New practices bring new challenges: the psychological experiences and needs of anesthesiologists transitioning to work in the AICU

New practices bring new challenges: the psychological experiences and needs of anesthesiologists transitioning to work in the AICU | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article New practices bring new challenges: the psychological experiences and needs of anesthesiologists transitioning to work in the AICU Junyang Chu, Lin Gao, Lei Xie, Hanqi Zhang, Lei Wang, Yixuan Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6864401/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background The global population aging continues to accelerate, also posing significant challenges to Chinese society. The growing geriatric population has substantially increased demand for critical care beds, compelling governmental initiatives to expand specialized Intensive Care Unit (ICU) capacity in addressing this deficit. The establishment of an Anesthesia Intensive Care Unit (AICU) in a comprehensive hospital has effectively alleviated the pressure on the general ICU. However, anesthesiologists have historically lacked sustained experience in prolonged critical care management, as their work was mostly limited to intraoperative and postoperative care management. The change in scope, target, content, and mode of work may have an impact on their physical and mental well-being. This qualitative study employs phenomenological interviewing with AICU anesthesiologists to systematically explore their lived clinical experiences and needs. The findings will provide references for managers to develop appropriate intervention measures. Methods This phenomenological qualitative study was conducted at Jiaxing University Affiliated Hospital, a tertiary academic medical center in Zhejiang Province, China. We conducted semi-structured interviews with 15 anesthesiologists working in the AICU from January 27, 2025, to March 30, 2025. Participants were recruited through purposive sampling. Interviews lasted 45–60 minutes, with data saturation determined when no new information emerged. Interview data were analyzed using Colaizzi's seven-step phenomenological method. Results Four core themes with twelve subthemes emerged from the analysis: (1) Negative psychological experiences, including sub-themes of "Challenges from cognitive and skill delays", "clinical anxiety during patient deterioration management", "stress from changing duties", and "impacts of research, administrative, and family roles";(2) Positive psychological experiences, including sub-themes of " sense of duty for AICU development ", "increased sense of professional accomplishment", "enhanced professional capabilities", and "strengthened non-technical skills"༛(3) Diversified support facilitates role adaptation, including sub-themes of "self-support", " team support reinforcement" ,and " family support engagement"(4) Needs and aspirations, including sub-themes of "improved training", "higher remuneration", and "streamlined management". Conclusion The transition of anesthesiologists to roles in the AICU is a complex and demanding process. This highlights the importance of hospital and departmental management in addressing the psychological challenges and needs faced by healthcare professionals during this shift. Efforts should be made to strengthen training, refine management systems, ensure equitable compensation, and foster a sense of professional identity and belonging. Such measures are essential for improving staff well-being and, ultimately, enhancing the quality of care. Anesthesiologist AICU Psychological experiences Needs Background Global population ageing continues to accelerate, posing substantial challenges across societal dimensions. This demographic shift exerts particularly acute pressure on healthcare systems. China, hosting 20% of the global geriatric population [ 1 , 2 ], faces intensified healthcare challenges. This demographic shift has precipitated a marked rise in perioperative critical care demands, with current general ICU capacity proving inadequate. The lessons learned from COVID-19 have encouraged governments worldwide to prioritize the expansion of reserves for critical care beds [ 3 , 4 ]. In recent years, the Chinese government has been encouraging the construction of more specialized ICUs to address the shortage of critical care beds. In history, the development of anesthesiology and critical care medicine are closely intertwined. In 1959, Dr. Max Harry Weil officially established the first ICU in the United States at the University of Southern California Medical Center, which was then managed by the Department of Anesthesiology [ 5 ]. In the United States, anesthesiologists who wish to practice critical care medicine must complete an additional 1-year fellowship in critical care medicine and pass the certification exam administered by the American Board of Anesthesiology in order to obtain the necessary qualifications [ 6 ]. Over recent decades, China has experienced rapid surgical volume growth alongside a persistent