Table 7.

Categories and issues for the theme, “Factors that decrease medical resident quality of life”

Category	Issues	Examples
Human resources	Teachers Managers	“The problem is more that it seems they don’t add anything. Most of the time you’d be better off solving the cases on your own than looking for supervision. But it ends up affecting you anyway, because at least you leave there feeling that “ah, who knows, I could have done something better, or done something different.” “We don’t feel the partnership between this preceptor group and the residents.”
Moral abuse	Medical assistants/ Multidisciplinary team	“Sometimes we’re treated badly by the nursing staff, and the team.” “Likewise assistants, there are some good assistants, but jeez, some assistants just humiliate you, even though they don’t know what you’ve been through that day.”
Demands	Personal, institutional	“I demand a certain level of perseverance from myself, I demand too much of myself sometimes.” “These here are the best students from the best colleges in Brazil – this already creates a certain expectation that, maybe if you didn’t have any, you got it right away. And it’s very annoying, you’re always being treated like the best of the best, we see this a lot in our residency.”
Financial resources	Financial dependence	“This is stressing me out right now, because before I had money that I saved the whole year that I was in the Navy. And then last year, I chose not to work and I’ve spent all the money I had. And now it's running out, and I'm having to go back to shiftwork, and so I’m trying to get back into the schedules.”
Time	Difficulty in time management	“We still don’t know how to manage our own time, but we’ll learn to do it during our lives. Nowadays we still don’t know how to say “no,” we’re beginning to figure it out, but we still don’t know how to say “no.” I guess we’ll learn over time.”
Reduced freedom	Relationship/leisure Required activities	“We give up things, I've given up certain relationships, I think people, I think especially for women, it’s very hard dating someone who isn’t a doctor.” “And so, I’ve felt a little of this, not being able to pay attention to my relatives, because I had to attend to other people, other sick people. So that, I suffer from this a little.”
Distant relationships	Residency colleagues/ Family/ Loneliness	“In the clinical residency at the hospital, people are very much in it for themselves only.” “So, you come home at night and have no one to share with, I miss that a bit.”
Sleep	Night shifts Lack of structure	“What annoys me is night shifts, it’s not sleeping at home.” “For me, the room is bad, it's completely filthy, and I’m really allergic.”
Lack of attention to health	Eating	"Having a short lunch hour annoys me as well, worse yet, if I can’t have lunch. It’s disrespectful not to have lunch break, it’s just not on.”
Work overload	Number of patients Workload Multiple tasks Multidisciplinary team inefficiency	“I also think volume, work overload really lowers the quality of life. Because I feel like I’m not being the best doctor for that type of patient.” “All the time I need to keep returning to places to check whether what I’d requested had been done.”
Changes of environment	Changes of city Loss of previous infrastructure Changes in responsibility	“Here people are colder. So, I suffered. I suffered. I called my mom. And I cried.” “So the change for me from student to resident what was most, the most difficult part was the responsibility. For me, the hardest, the most difficult sometimes was dealing with powerlessness or people’s deaths, however much we do everything we possibly can, a lot of people die.”
Professional actuation	Acting without technical knowledge	“And so, that consumed me a lot; I had to talk about palliative care, without ever having seen palliative care.”
Difficulty dealing with feelings	Attachment to the patient Insecurity Guilt	“I get very attached, I have this problem. I get very attached not only to the family, but I get very attached to the patients. Then I suffer so much with each loss.” “Help me? I'm suffering a bit this year with that. Because I’m not sure what I want to do.” “I went to a wedding and it was like a week later. And we commented – jeez, but it was so good, but I felt so guilty, stopping for the weekend on the eve of the test, being able to go and do something other than the residency.”