Supporting the Transition: New Obstetrics and Gynecology Resident Perspectives on Resources for Residency Preparation

ABSTRACT

Background

Numerous formal and informal resources exist to support the transition to residency. Little is known about how postgraduate year (PGY) 1 residents perceive and utilize these tools.

Objective

To explore PGY-1 obstetrics and gynecology (OB/GYN) residents’ perspectives on the utility and impact of structured and informal resources supporting the transition to residency.

Methods

We used a qualitative thematic analysis of in-depth interviews with PGY-1 OB/GYN residents using self-determination theory as a framework. In 2024, participants were recruited via email and social media from across the United States. Two residents performed virtual interviews. Three independent coders used inductive coding to analyze the data, then interpreted the patterns that emerged using self-determination theory as an interpretive framework.

Results

A total of 11 interviews were performed. Three themes were identified in residents’ experience that aligned with the core domains of self-determination theory: the heterogeneity of learning needs as new residents strive towards independence (autonomy), responsibilities for patient care serving as a powerful motivator for learning (competence), and the need for a supportive learning environment (belonging). Residents expressed diverse learning needs, and the abundance of tools often contributed to feelings of being overwhelmed.

Conclusions

Tailoring support strategies to align with learning goals may enhance the effectiveness of transition resources and promote early resident growth and well-being. Educators may help learners identify resources but also allow for learner autonomy in setting learning goals, focus on practical skills to develop competence in clinical duties, and create structures to support a culture of belonging.

Introduction

The transition from medical school to residency is one of the most challenging periods in a physician’s training.¹ First-year (postgraduate year [PGY] 1) residents must rapidly shift from supervised learning to assuming direct responsibility for patient care, often in high-stakes environments. The optimal way to support learners at the medical school to residency transition is not clear. Learners have described “bracing themselves” for the abrupt transition from student to physician with immense clinical responsibilities.¹ Recently, educators have developed a variety of different interventions.^2-10 An increasing number of medical schools have created transition-to-residency courses that vary in terms of content, length, and curricula.¹¹ Residency programs and specialties are investing in orientation programs and materials that differ based on the resources of each residency and specialty. Few studies have examined the effectiveness of these investments and resources, and most studies focus on learner perspectives on these resources.

In obstetrics and gynecology (OB/GYN), specialty-wide efforts have resulted in a wide variety of tools to support the transition. Understanding how PGY-1 residents utilize and perceive these resources can shed light on their evolving learning needs during this critical transition and provide a useful guide for future interns and their faculty mentors to navigate this critical period. This study aims to describe how PGY-1 OB/GYN residents engage with formal and informal educational resources during the transition to residency. We conceptualize the transition to residency as the early phase of PGY-1, when trainees adapt to new roles, responsibilities, and learning environments. Although this transition is most pronounced in the first several months, elements of this adjustment may extend throughout the intern year. Given that residents across specialties face similar challenges in this transition, these findings may have relevance beyond OB/GYN.

KEY POINTS

What Is Known

The beginning of residency is a period of transition, with minimal standardized resources to support new interns and limited understanding of how interns might utilize these resources.

What Is New

This qualitative study of new obstetrics and gynecology interns illuminates 3 themes that map to self- determination theory: the heterogeneity of learning needs as new residents strive towards independence (autonomy), responsibilities for patient care serving as a powerful motivator for learning (competence), and need for a supportive learning environment (belonging).

Bottom Line

Those wishing to support new residents through the transition to residency should consider how resources and support can be targeted to the needs of incoming interns.

Methods

Study Design

We conducted a qualitative exploratory thematic analysis to explore the lived experiences of PGY-1 OB/GYN residents during their transition from medical school to residency. We strove to capture the essence of residents’ perspectives and uncover the meanings they attribute to the resources and challenges encountered during this critical period. We used inductive coding to analyze the data. By combining this methodological and theoretical approach, we ensured that the study not only identified key resources but also contextualized their utility within the psychological needs and growth trajectories of early-stage residents.