anesthesiologist deficit [ 7 , 8 ]. To prioritize surgical services, ICU in most hospitals—except for a few—are no longer managed by anesthesiologists. Prolonged disengagement from critical care practice has led to attrition of relevant clinical competencies among anesthesiologists. Nevertheless, anesthesiology and intensive care medicine retain fundamental synergies in both theoretical frameworks and technical applications. Some key techniques mastered by anesthesiologists, such as regional nerve block techniques, are essential foundations for achieving multimodal pain management and accelerated postoperative recovery [ 9 – 11 ]. In addition, critically ill patients may benefit from a period of continued monitoring and treatment by an anaesthesiologist following surgery to maintain continuity of care. In this context, in December 2019, the National Health Commission issued Document No. 884, which explicitly recommended the establishment of Anesthesia Intensive Care Unit (AICU) in qualified hospitals. The aim was to ensure the safety of post-anesthesia patients and improve medical quality. AICU is intended to provide focused care for elderly patients, those with severe preoperative or intraoperative complications, and patients requiring vital organ system support and intensive management after major surgeries [ 12 ]. However, in the past, anaesthesiologists' work was mostly confined to intraoperative and short postoperative periods, and they lacked experience in managing critically ill patients for long periods of time. The change in scope, target, content, and mode of work could potentially have a serious impact on their physical and mental well-being. The purpose of this research is to interview anesthesiologists entering the AICU extensively, to gain insights into their work experiences and requirements, with the goal of providing recommendations for managers to implement corresponding intervention measures. Methods Study design This study utilized the phenomenological research method in qualitative research, employing one-on-one semi-structured in-depth interviews to collect data, as it allows for exploring and gaining a deeper understanding of participants' genuine psychological experiences and needs. Sampling and recruitment Semi-structured interviews with 15 anaesthesiologists entering AICU work at Jiaxing University Hospital from 27 January 2025 to 30 March 2025 were conducted using purposive sampling. Inclusion criteria: (1) Respondents were certified to practice and had at least 2 years of experience in anaesthesiology; (2) Respondents were first-time transfers to work in the AICU and lasted more than 3 months; (3) Willing to participate in the study and agree to share their psychological experiences. The exclusion criteria were as follows: (1) Interns and trainees; (2) Individuals who refuse to sign the informed consent form; (3) Those who cannot engage in normal communication or have a mental illness; (4) Those who drop out midway. Affiliated Hospital of Jiaxing University, a comprehensive public hospital, has 1700 beds and performs up to 40,000 surgeries annually. Participants characteristics were provided in Table 1 . Data collection Three interviewers conducted semi-structured in-depth interviews, all of whom had received training in qualitative research and psychological counseling, and were proficient in interview techniques. The interview time for each respondent will range from 45 to 60 minutes. Based on the research objectives, a systematic literature review was conducted, followed by in-depth consultations with clinical experts to develop a preliminary interview protocol. Cognitive pre-testing was subsequently performed with three purposively sampled anesthesiologists meeting the inclusion criteria to refine the interview framework. Following the pre-interview results, the interview outline was adjusted to produce the official interview guide (provided in Table 2 ).Choose a quiet, comfortable, and private lounge or meeting room for the interview location. The interviewer prepares the interview location and relevant materials in advance, adjusts the lighting and temperature to create a safe and relaxing environment, making the interviewee feel comfortable. Following written informed consent acquisition, semi-structured interviews were conducted employing active listening techniques with deliberate pauses. Non-directive probes and participant verification were strategically deployed to minimize interviewer influence while ensuring audiotaped data integrity through full audio recording. Data saturation is reached when no new information can be collected. Ethical considerations This study was approved by the Ethics Committee of Jiaxing University Affiliated Hospital (2024-LY-740) and registered in the Chinese Clinical Trial Registry (ChiCTR2500096590,ཛ2025-01-26 ཝ) .All procedures were performed in accordance with the Declaration of Helsinki. This research received written consent from the participants, provided a detailed explanation of the research purpose, methods, significance, and privacy protection measures to the interviewees before the interviews, and obtained signed informed consent. Data analysis and rigo After each interview, the audio recording will be transcribed into text within 24 hours and manually calibrated by two researchers. Import the interview data into Nvivo software and analyze the data based on Colaizzi's 7-step analysis method [ 13 ].The steps are as follows: (1) Read through all the interview data carefully to form an overall impression;(2) Analyzing important statements from an application professional perspective is significant༛(3) Encode meaningful recurring viewpoints.