Financial concerns , including debt , were rarely mentioned . Two of the residents mentioned student debt as a barrier to activities but not as an actual stressor for them . None of the residents expressed any concerns for their physical safety .
Example of a response concerning safety :
“ Just a significant amount of resident debt from student loans . The resident salary doesn ’ t always keep up .” ( 4th year anesthesiology resident )
Negative Impacts
TABLE 4 : Summary of Negative Impact to Wellness Question
Feeling disrespected Not getting time off when requested Not being included in decision making Forced to work extra hours Poor pay Feeling scrutinized constantly Too much paperwork Institutionally imposed activities of little value Feeling unappreciated Conflicts with other residents Gossip
Love and Belonging
The residents often spoke about how love and belonging were important to them . They wanted to feel part of a larger group and drew from the support of others to feel secure and valued . Conversely , being alone or feeling alone was detrimental to their overall sense of wellness . The importance of a spouse and family as well as spending time outside of work was discussed in terms of feeling love and as part of a supportive network . The residents also discussed how relationships with others can suffer and can be strained as a result of the demands of residency .
Example of a response concerning love and belonging :
“ At home I have a wife who I think loves me and an infant . The day-to-day of life would be much harder without her . I am lucky to have in-laws in town that are also very supportive .” ( 5th year otolaryngology resident )
Esteem
Esteem includes feeling respected and a sense of fairness and control over their lives . Residents talked about how the program could support them with scheduling and the impact of faculty on their esteem .
Example of a response concerning esteem :
“ Then , having people above you , so senior residents and staff that you feel are trying to help you as opposed to always like nitpicking . If you feel stressed that everything you ’ re doing is always being critiqued and criticized , it makes you on edge more .” ( 2nd year orthopedic surgery resident )
Self-actualization
The highest order need , self-actualization , included feeling accomplished and competent to provide care as a physician and progressing toward a goal . Wellness was described as an overall sense of happiness .
Example of a response concerning selfactualization :
“ Everyone always told me growing up , once you find what you love , that you ’ ll never work a day in your life . I never believed them . I always thought work was work until now . I found this and I can ’ t imagine being away from here more than for a small period of time . I won ’ t say that my wellness is tied to my career , but it certainly helps me feel fulfilled , that I ’ ve reached my potential , and that what I do makes a difference .” ( 4th year anesthesiology resident )
DISCUSSION
In the current study , residents were asked to discuss wellness and to describe how their wellness was supported by others in the GME environment . The residents ’ examples of positive wellness elements frequently focused on time ( e . g . time off , flexible scheduling ), support ( e . g . patience , sharing knowledge , and encouragement ), and social connection ( e . g . being invited to events on the floor , sharing food , socializing through outings , social media connections ). Examples of program wellness elements included career development and flexibility with time and schedule . Negative examples that impacted the residents ’ wellness included feeling disrespected , not being included in decision making , conflicts , and feeling unappreciated .
It is generally understood that the nature of resident education is stressful and demanding . As a result , vulnerable residents can experience significant threats to wellness , such as poor mental health and burnout 4 , which can carry over to their personal and professional lives . 11 In addition , even fundamental human needs such as sleep , eating , and exercise are often negatively impacted because of the demands of residency training . 7 The multidimensional aspects of resident wellness are recognized by the American Medical Association as outlined in its six aspects that are key for resident well-being . 12 The six elements include nutrition , fitness , emotional health , preventative care , financial health , and mindset and behavior adaptability . It is important to foster a culture of wellness during medical education by facilitating these basic needs , especially since negative experiences can lead to burnout and have a lasting effect on a resident ’ s education and career .
Maslow ’ s Hierarchy of Needs is often depicted as a pyramid of human needs in which higher order needs are dependent on baser needs , and all can be relevant to wellness . The most basic physiologic needs such as food , water , shelter , etc . form the bottom of the pyramid followed upward by safety , love and belonging , esteem , and self-actualization . Recently , scholars have adapted Maslow ’ s framework to identify a hierarchy of needs as it applies to resident physician experienc-
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