Transitioning to residency: a qualitative study exploring residents' perspectives on strategies for adapting to residency

Abstract Background Despite the widespread use of preparation courses, residents still experience the transition from student to resident as problematic and stressful. Although this transition highly depends on the organization residents work for, only a few studies address individual and organizational strategies that help them adapt. We need this information to optimize transitions and improve onboarding programs and faculty development initiatives. This study explores residents’ experiences with their own and other health care professionals’ strategies to help them adapt to residency, and residents’ perceptions of the impact of other health care professionals’ strategies on their own adaptation efforts. Methods We conducted a qualitative interview study with 16 residents from different hospital-based specialties in the Netherlands. To identify residents’ perceptions of their own and other healthcare professionals’ strategies, we used a template analysis based on the individual and organizational tactics originating from the theory of Organizational Socialization. In this study, we defined other healthcare professionals as residents, supervisors, nurses and advanced practice providers. Results Residents experienced five individual and six organizational strategies. When engaging in social interaction with other healthcare professionals, residents used individual strategies such as asking questions and establishing social relationships to learn how to behave in their roles as doctors and members of the healthcare team. They experienced different strategies from other healthcare professionals, which we clustered into interactional (between healthcare professionals and residents) and systemic strategies (functioning of the system around residents’ training program). These strategies facilitated or hindered residents’ own adaptation efforts. We found differences in perceptions of whether a specific strategy was facilitating or hindering. Some residents, for example, perceived the lack of a role model as facilitating, while others perceived it as hindering. Conclusion Residents felt that smooth transitions require strategic approaches from both residents and other healthcare professionals. They used individual strategies to learn how to perform new tasks, behave appropriately and understand their roles in relation to those of other healthcare professionals. We distinguished interactive and systemic organizational strategies. Organizational strategies positively or negatively affected residents’ own adaptation efforts. We found differences in perceptions of whether specific organizational strategies worked, depending on residents’ individual needs.