Graduate medical education faces housestaff stress: institutional dynamics and group process

The authors describe their efforts and experiences in presenting information on housestaff stress, dysfunction, and psychiatric morbidity to a committee of residency educators in their medical center. A complex group process emerged, which is discussed in the context of institutional background and "dynamics," the physician-psychiatrist relationship, and faculty role conflicts. Logistical problems in studying and intervening with such housestaff difficulties are presented, and formalized as a set of alternative approaches. A working plan is given in the form of ten initial goals. The authors' current approach, which is compared to "therapy for an institution," takes careful cognizance of resistances in the group process.