What Makes Anesthesiology Residency So Stressful? A 30-Day Snapshot

Research suggests stress in residency is increasing with burnout and maladaptive coping strategies contributing to negative psychosocial outcomes. However, details on how residents define their experience of stressful events in the context of their daily training are lacking.

Using a cross-sectional survey design, all clinical anesthesia residents in a large academic program were asked for a stressful event example experienced in the operating room over the past 30 days. Responses were reviewed by a panel, who developed a stress categorization system using a 3-round modified Delphi process. The finalized system was then applied to classify these stressful events reported by the residents. Additionally, thematic analysis was conducted to analyze the examples and identify themes.

Seventy-two of the 96 residents surveyed (83%) reported experiencing a stressful event in the past 30 days. Forty-four residents provided examples, 41 of which were legible and categorizable. A stress categorization system was developed (the Stress Objectivity Scale), comprising 4 categories: mild, moderate, severe, catastrophic. Applying this system to the residents' examples, 1/41 (2%) were mild, 21/41 (51%) were moderate, 11/41 (27%) were severe, and 8/41 (20%) were catastrophic. Thematic analysis identified several key themes including trainee vulnerability, clinical complications, colleague conflicts, and positive coping strategies.

This research contributes to the limited literature on what constitutes a stressful event in anesthesiology residency by providing concrete examples and developing a severity-based classification system. The findings revealed a relatively high incidence of severe and catastrophic events within a 30-day period. Future research will focus on determining the impact of stressors over longer periods of training and on interventions designed to lessen negative consequences.