Setting and Participants

We recruited PGY-1 OB/GYN residents through the OB/GYN program director email listserv and social media from January through May 2024 and offered $25 compensation to individuals for their time. Interested individuals completed an intake form (online supplementary data) with demographic information, including type of medical school, type of residency program, gender, and race/ethnicity. All individuals who completed the intake form were contacted via email and invited to participate based on participant availability. However, the research team monitored participant characteristics (eg, medical school background, program type) during recruitment to support diversity in perspectives.

Data Collection and Procedures

The research team developed an interview guide (online supplementary data) to assess the utility of specific tools used in the transition process, and 2 residents (N.C., O.A.) independently conducted the interviews. The research team consisted of 2 women OB/GYN residents (O.A., N.C.) and 3 OB/GYN faculty members, one man (Z.S.) and 2 women (H.K.M., A.F.W.), together representing 4 different academic medical centers. We had no prior relationships with participants.

Interviewers deidentified and uploaded transcripts created by the Zoom software into Dedoose software for coding. Transcripts were not returned to participants.

Data Analysis

Three researchers independently coded each transcript using inductive coding for thematic analysis. We created a stable codebook of 57 discrete codes which stabilized after 7 interviews (online supplementary data). Data collection and coding methods drew on techniques by Glaser and Strauss¹² and Williams and Moser.¹³ We performed axial coding to organize these codes into 8 categories. After inductive coding and category development, we identified alignment with the domains of self-determination theory (SDT), which was then used as a conceptual framework for thematic interpretation. SDT¹⁴ describes how intrinsic motivation requires the satisfaction of 3 psychological needs: autonomy, competence, and relatedness. We recognized thematic saturation after 9 interviews and analyzed 2 final interviews to confirm the interpretation.

Reflexivity and Trustworthiness

Considering the reflexivity of the research team, the interviewers were residents who shared career experiences similar to the participants, which might have facilitated rapport and deeper understanding, but also introduced bias in asking questions or interpretation. We minimized this effect by emphasizing the study’s independent nature to encourage participants to share critical perspectives without censorship. To mitigate bias, we developed the interview guide collaboratively and performed initial coding independently. The researchers’ roles as educators and clinicians shaped their interest in the subject but also risked framing the results based on preexisting assumptions. Bias was mitigated through team discussions to challenge and refine interpretations throughout the thematic analysis.

This study was reviewed and approved by the University of Michigan Institutional Review Board (Date: February 2024, HUM00246455).

Results

During the 4-month recruitment period, 54 individuals completed the intake form, and 11 residents were scheduled for interviews. Of the 11 individuals, 8 graduated from allopathic medical schools, 1 from osteopathic, and 2 from international medical schools. The residents were in a mix of residency programs, with 6 in university, 4 in community, and 1 in a combination university-community program. Interviews generally lasted for approximately 1 hour.

We grouped the resources and challenges that participating PGY-1 OB/GYN residents described into 3 themes that aligned with the domains described in SDT: the importance of autonomy in navigating heterogeneous learning needs, the drive for competence in the face of increased responsibility as new doctors, and the significance of finding their place within the health care team. We found that these themes predominated in resident reflections and reflect the delicate balance between overwhelming learning needs and a strong desire for growth and independence. Each theme is described in detail here, accompanied by illustrative quotes from the participants. Organized in this way, these themes offer insights into how educational interventions can better support residents during this pivotal time. The Table outlines the common challenges that residents identified and how these insights can be used to direct educational interventions.

Table.

Common Issues Identified by PGY-1 OB/GYN Residents and Insights to Support the Residency Transition

