From doing to leading: PGY-1 to PGY-2 transition.

BACKGROUND: Clinical trainees experience several professional transitions throughout their career, which can be exciting, anxiety-provoking or both. The first to second post-graduate year (PGY) transition for residents (junior doctors) in North America involves assuming new roles such as team leader, clinical supervisor, and teacher, often with minimal preparation. We explored resident experiences and emotions during this transition, and obtained their strategies for navigating this transition, through the lens of Bridges' transition model. This model has three stages: (1) ending, losing and letting go, (2) the neutral zone and (3) the new beginning. METHODS: We conducted one in-person focus group and subsequent one-on-one virtual semistructured interviews (due to COVID-19) of PGY-2 and PGY-3 residents who had previously undergone the transition. These sessions were recorded and transcribed, and thematic analysis was performed. FINDINGS: Four residents participated in the focus group, and 14 participated in one-on-one interviews. We identified five key themes: (1) not just a cog in the wheel, (2) contributing to growth of near-peers, (3) being flexible and adaptive, (4) emulating resident role models and (5) relationships with attendings. Residents suggested a transitions-focused retreat, simulation training to lead clinical emergencies, supervised opportunities for PGY-1s to act as PGY-2s coached by senior residents, and pairing PGY-1s with senior residents to help prepare for the transition. CONCLUSION: Professional transitions are both anxiety-provoking and exciting. Clinical trainees need preparation to successfully navigate multiple transitions. The Bridges' transition model could be useful in conceptualising transitions and planning curricula.

Perspectives of internal medicine residents on approaching serious illness conversations.

BACKGROUND: Navigating serious illness conversations is a critical competency for clinical trainees in any discipline, yet many feel underprepared to engage in such conversations. This study explored the challenges and emotions experienced by residents (junior doctors) when approaching serious illness conversations and how their perceptions might inform the development of effective communication skills curricula. METHODS: Using qualitative methodology, we explored the prior experience of Internal Medicine residents who attended communication skills workshops at Brigham and Women's Hospital between January and May 2020. Using an open-ended questionnaire, we solicited participants' reflections on conducting serious illness conversations. Narratives were de-identified and analysed for key themes. The Mass General Brigham Institutional Review Board approved the study. FINDINGS: Fifty-one out of 70 eligible residents (72.8%) completed the questionnaire. Qualitative analysis identified five key themes: (a) finding the time to do it right, (b) fear of using the wrong words, (c) managing the patient's response and emotion, (d) not knowing how much they can say and (e) finding meaning and fulfilment. Residents also proposed several practical strategies to enhance their communication training. DISCUSSION AND CONCLUSION: Though serious illness conversations were reported as stressful, study participants emphasised that the experiences enabled them to forge meaningful therapeutic relationships and led to a sense of fulfilment. The strategies recommended by our residents offer valuable insights to improve communication training, including through increased simulated and real-time skills practice. Cocreation of curricula by trainees and faculty could potentially address trainees' challenges, promote essential skills, and foster professional identity formation.