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Emotional Distress Among Physician Residents and Fellows: An Observational Study of Trainees Seeking Counseling Visits



Emotional distress, burnout, and depression occur frequently among graduate medical education (GME) trainees and may negatively affect patient care, education, and well-being. The authors aimed to characterize the causes and severity of distress among GME trainees seeking on-site counseling services at a large, multi-site, university-based training program in the USA.


The authors analyzed visits of all GME trainees seeking counseling from 2009 to 2012 and described trainee characteristics, level of distress, chief and secondary complaints, and initial visit outcomes.


GME trainees (n = 332; 14.1% of total population) attended 2017 counseling visits. Women comprised over half (60.7%) of the clients. Referrals originated from trainees themselves (79.8%), program leadership (16.6%), or partners (1.8%). Mean counselor-assessed distress level at intake was 4.1 (range 1–5). Mental health was the most frequent concern (46.1%), particularly depression (19.3%) or anxiety (11.5%). Other chief complaints included personal relationship (28.6%), career (21.7%), and physical health concerns (2.7%). Counselors referred nearly a quarter (22.7%) of trainees to additional services such as psychiatry, primary care provider, or career mentor. Most trainees (75.3%) returned for ≥1 follow-up counseling visits.


GME trainees seen in counseling report significant emotional distress from a broad range of sources. Further research should identify effective preventative and therapeutic interventions to reduce trainee emotional distress.

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The authors wish to thank Kenneth Cartwright for his invaluable assistance with data management.

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Correspondence to Anna Golob.

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Ethical Considerations

Our study protocol was reviewed by the University of Washington Institutional Review Board and determined to be exempt as it did not meet criteria for human subject research.


On behalf of all authors, the corresponding author states that there is no conflict of interest.

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The authors report no funding sources for this study.

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Golob, A., Beste, L.A., Stern, M. et al. Emotional Distress Among Physician Residents and Fellows: An Observational Study of Trainees Seeking Counseling Visits. Acad Psychiatry 42, 25–30 (2018).

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  • Graduate physician trainees
  • Depression
  • Wellness
  • Counseling