Health

Original Article
and quality of life of medical residents

health and quality of life of medical residents

Luciano Garcia Lourenção1*,Airton Camacho Moscardini2 Zaida Aurora Sperli Geraldes Soler3
Study conducted at the São José do Rio Preto School of Medicine – FAMERP, São José do Rio Preto, SP, Brazil

Abstract
Objective. To discuss the health and quality of life of medical residents.
Methods. Literature review analyzing the content of studies about the subject at hand. Sources for
this search consisted of: Biblioteca Virtual em Saúde (BVS [Virtual Science Library]), via BIREME
(Latin American and Caribbean System on Health Sciences Information); electronic databases Medline
(Medical Literature Analysis and Retrietal System On-Line), Lilacs (Latin American and Caribbean
Health Science Literature Database), and SciELO (Scientific Electronic Library On Line); and the search
engine scholar.google.com.br. The following descriptors were used: quality of life, stress, internship,
and residency, in English and in Portuguese. The bibliography collected in the process was then sorted
and analyzed to assess and discuss the primary aspects of the subject, considering which countries the
studies came from, when they were published, source, title, focus of study, and primary conclusions.
Results. The studies analyzed showed key results and conclusions, such as high rates of burnout
syndrome, stress, depression, fatigue, and sleep disorders among residents; problems coping; corre-
*Correspondência:
Rua São Luiz, 440 - Apto
lation between duty hours and quality of life; and the need to better regulate medical residency to
52-J improve work and educational conditions.
Jardim Europa - São José Conclusion. Implementing resident assistance programs leads to improvements in professional educa-
do Rio Preto/SP - Brazil tion and personal quality of life, improving relationships with patients. Though stressful, medical
CEP: 15.014-470 residency is an enriching experience, providing professional and personal development for physicians.
Phone/Fax: +55 (17)
3304-9318
luciano_gl@ig.com.br Key words: Quality of life. Stress. Internship and residency.

Introduction Various determining factors impact the health and quality

of life of medical residents. In that context, assessing their
Medical residency is a training process during which resi-
quality of life (QOL) helps support actions aimed at improving
dents should find a balance between the will to care and heal,
handling the feeling of helplessness before the complex health the personal and professional quality of life of residents. Conse-
care system they are inserted, and establishing the limits of their quently, the process helps ensure improvements in service quality
own personal and professional identity.(1) for patients.
The practice of medicine has intrinsic characteristics which, Quality of life depends on intrinsic and extrinsic factors.
by themselves or in combination, define a professional envi- Therefore, because of their places in society, quality of life
ronment consisting of the emotional stimuli accompanying the means something unique for each individual. This means we
process of becoming sick. Stimuli include frequent contact with cannot standardize quality of life, as it has different meanings
pain and suffering, handling physical and emotional intimacy, for different individuals, depending on their objectives, goals and
caring for terminal patients, and handling difficult, whiny,
intentions(5). QOL cannot be measured solely in terms of how long
rebellious, uncooperative, demanding, self-destructive, and/or
someone lives, because various factors can influence it, such as
chronically depressed patients, as well as handling the uncer-
health, housing, work, leisure, and satisfaction, among others(6).
tainties and limitations of medical knowledge and the health
care system, which clash with demands and expectations from This article discusses the issue of the health and quality
patients and family members, who want nothing but certainty of life of medical residents, making considerations about the
and assurances(2,3,4). literature on the subject.

1. Coordenador do Curso de Enfermagem da União das Faculdades dos Grandes Lagos –UNILAGO; Docente da União das Faculdades dos Grandes Lagos - UNILAGO
e da Fundação Municipal de Educação e Cultura de Santa Fé do Sul –FUNEC e Coordenador da Vigilância Epidemiológica do município de São José do Rio Preto,
são José do Rio Preto, SP
2. Docente e orientador da graduação e pós-graduação da Faculdade de Medicina de São José do Rio Preto –FAMERP, São José do Rio Preto, SP
3. Livre-Docente do Departamento de Enfermagem em Saúde Coletiva e Orientação Profissional; Docente e Orientadora da graduação e pós-graduação; Diretora
Adjunta de Extensão de Serviços à Comunidade da Faculdade de Medicina de São José do Rio Preto –FAMERP, São José do Rio Preto, SP

Rev Assoc Med Bras 2010; 56(1): 81-90 81

Lourenção LG et al.

