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December 15, 2004

Graduate Medical Education Research in the 21st Century and JAMA On Call

Author Affiliations

Author Affiliations: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, Calif (Dr Lim). Dr Lim is Editor, JAMA On Call, and Dr Golub is Senior Editor, JAMA.

JAMA. 2004;292(23):2913-2915. doi:10.1001/jama.292.23.2913

The first six months were hell; the second six months were purgatory; the third six months were heaven; and when it came time for me to leave, I wept bitter tears.

    Mary Elizabeth Bates, MD, 1948, on internship1

Few experiences in the course of medical training are as galvanizing as the period during which trainees make the transition between student and practicing physician. Residency forms the core of a physician’s identity and provides the fundamental cognitive and procedural skills that define a career. Unfortunately, for many residents there may be no near-celestial experiences, and tears that are shed during the first year may not represent regret for its conclusion. In this issue of JAMA, Thomas2 addresses burnout within residency training programs, an alarmingly underrecognized and understudied phenomenon common among trainees. Her systematic review attempts to describe the prevalence of resident burnout; clarify the role of demographics, work characteristics, and personality in its development; and assess its impact on resident health and well-being and on performance in patient care. What is very striking in this review is the general methodological weakness of the evidence addressing this important problem, leaving as many questions as answers.