Survey shows perceptions of stress among pathology residents

Researchers from Boston University School of Medicine (BUSM) conducted a nationwide survey to identify stressors perceived by pathology residents. The survey appears online in the December issue of the American Journal of Clinical Pathology.

Studies in other specialties have found that stress during residency training affects efficiency, productivity, error rates and physician burnout. Immediate effects of stress include increased heart rate and increased white blood cell count. The long-term effects include cynicism, apathy, depression, emotional exhaustion, hostility, alcohol and substance abuse, obsessive compulsive disorders, and other dissociative behavioral patterns. These factors have not been studied in this unique specialty field where patient and ancillary support staff related stressors are minimal, according to senior author Lija Joseph, MD, associate professor of pathology and associate residency program director of the anatomic and clinical pathology training program at BUSM.

The researchers generated a list of 17 specific key stressors based on literature review and a focus group that identified the most common stressors in this specialty. Pathology residents and pathology residency program directors were asked to rate these stressors on a scale of one through five, with one considered least stressful and five considered most stressful. The survey also offered a not applicable choice and three open ended questions that allowed participants to include additional stressors not listed in the survey. Unique stressors that emerged in this survey included faculty favoritism and bias as well as lack of professionalism among faculty members. Lack of mentoring and variability in faculty expectations may be a factor that deters graduates from residency programs from choosing academics as a career choice.

Survey respondents included 35 pathology residency program directors and 148 pathology residents. Every item listed on the survey was identified as a significant stressor by at least a few participants. Program directors and residents acknowledge that perceptions of stress exist in their programs. Both groups identified the stressors; work overload inhibits learning, variability in faculty expectations as the top two stressors in a pathology training program. Residents ranked lack of elective time and pressure to teach and to do extra projects as significant stressors. Program directors recognized board examinations, in-service examinations, family and financial concerns and job opportunities as significant stressors.

“This survey is the first of its kind and is a very preliminary attempt to identify stressors and provide objective data that program directors can work with in their quest to orchestrate an ideal pathology residency program,” said Joseph. “The concordance of the resident and program director responses suggests that these are not random issues, and we are beginning to see a pattern of stressors in pathology training programs.”

Researchers further noted that faculty collectively facilitating a process to alleviate stress among residents, direct faculty supervision of residents, clearly delineating which tasks are optional and which tasks are elective and establishing consensus among teaching faculty are ways to mitigate stressors.