Methods Table 2 - Distribution of studies by period/year of publication

This study reviews the literature about health and quality Period/Year of Publication Number %
of life of medical residents, as well as studies connected to the 1970s 1 2.38
subject, and analyzes study content in terms of the issue. 1979 1 2.38
Sources for this search consisted of: Biblioteca Virtual 1980s 1 2.38
em Saúde (BVS [Virtual Health Library]), via BIREME (Latin 1986 1 2.38
American and Caribbean System on Health Sciences Informa- 1990s 7 16.66
tion); electronic databases Medline (Medical Literature Analysis 1991 1 2.38
and Retrietal System On-Line), Lilacs (Latin American and Carib- 1993 1 2.38
bean Health Science Literature Database), and SciELO (Scientific 1994 1 2.38
Electronic Library On Line); and the search engine scholar.google. 1996 1 2.38
com.br. The following descriptors were used: quality of life, stress, 1997 1 2.38
internship, and residency. 1998 2 4.76
The bibliography collected in the process was then sorted 2000s 33 78.58
and analyzed to assess and discuss the primary aspects of health 2000 1 2.38
and quality of life of medical residents in the studies, considering 2001 1 2.38
which countries the studies came from, when they were publi- 2002 1 2.38
shed; for each study, the review considered source, title, focus 2003 2 4.76
of study, and primary conclusions. 2004 3 7.15
2005 7 16.66
Results 2006 9 21.43
Forty two studies about health and quality of life of medical 2007 6 14.29
residents or connected to the subject were selected and analyzed, 2008 3 7.15
comprehending 38 (90.48%) articles, two (4.76%) doctoral disser- TOTAL 42 100
tations, one (2.38%) master’s thesis, and one (2,38%) editorial.
Table 1 shows the distribution of studies by country of origin
of authors, showing that 37 (88.10%) studies come from the
Discussion
Americas, 16 of which (38.10%) from Brazil.
In terms of year of publication, we see an increase in the In reviewing the literature about health and quality of life of
number of studies starting in the 1990s. The increase grows medical residents, we find that studies about the subject increase
even stronger in 2004, as shown by Table 2. significantly from 2004 onwards, with many studies written
Table 3 shows the distribution of studies by source/title, focus by Brazilian (38.10%) and American (33.34%) authors. The
of study, and conclusions. We find that studies in this review primary issues discussed are burnout syndrome, sleep disorders,
discussed subjects such as burnout syndrome, sleep, stress stress, fatigue, and life and work coping strategies.
and fatigue, coping strategies, and quality of life and duty hours Considering medical residencies are teaching programs
of residents, as well as how residents see their education. The defined by full-time training under supervision, they are the
studies analyzed showed key results and conclusions, such as best method available for enhancement and specialization in
high rates of burnout syndrome, stress, depression, fatigue, and the health sciences.
sleep disorders among residents; problems coping; correlation It is well known that residents experience various types of
between duty hours and quality of life; and the need to better stress during training, and that such stress factors can cause
regulate medical residency to improve work and educational harmful effects on residents, impacting quality of patient care.
conditions. For Tokarz et al.7, factors such as student-doctor transi-
tion, professional responsibility, social isolation, fatigue, sleep
deprivation, overwork, fear of committing mistakes and other
TABLE 1 - Distribution of studies by country of origin factors connected to the residency educational process are
COUNTRY Number % associated with psychological, psychopathological and beha-
Brazil 16 38.10 vioral responses, including depressive states accompanied by
United States 14 33.34 suicidal thoughts, excess alcohol consumption, drug addiction,
Venezuela 04 9.52 chronic anger and the development of bitter skepticism and
Canada 02 4.76 gallows humor, turning medical residents into a high risk group
Peru 01 2.38 for emotional conditions.
Switzerland 01 2.38 According to Lima et al.8, medical residents can be more
Germany 01 2.38 susceptible to burnout syndrome (defined by Maslach(9) as a
Belgium 01 2.38 cumulative reaction to continuous occupational stress factors,
Ireland 01 2.38 characterized by severity, disruption of adaptation, development
Spain 01 2.38 of negative attitudes and behaviors leading to lower personal
TOTAL 42 100 achievement at work) because they have to answer to demands

