“A place to have fellowship”: implementing group counseling in a clinical fellowship program

The American College of Graduate Medical Education (ACGME) has endorsed recommendations to promote individual counseling services to support trainees. However, there are limited data and no clear recommendations related to group counseling services, a format that may be scalable and support peer connection. This paper has two primary objectives: (1) to describe the implementation of group counseling as a method of providing formative, normative, and restorative supervision to GME trainees and (2) to report participants’ experiences within the program. In September 2019, the fellowship program implemented regular group counseling for fellows, with ongoing feedback collected to optimize logistics. Between November 2023 and January 2024, we worked within an interpretivist paradigm to explore experiences with group counseling by conducting semi-structured individual interviews with former and current fellows, which were transcribed and analyzed thematically. This study was deemed exempt from review by the Institutional Review Board. Eleven out of 13 current or former fellows (85%) participated in the interviews. Participants described the challenges of their training and perceived benefits of group counseling related to well-being, connection, and professional identity development. They offered the following recommendations for group counseling: clear confidentiality guidelines, protected time during work hours, facilitation by a mental health clinician based outside the training program, and optional attendance. This study suggests that professionally facilitated group counseling may offer perceived benefits for trainees. Further research is needed to address attendance challenges and explore strategies for integrating group counseling into different training programs.