Resident Doctors’ Mental Health Shifts Dramatically Across Training Stages, Study Reveals

Behind every attending physician stands a resident who once doubted whether they could survive the night shift, the intensive care unit rotation, and the crushing weight of a training system that demands clinical mastery while offering little psychological shelter. New research from China now suggests that the inner life of these doctors-in-training is not a single, static struggle but a staged journey, with confidence, well-being, burnout, and professional identity each rising and falling in predictable patterns as the years of standardized residency training unfold. The finding, published in BMC Health Services Research, carries implications far beyond one hospital or one country, because residency programs worldwide grapple with the same question: how do you protect the mental health of trainees whose challenges change every year?

The study, led by Bin’e Wang, Mei Lu, and Ming Tao of the Affiliated Hospital of Zunyi Medical University, together with colleagues at Zunyi Medical University, took a deliberately close-up look at the psychological experiences of resident trainees enrolled in China’s mandatory standardized residency training program. Standardized residency training, known as SRT, is the compulsory pathway through which every newly graduated physician in China must pass before practicing independently. Trainees commonly face heavy workloads, low remuneration, ambiguous professional identity, psychological stress, and burnout, yet most prior research has treated these burdens as if they were uniform across the entire training period. Few studies have compared psychological experiences across training stages, even though the challenges trainees confront and the support they need vary substantially from one stage to the next.

To capture that variation, the researchers employed a descriptive phenomenological design, a qualitative approach rooted in the philosophy of phenomenology, which seeks to describe lived experience exactly as participants perceive it rather than through the lens of pre-existing theory. Using purposive sampling, the team selected 33 resident trainees at different stages of training from a tertiary Grade A hospital, the top tier of China’s hospital classification system and a setting where trainees encounter some of the most demanding clinical environments, including intensive care units. Each trainee participated in a semi-structured interview, a format that follows a prepared interview guide while allowing participants to raise unexpected themes in their own words. The interviews were transcribed with the assistance of the AI transcription feature of Tencent Meeting, used only for preliminary text conversion; the authors then manually proofread every sentence against the recordings and bear full responsibility for the content.

The researchers analyzed the interview data using Colaizzi’s seven-step method, a rigorous qualitative analysis framework that moves from reading the transcripts and extracting significant statements to formulating meanings, clustering themes, and validating the resulting themes against the original accounts. The analysis, reported in accordance with the Standards for Reporting Qualitative Research, yielded three core themes that together describe a staged psychological trajectory rather than a unitary or static experience.

The first theme traced the phased accumulation of self-efficacy, the psychological construct describing a person’s belief in their own capacity to execute the behaviors needed to perform successfully. In the earliest stage of training, residents described positive experiences that built this confidence from the ground up: first successful procedures, first reassuring evaluations from supervisors, first moments when a patient’s condition improved under their watch. Self-efficacy accumulated gradually, fed by mastery experiences and social persuasion, until it reached a point of stable maintenance in later stages, when trainees no longer questioned whether they belonged in the hospital but instead relied on established routines to carry them through clinical demands. The trajectory suggests that early training is a critical window in which psychological foundations are laid, and that positive early experiences are not merely pleasant but structurally necessary for the confidence residents will draw on for years.

The second theme revealed an inverse psychological relationship between subjective well-being and job burnout across the training stages. Subjective well-being, the scientific term for how people evaluate their own lives in terms of positive feelings and satisfaction, declined as training progressed, while burnout emerged and intensified. Burnout, in the occupational psychology literature, is characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, and it is a recognized hazard in medical training worldwide. The study’s trainees described a pattern in which the early idealism and energy of the first stage gave way to declining well-being and the emergence of burnout in later stages, a reversal that the researchers describe as inverse psychological experiences of well-being and job burnout. This finding is technically significant because it implies that burnout is not simply the residue of an exhausting first year; it can deepen precisely when trainees are expected to be most competent and most independent, at the very point when programs typically reduce supervision and psychological support.

The third theme concerned professional identity and development, charting a movement from idealistic identification to realistic confusion. In the early stage, trainees identified strongly with the idealized image of the physician, embracing the profession’s prestige and purpose with something approaching enthusiasm. As training advanced and they confronted the realities of the job, including heavy workloads, low remuneration, and the ambiguous professional identity that China’s trainees commonly report, that idealistic identification eroded into realistic confusion. Trainees questioned what kind of doctor they were becoming, what the profession actually offered them, and whether the identity they had entered training to assume still matched the person emerging from it. Professional identity, in the vocational psychology literature, is the integration of one’s self-concept with the values, norms, and role expectations of a profession, and its destabilization is a known risk factor for attrition and mental health problems in medical trainees.

Taken together, the three themes support the study’s central conclusion: the psychological experiences of resident trainees during standardized residency training are phased rather than unitary or static. Confidence builds in stages, well-being and burnout move in opposite directions across stages, and professional identity transforms from idealism to confusion as the realities of the profession replace its ideals. Because the challenges and support needs vary by stage, clarifying stage-specific experiences is essential for designing targeted interventions, improving training quality, and protecting trainees’ mental health. A support system calibrated to the first stage, when self-efficacy is fragile and idealism is high, would look very different from one calibrated to the later stages, when burnout deepens and identity confusion sets in.

The researchers argue that standardized residency training management should therefore pursue two goals simultaneously: cultivating clinical competence and establishing a phased psychological support system, so as to optimize trainees’ psychological experiences and promote positive psychological feelings. In practical terms, that could mean pairing early-stage residents with supervisors who provide frequent mastery experiences and encouragement, monitoring well-being and burnout longitudinally rather than at a single point, and offering identity-focused mentoring in later stages when realistic confusion is most likely to take hold. The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Hospital of Zunyi Medical University, with participants’ privacy strictly protected and all records anonymized. It was supported by the Zunyi Medical University Innovation and Entrepreneurship Training Program, and the authors declare no competing interests.

For the global medical community, the study offers a technical framework with viral potential: the idea that residency is not one psychological experience but several, each with its own hazards and its own remedies. As health systems worldwide confront physician burnout, attrition, and a widening mental health gap among trainees, the message from this qualitative study is clear. If programs want residents to emerge as confident, well, and professionally grounded physicians, they must stop treating the training years as a single block and start reading them as a staged journey, intervening at each stage with the psychological support that stage demands. The 33 trainees who shared their experiences despite demanding clinical schedules made that message possible, and their openness may reshape how training programs think about the minds behind the white coats.

Subject of Research: Stage-specific psychological experiences of resident trainees in standardized residency training

Article Title: Stage-specific psychological experiences of resident trainees in standardized residency training: a qualitative study

Article References: Wang, B., Lu, M., Ji, J., Gao, F., Wang, H., Yuan, Y., & Tao, M. (2026). Stage-specific psychological experiences of resident trainees in standardized residency training: a qualitative study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15858-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15858-4

Keywords: residency training, physician burnout, mental health, medical education, qualitative research, professional identity, self-efficacy, subjective well-being, Stage-specific, psychological, experiences, resident