82 Rev Assoc Med Bras 2010; 56(1): 81-90

Health and quality of life of medical residents

TABLE 2 - Distribution of studies by period/year of publication

SOURCE/TITLE FOCUS OF STUDY CONCLUSIONS

Patient Educ Couns. 2008

Aug;72(2):194-200
Education during residencies and patient care could improve
Well-being in residency: effects on rela- Well-being in medical residency
tionships with patients, interactions with
with actions promoting the well-being of medical residents.
colleagues, performance, and motivation

BMJ. 2008 Mar;336(7642):448-91

Rates of medication errors among depressed Depression and burnout among Depressed residents make six times as many errors as nonde-
and burnt out residents: prospective cohort pediatrics residents pressed residents.
study

Acta Clin Belg. 2008

Nov-Dec;63(6):363-71 Shorter duty hours have been proposed as a way of improving
Restriction of duty hour for residents in Restriction of weekly duty hours the health and quality of life of medical residents. However, the
internal medicine: a question of quality of for residents. authors suspect the change could negatively impact education,
life but what about education and patient as well as patient security and satisfaction with care.
safety?

Am J Orthop. 2007 Dec;36(12):E172-9

Resident work-hour rules: a survey of
Opinions of residents and Residents and program directors have different opinions about
residents’ and program directors’ opinions
program directors about reducing weekly work hours. However, both agree that quality
and attitudes.
reducing weekly duty hours. of life has significantly improved with shorter work hours.

J Gen Intern Med. 2007;22(1):102-6 Residents’ acceptance of lower

Most residents disagreed with the notion of longer training
Internal Medicine Residents Reject “Longer work loads and longer training
periods.
and Gentler” Training periods

Self-esteem is above average for 39.6 percent of physicians.

For 38.7 percent of students, Medicine was chosen because
Radiol Bras 2007;40(2):99-103 Psychosocial profile of radi-
of personal aptitudes or goals. For 50.9 percent of physicians,
O perfil do médico em formação em radio- ology and diagnostic imaging
clients understand and learn the information they convey. And
logia e diagnóstico por imagem residents
77.4 percent of physicians are capable of answering patients’
questions.

Curr Opin Anesthesiol. 2007

Dec;20(6):580-4
Medical residents experienced improvements in quality of life
Duty hours restriction and their effect on
Effect of duty hours restrictions after duty hours were restricted. However, it is not clear if
resident education and academic depart-
on resident education patient security and quality of professional education improved
ments: the American perspective
or not.

Rev Assoc Med Bras 2007;53(2):95-107

How medical residents see medical Better working conditions for medical residents requires improved legisla-
Residência médica: contribuições dos
residency tion on medical residency.
médicos residentes ao debate [editorial]

Among medical residents, 78.4 percent suffered from burnout syndrome.

Rev Bras Educ Méd. The majority of cases come from Orthopedics, Pain Clinic, Surgery, Pedia-
2007;31(2):137-46 trics, Gynecology and Obstetrics. The authors suggest creating burnout
Síndrome de Burnout em residentes Burnout among residents prevention programs to help health care professionals avoid the condition.
da Universidade Federal de Uber- The study underlines the need to continue researching the subject and to
lândia - 2004 develop more complex models to understand burnout syndrome among
medical residents.

Rev Assoc Med Bras 2010; 56(1): 81-90 83

Lourenção LG et al.

Clin Orthop Relat Res. 2006

Quality of life, burnout and
Aug.;449:134-7 Burnout rates among residents were proportional to their duty
overall health of residents and
Effect of duty hour standards on burnout hours.
among orthopaedic surgery residents
university faculty.