Psychological Need Outlined in Self-Determination Theory	Common Issues Identified by PGY-1 Residents	Strategies to Support the Transition to Residency
Autonomy	Overwhelming number of resources	Curate a structured, prioritized list of high-yield tools (eg, OBG Project, CREOGs Over Coffee) to prevent overload.
	Heterogeneous learning needs	Offer customizable, self-directed learning plans with options for hands-on, practical, and asynchronous resources.
Competence	Limited preparation for practical skills	Develop interactive orientation programs and residency boot camps focusing on clinical tasks like suturing, ultrasound, and patient positioning.
	Uncertainty about setting goals	Provide goal-setting frameworks and coaching to guide interns in identifying and pursuing their learning objectives.
	Difficulty navigating residency systems	Include training on hospital-specific tools (eg, EMR systems, Epic SmartPhrases) during orientation or early residency.
Relatedness	Lack of psychological safety	Foster a culture of support through peer mentoring, near-peer teaching, and facilitated discussions normalizing struggles.
	Feelings of isolation or imposter syndrome	Integrate peer support groups or formal mentorship programs to help residents build relationships and combat self-doubt.
	Stress from balancing personal and professional life	Offer wellness resources, time management workshops, and access to counseling services to reduce anxiety and support adaptation.

Abbreviations: PGY, postgraduate year; OB/GYN, obstetrics and gynecology; CREOG, Council on Resident Education in Obstetrics and Gynecology; EMR, electronic medical record.

Theme 1—Autonomy: Residents Experience Individual and Varied Learning Needs as They Strive Towards Independence

Residents identified heterogeneous learning needs and felt overwhelmed by the sheer number of possible resources to use. We found that there was no single approach to learning that worked for everyone. As Resident 6 noted, “Everyone’s going to have a different transition.” This reflects the heterogeneous learning needs that residents experience as they strive toward independence. Self-directed learning emerged as a shared value, with many residents reflecting on the need to optimize their individual approach. Resident 2 explained, “In residency you’re really forced to prioritize your learning style… you have limited time and too many resources, and you have to figure out how to prioritize what to use.” This challenge of figuring out personal learning preferences within time constraints was echoed throughout the interviews.

Residents expressed varying learning needs, from learning the clinical steps needed to prepare to scrub into cases in the operating room (OR) to the administrative activities that accompanied the work, such as documenting cases. Resident 3 highlighted the wide range of practical skills required, such as prepping patients for surgery and positioning in the OR, which often weren’t intuitive or formally taught. “A lot of that stuff is not very intuitive… My program never taught us how to log cases.” In addition to learning to be effective clinically and navigate administrative requirements, residents spoke about building their knowledge base, often looking to electronic resources like the OBG Project website⁹ and the CREOGs (Council on Resident Education in Obstetrics and Gynecology) Over Coffee podcast¹⁵ for quick, helpful learning tips. Alongside the magnitude of learning tasks, time pressures from long work hours forced residents to focus on smaller, manageable pieces of learning. Resident 11 pointed out the difficulty of creating a structured learning plan independently, emphasizing how resources, like the #OBGYN Intern Challenge that provided a structured pre-residency curriculum via social media,¹⁶ made it “much easier to keep up with.” While many residents signed on to learning plans described by others, they also frequently appreciated that their knowledge-building was individualized and was more effective when focused on the particular challenges that they encountered through the course of their work.

In addition to learning, residents were also preoccupied with managing stress and adapting to the new demands of residency life. As Resident 9 reflected, “You just don’t really know what you’re getting yourself into, and I don’t think there’s really any great way to prepare for it.” The overwhelming combination of work hours, moving to new places, and managing personal life added to the challenge of learning, often hindering the retention of specific knowledge over the long term. Despite this, residents aspired to autonomy in their learning, but many, including Resident 9, admitted to feeling underprepared: “I don’t feel like I was prepared, but I don’t know what would have helped me.” Although residents valued scaffolding in the form of curated resources or goal-setting support, they describe wide variations in learning needs and motivation, making a one-size-fits-all learning plan challenging.

