The challenge of integrating professionalism and mentoring in a program for medicine residents: a pilot study using critical incident reports

Introduction and description of the problem

Residents deal with high levels of stress during their training. They face routinely emotional charged situations and not always have the resources and support to cope with present demands – difficult patients, sleep deprivation, fatigue, not enough time to social and familial engagement and high competitiveness, among other distressful situations. Studies performed worldwide report high levels of depression, anxiety, burnout and other psychological problems during this phase. Mentoring programs are described as a good tool to address those issues, but its feasibility and usefulness amongst residents are not easily achieved.

Objective

Aiming at developing a Mentoring Program for the residents of the Division of General Internal Medicine and Semiology - Department of Internal Medicine of the School of Medicine – University of São Paulo, we developed an exploratory study to get a better understanding on the challenges and difficulties our residents face during their training. Our purpose is to define goals to be met and then chose teaching and assessment methods to be implemented considering available faculty and resources.

Methodology

We evaluated the description and reports regarding a previous Mentoring program implemented at the institution 10 years ago and closed sub sequentially. We collected 96 critical incident reports from the residents presently involved in the program (80%), describing situations experienced by them as emotionally charged.

Analysis

The critical incidents reports were analyzed by 2 researchers (T.K; C.A.L) and 6 categories were defined as recurrent and typical. Those 6 categories were discussed between the coordination group and were all found to be connected to professionalism issues.

Results

A Mentoring program was designed and is being pilot tested during the last 5 months, including support groups and Professionalism content in the form of video-lectures. Those issues are being gradually included in all forms of assessment during Residency. This process will continue for another 6 months in order to define the final program to be implemented in the long term. Alignment between objectives, methods and assessment is our main objective for this pilot phase of design.

Conclusions

Professionalism is well defined and recognized as a basic competence but not always systematically taught during graduation. Professionalism assessment is still a challenge but its relevance is clear in international discussions. Mentoring Programs seem to be an appropriate setting for those issues to be reflected upon. Its efficacy needs to be evaluated longitudinally, as well as the influence that a Mentoring Program has being and levels of Professionalism.