Am J Obstet Gynecol. 2006;195(5):1450-6 How residents and faculty see Residents and faculty disagree about the impact of the reform
Eighty hour work reform: faculty and resi- the 80 hour work week for on resident education and patient care, but agree that it
dent perceptions medical residents. improves quality of life for residents.

Am Surg. 2008;74(6):542-7 Professors believe shorter duty hours could help resident education and
Three-year results of mandated work hour Impact of duty hours restrictions on patient care, while residents believe it wouldn’t. However, both agree
restrictions: attending and resident perspec- patient care and resident education that shorter duty hours mean an improvement for the quality of life of
tives and effects in a community hospital professionals.

Med Princ Pract.

2006;15(4):276-80 Stress levels among residents and
Forty two percent of residents consider themselves under major stress,
Influence of residency training on relation between stress and compro-
with 21 percent claiming that the stress interferes with their family lives.
personal stress and impairment in mises in family life.
family life: analysis of related factors

Ann Surg. 2006;243(6):864-75 There are several concerns with the professional education of surgical
The impact of the 80-hour resident The impact of the 80-hour resident residents. Though restricting the duty hours of residents has had no
workweek on surgical residents and workweek on residents. measurable impact on the quality of patient care, there have been signifi-
attending surgeons cant improvements in the quality of life of residents.

BMC Health Serv Res. 2006 Aug 14;6:98 Swiss residents arguments
Swiss residents arguments for and against a for and against a career in
The primary complaint from residents is the structural deterio-
ration of working conditions.
career in medicine medicine.

Thirty eight percent of residents were excessively sleepy and

BMC Health Serv Res. 2006 Oct 19;6:136 The use of drugs among resi-
7 percent were very sleepy, while 46 percent regularly used
The use of sleep aids among Emergency dents for sleep management or
alcohol, antihistamines, sleeping pills, benzodiazepines or
Medicine residents: a web based survey to fight sleepiness
myorelaxants.

Interface Comun Saúde Educ

Authors found feeling of profession losing respect, resentment
2006;9(18):103-16 Perceptions of physicians who
because of diminishing power of medical knowledge, percep-
Médicos residentes e suas relações com/e concluded the Obstetrics/
tion of medicine as more business than profession, uncertainty
no mundo da saúde e da doença: um Gynecology residency about the
about double roles (student and professional), difficulties with
estudo de caso institucional com residentes period.
em Obstetrícia/Ginecologia
death and sorrow.

Work experiences of first-year

Z Psychosom Med Psychother.
medical residents and their
2005;51(2):163-78 Female residents have more positive social relations at work and work
impact on residents’ physical
Stress at work and well-being in harder on activities than male residents.
integrity and psychological
junior residents
well-being.

BMC Med Educ. 2005 Jun 22;5:21

Well-being in residency training: a
survey examining resident physician Thirty four percent of residents consider their lives stressful,
Well-being of residents.
satisfaction both within and outside with women suffering more than men.
of residency training and mental
health in Alberta

84 Rev Assoc Med Bras 2010; 56(1): 81-90

Health and quality of life of medical residents

Acad Med. 2005 Jan;80(1):98-102 Quality of life of residents

Compliance with common program and education environment,
requirements in Brazil: its effects as seen through violations Violations of the program impact the quality of life of residents and the
on resident’s perceptions about of Programa de Requisitos educational environment.
quality of life and the educational Comuns (Common Require-
environment ments Program).

São Paulo: Universidade de São

Cognitive performance of
Paulo, Faculdade de Medicina; 2005
residents for differential char-
Aquisição de conhecimentos, estraté-
acteristics in terms of affective Residents with positive affective and motivational profiles
gias de aprendizado, satisfação com
and motivational variables and acquire knowledge during the first two years of residency, while
o ambiente de ensino e qualidade
variables related to perceptions residents with less positive profiles show no gains.
de vida de médicos residentes de
of the educational context and
anestesiologia. Estudo longitudinal
quality of life.
multicêntrico [tese]

Arch Venez Psiquiatr Neurol.

