsibility, professional growth, and meaningfulness in medicine. The included studies demonstrated that long work hours, heavy workloads, and unmet personal needs contributed to distress; however, these effects were often influenced by whether residents perceived opportunities for learning, growth, and meaningful patient care.
Several studies described emotionally difficult events—including medical errors, adverse patient outcomes, ethical conflicts, and challenging patient encounters—as particularly distressing when they threatened residents' confidence or professional sense of self. Other studies found that similar challenges could promote resilience or thriving when accompanied by adequate support, autonomy, or educational opportunities.
Interpersonal relationships also played a substantial role. Across the reviewed studies, residents described support from their peers and supervisors as helping them mitigate distress and promote well-being. Meaningful interactions with patients and families were associated with positive emotional experiences, whereas conflicts with patients, families, supervisors, or colleagues were linked to frustration, guilt, powerlessness, isolation, and moral distress.
The review also highlighted the influence of broader structural factors. For instance, the studies described medical culture, hierarchical decision-making, administrative burdens, health care corporatization, stigma, and social inequities as factors that could affect residents' emotional experiences. Several studies reported that residents experienced distress when institutional expectations conflicted with their professional values or understanding of appropriate patient care.
Importantly, the investigators noted that similar stressors did not consistently produce the same emotional responses. Across the studies, residents' reactions appeared to vary depending on the available support, workplace context, personal development, and how experiences were incorporated into their evolving professional identities.
The review has several limitations. As a scoping review of qualitative research, it was designed to identify themes and generate conceptual insights rather than quantify associations or establish causal relationships. Most of the included studies were cross-sectional, sample sizes were often small, and the findings were limited to studies conducted in the United States and Canada. The investigators also acknowledged that thematic synthesis and study-selection decisions may have influenced the concepts emphasized in the final model.
Overall, the findings suggested that resident well-being may be better understood through frameworks that extend beyond burnout alone.
"[I]t was not exclusively work that generated work-related emotions, but rather the interplay between work and issues of the developing self," wrote lead study author Jessica McLaughlin, BS, of the Division of General Internal Medicine and Health Services Research in the Department of Medicine at the University of California, Los Angeles, and colleagues.
The study authors reported no conflicts of interest.