Theme 2—Competence: Responsibility for Patient Care Powerfully Motivates Learning Through the Residency Transition

Residents were motivated to develop competence to feel deserving of the responsibility for patient care. Residents worried about limited preparation for practical skills and difficulty navigating new systems, voicing uncertainty about setting goals in the unfamiliar learning context. Many residents described this shift as an abrupt transformation in their professional identity. As Resident 2 put it, there is “a separation in your identity as a medical student and as a resident.” Resident 5 echoed this sentiment, reflecting, “Overnight you’re done being a student. You have this doctor title, except you don’t know how to be a doctor just yet.” This “giant shift in your responsibilities” (Resident 6) drove PGY-1 residents to desire the development of clinical savvy quickly to function as physicians. The fear of being unprepared on day one was a common motivator for self-directed learning. Resident 8 explained, “There’s just some fear of being day one, and being unprepared, or feeling like you’re on your own…I was very scared about… OB emergencies and taking care of OB patients and clinic.” This apprehension about having responsibility for patients drove many incoming residents to focus on practical, hands-on patient care skills.

Residents spoke about the importance of clinically relevant skills like suturing, patient positioning, and ultrasound, which were crucial for early clinical care. Hands-on learning was seen as indispensable. Resident 3 remarked, “It’s not like you can really prepare for that. I think once you’re a resident, you’ll have to do it, so you just get used to it.” However, some residents felt that more hands-on exposure before residency would have better prepared them for the steep learning curve. Resident 11 suggested that “more hands-on or active learning rather than just somebody throwing up lecture slides” would help PGY-1 residents apply knowledge more effectively. Many residents also highlighted the value of just-in-time learning. Resident 6 noted, “It was so much learning on the ground, [such as] how do I set up this hysterectomy,” while Resident 7 wished for more orientation before residency on practical demonstrations, as “the first couple weeks were so busy.”

In addition to technical skills, residents faced challenges in balancing their learning needs with the responsibility of navigating complex systems, such as the electronic medical record (EMR). Several mentioned the importance of learning how to use Epic SmartPhrases efficiently during orientation, as this knowledge would help streamline patient care. Furthermore, managing relationships within the health care team posed another challenge. As Resident 3 described, “You’re a doctor, but you’re kind of in the middle of a conflict between the seniors and the nurses and patients,” requiring residents to adapt their communication styles quickly making it a “hard transition.” Learning resources have the capability of helping prepare learners for their patient care roles but can also hinder learning if it feels too overwhelming. Despite these challenges, the responsibility for patient care remained a powerful motivator, driving PGY-1 residents to desire resources to overcome these obstacles and grow into capable, autonomous physicians.

Theme 3—Relatedness: Residents Are Motivated to Belong on the Team and Find Their Place in the Health Care System

Residents experience feelings of isolation and imposter syndrome in their new roles and stress from balancing personal and professional life. They expressed the importance of psychological safety in their new communities of work and learning. They describe the transition to being part of the team as not only learning the residency culture but also understanding how to function within a team, how to ask for help, and how to build interprofessional relationships. They spoke about the importance of a safe learning environment, where residents feel comfortable making mistakes without fear of judgment. As Resident 2 explained, a safe learning environment is one “where it’s ok to make mistakes and not feel like it says something about you as a person.” This sense of psychological safety is crucial for fostering growth, particularly during the challenging transition from student to resident.

Peer relationships play an especially important role in this adjustment. Resident 7 described the value of a supportive learning environment in sustaining them through the early months of residency: “I could see if people were mean to me [during my first couple of blocks] …I would have crumbled. I would not have been able to emotionally sustain the onslaught of new information and the scariness of being like, ‘Oh, I’m the doctor now,’” which is why this resident said, “I run everything past a chief or an attending.” However, the pressure of being responsible for patient care can be overwhelming, especially when PGY-1 residents are expected to make decisions in the absence of more experienced team members. New learners know that they will make mistakes, but as this resident said, if “I didn’t have a supportive learning environment, it would absolutely have crushed me.”

Near-peer senior residents often emerge as the most effective teachers and role models during this transition, helping PGY-1 residents gain confidence and find their place on the team. However, many residents struggle with imposter syndrome, comparing themselves to others who seem more capable. Resident 1 voiced this insecurity, wondering, “Am I struggling as much as the other interns? I feel like I’m struggling more than other people, and I don’t know why.” Normalizing these feelings of inadequacy helps residents tolerate the stress. Resident 7 recalled being reassured by the expectation that “everyone goes through it”, even if “it’s going to be slapping you in the face a little bit for the first few weeks” and Resident 6 echoed, “Everyone does it, and everyone gets through it.”

