The Stress of Residency: A Review of the Literature
Abstract
• A review of empiric studies of the stresses of residency training and descriptions of intervention programs and mental health resource surveys published since 1980 indicated that inadequate sleep and fatigue are major stressors for residents, but they are only part of a more complex situation influenced by time demands, social support, and maturational factors. Other important stressful aspects of training appear to be those that interfere with social support. Increased anger, not depression, is emerging as the predominant mood change during residency, but the effects of any mood change on patient care have not been studied. Despite growing evidence of the need for change in training programs, especially attention to the affiliative needs of residents, few intervention programs have been reported. (Arch Intern Med1988;148:1428-1435)
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Medical internship is a period of high stress.
“It is a time of high stress (Butterfield, 1988)”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Butterfield, 1988
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“Lastly, the age gap between graduates creates other potential hurdles for nontraditional, older-aged students to overcome.(39)”
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BackgroundOliver, J. J., Ediger, D. S., Phelps, J., Hoffman, A. L., Martin, A. W., Martin, S. A., Bridwell, R. E., Aebersold, S. D., Cole, R., & Ransom, J. C. (2025) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2025.06.044 · Cited by 2 · see citing works
ALPAĞUT, G. Ş., Ayvat, P. U., & Parlak, İ. (2022) · Forbes Journal of Medicine · doi:10.4274/forbes.galenos.2022.72621 · Cited by 2 · see citing works
Ross, J. M., Watson, N. L., Hamlin, N. J., & Schmidt, J. E. (2024) · Military Medicine · doi:10.1093/milmed/usae270 · Cited by 2 · see citing works
Stress management: Corpus-based insights into vernacular interpretations of stress
Stvan, L. S. (2014) · Communication & Medicine · doi:10.1558/cam.v10i1.81 · Cited by 2 · see citing works
“A number of studies specifically focus on stress created within medical school training (Butterfield 1988; Shapiro et al. 2000; Radcliffe and Lester 2003). most literature involving the word stress, however, simply assumes one of the definitions.”
BackgroundPsychiatry Residents’ Attitudes Toward Personal Involvement in Research
Mulderig, J. K., Sansone, R. A., & Fine, M. A. (1992) · Academic Psychiatry · doi:10.1007/bf03341375 · Cited by 2 · see citing works
Miller, S. F. (1992) · The American Journal of Surgery · doi:10.1016/s0002-9610(05)80908-0 · Cited by 2 · see citing works
The clinical psychologist as program consultant: When is enough enough?
Sheridan, K. (1995) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/bf01990883 · Cited by 2 · see citing works
“Studies on sources of residency stress are the most common and represent both theory (Hoekelman, 1989) and quantitative data ( Butterfield, 1988; Lee, 1987) to support conclusions.”
BackgroundMethodStress and the anesthesiologist
Gilbert, M. (1993) · Acta Anaesthesiologica Scandinavica · doi:10.1111/j.1399-6576.1993.tb03660.x · Cited by 2 · see citing works
Slonim, T.-Y., SLONIM, M. A., Daychman, G., et al. (2002) · Computers in cardiology · doi:10.1109/cic.1997.647911 · Cited by 1 · see citing works
Chen, C., Cheng, Y.-H., Shen, Y., Kung, C., Chien, P., & Hsieh, C. (2021) · Healthcare · doi:10.3390/healthcare9070912 · Cited by 1 · see citing works
“Inappropriate emotional stress can also impact the bedside skills of health workers [31,32].”
Background
- Authors
- Butterfield, P. S.
- Corresponding author
- Butterfield, Paula S.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1988-06-01
- Volume
- 148
- Issue
- 6
- Pages
- 1428
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W4319704952
- Cited by
- 112
- References
- 0
- Citations by year
- 2025: 5 · 2024: 3 · 2022: 5 · 2021: 2 · 2019: 4 · 2018: 5 · 2017: 1 · 2016: 1 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 1
- FWCI
- 17.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- residency training, medical residents, occupational stress, sleep deprivation, fatigue, social support, anger, mood changes, mental health resources, intervention program, time requirements, training program reform
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