2005;51(104):12-5
Estrés Laboral y Mecanismos de Afron-
Stress, coping mechanisms, and Medical residents with nonfunctional coping styles are more susceptible to
tamiento: su relación en la aparición del
burnout among residents. burnout syndrome.
Síndrome de Burnout en Médicos Resi-
dentes del Hospital Militar “Dr. Carlos
Arvelo”

Rev Fac Ciênc Méd Sorocaba.

2005;7(3):15-9 Eighty one percent of residents and 72 percent of students show symp-
Depression among medical
Rastreamento Epidemiológico da toms of depression, especially women. They mostly drink alcohol, smoke,
students and residents.
Sintomatologia Depressiva em Resi- are single and do not live alone.
dentes e Estudantes de Medicina

J Gen Intern Med. 2005 Jul;20(7):559-64

Relationship Between Increased Personal Relationship between well- Increased mental well-being is associated with enhanced
Well-Being and Enhanced Empathy Among being and empathy. empathy among residents.
Internal Medicine Residents

São Paulo: Universidade Federal

de São Paulo, Escola Paulista de
Medicina; 2004 Residents have low quality of life. Education system needs
Quality of life of residents
Avaliação da qualidade de vida em improvement.
residentes de medicina da UNIFESP-
EPM. [tese]

Rev Bras Anestesiol. 2004 The 24- or 30-hour shift causes pathological sleep latency values,
set-out;54(5):693-9 Fatigue and stress among reflecting extreme fatigue among anesthesiology residents. Regulation of
O plantão noturno em anestesia residents number of hours of rest after shift is key.
reduz a latência ao sono

São Paulo Med J. 2004;122(4):152-7

Residents were predominantly young, single, female, and
Clinical and demographic profile of users Clinical and demographic
requesting help during their first year. Those looking for help
of a mental health system for medical profile of residents who use a
spontaneously had higher rates of adherence. Depression and
residents and other health professionals mental health system.
undergoing training at the Universidade
anxiety were the most frequent diagnoses, followed by suicidal
Federal de São Paulo
thoughts.

Rev Assoc Med Bras 2010; 56(1): 81-90 85

Lourenção LG et al.

Most residents reported improved quality of life. Some reported negative

Ann Surg. 2003;237(4):449-55 impacts on surgical training and quality and continuity of patient care.
Implementing resident work hour limi- Duty hour limitations for resident Negative perceptions of the impact of duty hour restrictions were prevalent
tations: lessons from the New York state work. among physicians with more time as residents and residents in academic
experience medical centers than among recent residents and residents working at
community hospitals.

Rev Bras Oftalmol 2003;62(11):776-81

Primary motivational factors were the ability to help people see
Motivações e percepções de médicos Motivations and perceptions better, opportunity to perform surgery, work hours, technolog-
residentes em relação à escolha da leading medical residents to ical innovation, the fact that high risk, life or death situations
carreira em Oftalmologia choose ophthalmology. are rare, and pursuit of higher quality of life for patients and
physicians.

Residents leave their support network (family, friends and

spouses) due to the high demands for technical and interper-
Aletheia. 2002 Jan-Jun;(15):93-101
sonal skills, as well as the significant amount of time they need
Obligatio faciendi: identificando Stress factors among residents
to dedicate to their work. They also need to navigate various
estressores no contexto do trabalho
roles within institutions, roles which often clash with one
another.

The tutoring activities of residents at the FMUSP pain clinic

enables residents to develop resources to better handle the
Rev Hosp Univ 2001;11(1/2):59-63
obstacles they encounter in the process, thus allowing them
Os dilemas da formação do médico Difficulties in medical education
to take more advantage and find greater satisfaction in their
e os tutores na residência de clínica and the practice of medicine.
activities, as well as improved relationships with staff and
médica da FMUSP
patients, and improved conditions for better professional and
personal choices.

