Resident Physicians’ Work-Related Emotional Experiences: A Scoping Review of Qualitative Research

BACKGROUND: Medical residency is a transformative but emotionally intense period, marked by long hours, constrained autonomy, complex hierarchies, and existential challenges. While the literature widely acknowledges consequent burnout, the "burnout" framework may not encompass the range of residents' emotional experiences or account for institutional and developmental influences. This article synthesizes qualitative research on US and Canadian medical residents' work-related emotional experiences to elucidate: (1) applications of qualitative methodology for understanding residents' work-related emotional experiences, (2) dynamics and causes of such experiences, and (3) gaps in knowledge. METHODS: We queried Medline, Embase, Web of Science, and Cochrane for studies published between 1952 and 2023. Our search initially yielded 11,555 records, manually deduplicated to 9486. We applied strict inclusion criteria for population, method, and topic, yielding 56 articles for analysis. Using a structured template, we abstracted study characteristics. We conducted descriptive analysis of discrete article characteristics and thematic analysis of article findings. RESULTS: We generated three major themes: Identity and Development, Interpersonal Dynamics, and Structural Dynamics. Our core finding was that residents' work-related emotional experiences emerged from dialectical interaction between an evolving identity and residency's challenges, with various interpersonal and structural factors influencing that interaction. The literature suggested it was not exclusively work that generated work-related emotions, but rather the interplay between work and issues of the developing self. DISCUSSION: Residents' work-related emotions arise from the ways their values and identities interact with the rigors of a prolonged "baptism by fire." Work challenges, identity development, interpersonal interactions, and systemic factors combine in multilayered, oft-unpredictable ways to produce subjective experiences that encompass more than just "burnout." Our findings suggest that resident well-being interventions must go beyond logistical and psychological interventions, directly addressing the deeper, existential challenges inherent to transitioning from student to physician.