Muddling through a merger: a qualitative study of two combined family practice residencies

Mergers of residency training programs have become more common, but little has been published about their educational impact. Following our own merger, we sought to understand this process and its aftermath by conducting focus groups.

Three 1-hour focus groups were conducted-one with third-year residents, one with first- and second-year residents, and one with core faculty members. The interview script was based on a five-factor transitional model where each factor represented a potential fracture point that could result in organizational conflict. The five factors were curriculum, corporate culture, day-to-day operations, teaching environment, and financial resources. Focus group audiotapes were transcribed, and the investigators independently identified themes using an immersion and crystallization approach. Feedback from participants was obtained.

Themes identified included unmet potential of the combined curriculum, a blending of two disparate cultures resulting in feelings of loss and displacement for some, and a sense of rapid policy change and lack of resident and faculty accountability. Faculty recommendations for other programs involved in mergers include creating frequent facilitated retreats, acknowledging loss, and establishing new rituals for the combined program.

The transition through a merger of two residency programs is difficult and has direct educational and emotional impact. Such difficulties can, in part, be predicted, and improved communication and planning may facilitate this process.