Invest Clín. 2000;41(4):219-35

El concepto de “calidad de vida en We need to add knowledge about quality of life to medical
los estudiantes de medicina y resi- Concept of quality of life. education, as well as the practical utility of QOL in professional
dentes de postgrado de un hospital practice.
universitario

Rev Assoc Med Bras. Stress factors in training and

The magnitude of the stress during Medical Residency comes
1998;44(1):28-34 the effects of said stress on
from the interaction between three kinds of stress: profes-
Natureza e magnitude do estresse na residents and on quality of
sional, situational, and personal.
Residência Médica patient care.

Psychiatr on Line Braz. 1998;(3):10 Though stressful, medical residency provides professional and
Psychological aspects related to
Residência Médica:estresse e personal development for physicians.
medical residency.
crescimento

Almost half of all residents have problems coping with emotional stress,
Rev Med Hered 1998;9(2):63-8
which has a negative impact on the doctor-patient relationship and on
Modos de afrontamiento al estrés en resi- How residents cope with stress.
performance, thus proving the need for strategies to help residents cope
dentes de medicina
with stress.

86 Rev Assoc Med Bras 2010; 56(1): 81-90

Health and quality of life of medical residents

São Paulo Med J. 1997 To improve the overall quality of Universidade Federal de São
Nov-Dec;115(6):1570-4 Paulo’s residency program, for both professionals and patients,
A pioneering experience in Brazil: seeking to decrease stress levels among residents, foster
Implementation of an assis-
the creation of a center for assistance professional and personal development, prevent professional
tance and research center for
and research for medical residents dysfunction and emotional disorders, offer psychological treat-
medical residents.
(NAPREME) at the Escola Paulista ment, assess tutors in residency programs, and develop survey
de Medicina, Federal University of programs to better identify risk factors for emotional problems
São Paulo during residency.

CMAJ. 1996 Jun;154(11):1657-65 The authors come to the conclusion that psychological abuse,
Abuse, discrimination and
Resident’s experiences of abuse, discri- discrimination and sexual harassment are common problems
sexual harassment among
mination and sexual harassment during among residents, requiring work from multiple professional
residents.
residency training specialties.

Maracay: Universidad de Carabobo,

Facultad de Ciências de la Salud;
1994 Fatigue among gynecology The authors found female residents ingested less stimulants
Jornada prolongada y fatiga em and obstetrics residents with than male residents, and that the less hours of sleep, the more
médicos residentes del gineco- prolonged duty hours. fatigued residents there were.
obstetricia: Hospital geral de Maracay,
Venezuela, 1994 [dissertação]

Arch Hosp Vargas Second-year residents had the greatest surgery duty hours. Third-year
1993;35(3/4):135-42 residents performed fewer surgical procedures and are not performing as
Evaluación de la carga de trabajo Duty hour of residents. many as they should or at the proper complexity levels.
quirúrgico de residentes del post-
grado de cirugía general

Residency is associated with feelings of depression, anger,

cynicism and emotional retraining, but there is no great concern
with the possible effects of those feelings on future actions
J Gen Intern Med. 1986;1(4):252-7 Relationship between profile of
and professional attitude of physicians. Therefore, the author
Stress in residency: a challenge to residents, stressful experiences and
states that residents need more support and personal guidance
personal growth psychosocial adaptation.
to become good physicians and that residency programs should
offer support to help professionals develop the communication
skills they need to become competent professionals.

Acad Med. 1991;66(5):301-3

The relationship between residents’ Women reported higher levels of stress than men; however, they did not
characteristics, their stress experi- Stress among residents report high levels of emotional suffering. The time assigned to education
ences, and their psychosocial adjust- by residents was correlated with residents’ humor and annoyance levels.
ment at one medical school

Factors such as student-doctor transition, professional responsibility,

social isolation, fatigue, sleep deprivation, overwork, fear of commit-
Chicago: American Medical Associa- ting mistakes and other factors connected to the residency educa-
tion; 1979 tional process are associated with psychological, psychopathological
Challenges of medical resident
Beyond survival: the challenge of and behavioral responses, including depressive states accompanied
during educational process.
the impaired student and resident by suicidal thoughts, excess alcohol consumption, drug addiction,
physician chronic anger and the development of bitter skepticism and gallows
humor, turning medical residents into a high risk group for emotional
conditions.

