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A National Survey of Working Conditions

Steven R. Daugherty, PhD; DeWitt C. Baldwin, Jr, MD; Beverley D. Rowley, PhD

JAMA. 1998;279:1194-1199.

Context.— Concerns about the working and learning environment of residency training continue to surface. Previous surveys of residents have focused on work hours and income, but have shed little light on how residents view their training experience.

Objective.— To provide a description of the internship year as seen by a large cross section of second-year residents.

Design.— Mail survey conducted in 1991.

Setting.— Residency programs in the United States.

Participants.— Random 10% sample (N=1773) of all second-year residents listed in the American Medical Association's medical research and information database.

Main Outcome Measures.— What and who contributes most to residents' learning during internships, degree of satisfaction with the internship experience, on-call and sleep schedules, incidents of perceived mistreatment or abuse, observations of unethical behavior, and experiences of harassment or discrimination.

Results.— A total of 1277 surveys (72%) of 1773 mailed were returned. Overall, respondents reported a moderate level of satisfaction with their first year of residency. On a scale of 0 to 3, residents rated other residents as contributing most (score of 2.3) to their learning, with special patients ranked second (2.1). During a typical work week, residents reported that they spent an average of 56.9 hours on call in the hospital. A total of 1185 (93%) residents reported experiencing at least 1 incident of perceived mistreatment, with 53% reporting being belittled or humiliated by more senior residents. Among women residents, 63% reported having experienced at least 1 episode of sexual harassment or discrimination. A total of 45% of residents reported having observed another individual falsifying medical records, and 70% saw a colleague working in an impaired condition, most often lack of sleep. Regression analyses suggest that satisfaction with the residency experience was associated with the presence of factors that enhanced learning, and fewer experiences of perceived mistreatment.

Conclusions.— Residents report significant problems during their internship experience. Satisfaction with internship is enhanced by positive learning experiences and lack of mistreatment.

From Rush Primary Care Institute and Rush Medical College, Chicago, Ill (Dr Daugherty); American Medical Association, Chicago (Dr Baldwin); and the Maricopa Medical Center, Phoenix, Ariz (Dr Rowley).

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