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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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“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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BackgroundInfluentialThe Accelerated Internal Medicine Program at the University of Kentucky
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BackgroundStress, work and professional satisfaction and militancy among Canadian physicians
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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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Battikha, E. C., Carvalho, M. T. D. M., & Kopelman, B. I. (2014) · Revista Paulista de Pediatria · doi:10.1590/s0103-05822014000100003 · Cited by 5
“The stress that he they are submitted to during the process of learning and practice, as well as in the relationship with patients, has been a focus of interest, with proposals of interventions((25-27)).”
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Feasibility of a brief mindfulness-based program for burnout in pain healthcare professionals
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“Over a decade ago some authors started advocating that special attention should be paid to health care providers (Butterfield, 1988) and this remains relevant to the present date (Martín-Brufau et al., 2020; Liu et al., 2021).”
BackgroundSex differences in occupational stress and work satisfaction among physicians
Burke, R. J., & Richardsen, A. M. (1991) · Stress Medicine · doi:10.1002/smi.2460070205 · Cited by 4
Editorial comment: Regarding “moral angst for surgical residents: A qualitative study”
Lynch, T. G. (2010) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2009.10.009 · Cited by 3
“It is not unreasonable to assume that these presures can result in the increased incidence of depression, nger, and cynicism observed in residents.(3,5)”
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
ALPAĞUT, G. Ş., Ayvat, P. U., & Parlak, İ. (2022) · Forbes Journal of Medicine · doi:10.4274/forbes.galenos.2022.72621 · Cited by 2
Metadata
- 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
- Social Sciences › Education › 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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