Rev Assoc Med Bras 2010; 56(1): 81-90 87

Lourenção LG et al.

from supervisors, society at large and themselves. They also expe- conditions, including an imbalance between personal and
rience dual roles: supervisors expect they will learn like students, professional lives. In their study about arguments for and against
with exhaustive work shifts and mandatory assignments, but a career in medicine, residents claim that making medicine an
also act like professionals, which requires increasing levels of appealing career once more would require making sustainable
responsibility, competence, and efficiency. changes to health and to the social and political scenario.
Studying burnout syndrome among the medical residents of Studying duty hour restrictions for residents, Whang et al.19
the Universidade Federal de Uberlândia, Lima et al.8 found high found that most residents mentioned improved quality of life
rates of burnout among residents, a worrisome fact indicating following duty hour restrictions.
the need for preventive and healing measures. According to the Gopal et al.20, however, in surveying residents about accep-
authors, variables such as duration of course, work overload, tance of duty hour restrictions and longer curricula in the United
duty hours, major personal investment, and giving up time for States, found that most disagree with the notion of extending the
leisure, family, friends and all other activities, as well as the need educational period. Only residents with burnout syndrome or who
to complement education with medical residency can all cause knew the criteria for the syndrome were flexible in accepting a
residents to burn out. 60-hour work week in lieu of an 80-hour one.
In reviewing the scientific literature on training as part of Shanafelt et al.21 found that the greater the mental well-being
medical residency, primarily in particular specialties, we find of residents, the more enhanced their empathy. Ratanawongsa
that professionals suffer high rates of health issues that interfere et al.22 found that well-being interferes with patient relations,
with quality of life and, consequently, with the quality of care interactions with peers, performance, and motivation. The Irish
provided to patients. residents surveyed by the authors claimed greater well-being
In the United States, Fahrenkopf et al.10 studied rates of favored the decision-making process. The results reaffirm the
depression and burnout syndrome among pediatrics residents need for investing in improvements to this professional training
to assess the relationship between the two conditions and medi- system.
cation errors. Though they found no relation between burnout According to Ratanawongsa et al.22, resident training and
syndrome and increased rates of medical errors, they did find patient care would improve with actions focused on the well-
that these two are the primary conditions afflicting pediatrics being of residents. Cohen and Patten23, in a study on the well-
residents. being of residents in Alberta, Canada, found that 34 percent of
In an epidemiological survey of depressive symptoms among residents consider their lives stressful, with more women afflicted
medical students and residents, Gabriel et al.11 found that than men. Prolonged pressure was singled out as the primary
medical students have major rates of depression, which can stress factors by residents, who claim they would not choose
compromise the quality of patient care. The authors also found a career in medicine if they could start their professional lives
that female students and residents suffer more than male ones, over. There was also a strong correlation between intimidation
and that most residents habitually drink alcoholic beverages. and sexual harassment of female residents.
Ríos et al.12 assessed stress levels among residents and rela- A study on abuse, discrimination and sexual harassment
tion between stress and compromises in family life, finding that among Canadian residents shows that 50 percent of residents
stress interferes with family relationships and can be harmful suffered psychological violence from patients, family members
to family life. and supervisors, women more often than men; 5.38 percent
In the United States, Archer et al.13 assessed stress factors of residents, all female, claimed to have been victims of sexual
among residents and their psychosocial adaptations; they found discrimination; 40 percent claimed to have suffered sexual haras-
that duty hours and low pay were the primary sources of stress. sment of some kind, their most common reactions to it being
Another important problem afflicting residents is excessive embarrassment (24%), anger (23.8%), and frustration (20.8%).
sleepiness secondary to long shifts. An American study found The data show that psychological violence, discrimination and
that most residents feel sleepy and have trouble sleeping, regu- sexual harassment are common problems among residents,
larly turning to alcohol or sleeping aids to try and fall asleep14. requiring work from multiple professional specialties24.
A study on prolonged duty hours and fatigue among gyneco- Buddeberg-Fischer et al.25 surveyed the work experiences of
logy and obstetrics residents in Venezuela showed that profes- first-year medical residents and their impact on their physical
sionals, especially males, ingest stimulants, and that residents integrity and psychological well-being. They found that women
in this condition have unacceptably high rates of fatigue. The receive less guidance than men during residency, but have more
author stresses the need for work schedules that include periods positive social relations and work harder on activities than their
of rest during 12-hour shifts15. male peers. The absence of supervisors, undefined hierarchies,
Residents have informal knowledge about quality of life, stress and excess responsibilities were mentioned as risk factors
but it is not actually applied.16 Macedo17 found that residents’ for symptoms of anxiety and depression.
quality of life in terms of vitality, social life, emotional life, and Barack et al.26 surveyed orthopedic surgery residents and
mental health are comparable to those of patients with chronic university faculty to measure quality of life, burnout syndrome,
conditions. González et al.16 suggest knowledge about quality of and overall health. Students had high rates of burnout and
life, as well as its practical usefulness in professional life, should emotional exhaustion. The authors found that shorter duty hours
be incorporated into medical education. lead to higher quality of life, decreasing burnout rates among
Buddeberg-Fischer et al.18 found the primary complaint residents.
among Swiss residents is the structural deterioration of working Belgium restricted the work week to 48 hours for residents in