Residents rarely volunteered thoughts on formal faculty coaching or mentoring systems. When asked about these experiences, they were viewed positively but rarely present during the initial stages of establishing a sense of belonging in the program. Resident 2 described working with their coach as “helpful in a personal development way, to keep developing as a person outside of being a resident, to keep holding myself accountable to the things that I want to do that make me a whole person, will ultimately make me a better physician.” But often these types of encounters with faculty for formal goal setting were viewed as separate from the adjustment in the transition, which was viewed from a more immediate, short-term perspective focused on meeting the demands of the day and building relationships with their clinical teams.

Discussion

First-year OB/GYN residents reflecting on their transition to residency describe a process that is overwhelming, time-consuming, and stressful. Their reflections highlight the relevance of 3 intersecting domains of SDT: autonomy, competence, and relatedness to early learning and professional development of doctors. These data demonstrate the tension between the desire for independence and the constraints of training, revealing how autonomy in residency is inherently bounded yet still essential to motivation and growth. While these insights come from OB/GYN residents, the developmental challenges of constrained autonomy, evolving competence, and the need for psychological safety are common to all specialties.

We selected SDT to frame the findings because its focus on motivation and psychological needs is useful to the questions facing learners during the residency transition. SDT has been used to guide medical education to harness motivation for greater learning and well-being.^17,18 To provide support without undermining growing independence, curating high-yield resources can be viewed as scaffolding rather than prescriptive guidance. Creating programs that allow hands-on training underscore competence and readiness to care for patients at the bedside. Fostering relatedness through supportive team cultures allows for all 3 of the needs described by SDT as essential to sustain intrinsic motivation. These findings align with other qualitative studies of transitions in residency, which similarly depict the shift to supervised practice as both formative and destabilizing. Scholars argue that the basic needs of safety and belonging must be met before higher-order professional growth can occur.¹⁹

We suggest ways that residents can best learn to use their scarce resources of time and attention, outlined in the Table. Orientation programs and boot camps can prioritize just-in-time resources, practical technical skills training, and use of electronic health systems.

Socialization efforts that help residents feel connected to their peers and integrated into the team contribute to a safer learning environment. While residents need to identify unique learning needs, normalizing general structures and building community through small-group workshops, like the CREOG Readiness for Residency curriculum, can address many of the needs of this transition.^20,21 Since it has been well established that learners from backgrounds underrepresented in medicine face additional challenges and do not always get the mentorship and learning support they need during medical school, residency programs can try to level the playing field by providing the same high-yield resources for all incoming residents.^22,23

This study has several limitations. The residents volunteering to engage with the transition-to-residency preparation may have had smoother or more disruptive transitions to residency and are not necessarily transferable to the experiences of all residents. Additionally, the interviews conducted by fellow residents, while fostering rapport, may have influenced responses due to perceived peer expectations. Finally, the reliance on retrospective self-reporting may be impacted by recall bias, as residents reflected on past experiences rather than reporting in real-time. Future research should examine how structured, developmentally tailored transition interventions such as coaching and other learning supports can be implemented and evaluated across training programs to enhance early resident development and well-being.

Conclusions

Using SDT as an interpretive framework, we discovered a wide variety of learning needs and resources used by PGY-1 OB/GYN residents as they navigated the pursuit of autonomy, competence, and belonging.

Author Notes

Funding: This work is supported by the American Medical Association’s Reimagining Residency Grant “Right Resident, Right Program, Ready Day One” awarded to the Association of Professors of Obstetrics and Gynecology.

Conflict of interest: The authors declare they have no competing interests.

Disclosure: AI was not used in writing this article.

This work was previously presented at the CREOG & APGO Annual Meeting, February 26-March 1, 2025, Philadelphia, Pennsylvania, USA.

Editor’s Note

The online supplementary data contains the intake form and interview guide used in the study and axial coding for issues PGY-1 OB/GYN residents consider for supporting the transition to residency.