88 Rev Assoc Med Bras 2010; 56(1): 81-90

Health and quality of life of medical residents

1999, a measure still being debated in Europe. The United States learning conditions for medical residents requires improvements
recently restricted the work week to 80 hours for residents(27). to the legislation regulating medical residency, as well as, above
Several studies have been performed in the United States to all, its enforcement. Also, regulatory bodies urgently need empo-
assess the impact of duty hour restrictions on professional trai- werment and the involvement of all stakeholders.
ning and patient care27-31. Though stressful, medical residency is an enriching expe-
In the United States, Dola et al.32 surveyed resident and rience, providing professional and personal development for
faculty opinions about duty hour restrictions for residents. They young physicians.42 However, Residency is associated with
found that 45.3 percent of residents believe restricting duty hours feelings of depression, anger, cynicism and emotional retraining,
improves the quality of patient care, while only 8.8 percent of but there is no great concern with the possible effects of those
professors share that notion. However, both agree that the reform feelings on future actions and professional attitude of physicians.
improved the quality of life of residents. Therefore, residents need more support and personal guidance
In Brazil, though the law (Decreto 80.281/1977) already to become good physicians and residency programs should offer
restricts the work week to 60 hours, with 80 to percent assigned support to help professionals develop the communication skills
to service and the rest to classroom and complementary work, they need to become competent professionals.43
several studies find major health issues secondary to prolonged
duty hours, including burnout syndrome, depression, fatigue, Conclusion
stress, and anxiety8,15,33-37. The results tell us the service and
In reviewing the literature on the quality of life of medical
resident training should be reformed to improve the quality of
residents, we found high rates of health issues that interfere with
life of residents, thus improving the quality of patient care in
the quality of life of medical residents and, consequently, with
Brazilian health care facilities.
the quality of care provided to patients.
In 1981, the National Medical Residency Committee created
Though stressful, often with improper arrangements for
Programa de Requisitos Comuns (Common Requirements
professional training, which compromises the quality of life of
Program) to regulate the work hours of medical residents.
medical residents, medical residency is an enriching experience,
Oliveira Filho et al.38 found that violations of the common
providing professional and personal development for recent
requirements program are associated with poorer perception of
graduates from medical schools.
key aspects of overall quality of life, residency quality of life, and
The review found that Brazil needs to change the legal regu-
worsened educational environments.
latory standards for medical residency, as well as that resident
Residents have a lot of trouble coping with stress and poor
assistance programs should be implemented to improve work
working conditions. Studies about coping strategies have shown
and learning conditions, which in turn would aid the develop-
that almost half of all residents have problems coping with
ment of professional skills and improve personal quality of life
emotional stress, which has a negative impact on the doctor-
for medical residents.
patient relationship and on performance, thus proving the need
for strategies to help residents cope with stress.33,34 Blandin et
al.33 stress that medical residents with dysfunctional coping
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