༛(4) Group similar topics and descriptions together༛(5) Giving a thorough description༛(6) Distinguishing similar perspectives; (7) Should there be any doubts, verify with the respondent. Table 1 Participants characteristics Participant Gender Education Professional Title Marital status Participant 1 Female Master's Degree Associate Chief Physician Married Participant 2 Male Master's Degree Associate Chief Physician Married Participant 3 Female Master's Degree Attending Physician Married Participant 4 Female Master's Degree Attending Physician Married Participant 5 Female Master's Degree Attending Physician Married Participant 6 Male Master's Degree Attending Physician Married Participant 7 Male Master's Degree Attending Physician Married Participant 8 Male Master's Degree Attending Physician Married Participant 9 Female Master's Degree Resident Physician Single Participant 10 Female Master's Degree Resident Physician Single Participant 11 Female Master's Degree Resident Physician Single Participant 12 Female Master's Degree Resident Physician Single Participant 13 Male Bachelor's Degree Resident Physician Single Participant 14 Female Bachelor's Degree Resident Physician Single Participant 15 Male Bachelor's Degree Resident Physician Single Table 2 Interview guide Question 1 What changes have you experienced in your role and responsibilities after transitioning from the Department of Anesthesiology to the AICU? How has this transition affected you personally and professionally? Question 2 What challenges did you encounter after transitioning to work in the AICU ? How did you address or overcome them? Prompt : Medical equipment? Therapeutic drugs? Invasive procedures? Auxiliary examinations༟ Question 3 How do your emotions respond to changes in a patient's condition or to patient death? Question 4 What strategies do you use to manage work pressure and negative emotions? Question 5 What do you think are the current challenges in AICU operations? What recommendations would you make to AICU managers? Question 6 How would you describe your sense of professional accomplishment and belonging while working in the AICU? Results The thematic analysis was concluded with 12 sub-themes under four themes. The four themes are negative psychological experiences, positive psychological experiences, multidimensional support systems enhanced role adjustment, and needs and aspirations. Negative psychological experiences This topic describes the negative psychology that anesthesiologists experience when transitioning to work in the AICU due to various issues. Four sub-themes emerged: "challenges from cognitive and skill delays", "clinical anxiety during patient deterioration management", "stress from changing duties", and "impacts of research, administrative, and family roles". Challenges from cognitive and skill delays The majority of anesthesiologists reported a clinically significant discrepancy between their perioperative management expertise (e.g, hemodynamic optimization, anesthetic protocols) and the multidimensional competencies required in AICU. This competence gap—characterized by deficits in critical care diagnostics, therapeutic decision-making, and emergency response experience—manifested as diminished clinical confidence, maladaptive avoidance behaviors, and professional disengagement within the AICU setting. “We managed a case of abdominal compartment syndrome wherein multimodal interventions to reduce intra-abdominal pressure yielded suboptimal therapeutic response. We doubted our ability to handle such a complex condition.” (Participant 2). “At first, I was unfamiliar with pharmacotherapeutic management of anticoagulants, antimicrobials, and nutritional support protocols , coupled with technical inefficiency in essential critical care procedures including thoracentesis, open tracheostomy, and therapeutic bronchoscopy. When faced with sudden situations, I feel very flustered and under a lot of pressure, often needing to seek help from attending intensivists and specialist doctors." (Participant 7). “I need to keep learning constantly to meet the demands of my job, but the learning process does bring a lot of pressure and anxiety, especially when I have to grasp a large amount of knowledge in a short period of time, I feel overwhelmed." (Participant 10). “In contrast to surgical anesthesia, AICU requires extensive documentation work with strict quality standards. Anesthesiologists frequently lack adequate training, leading to potential case deficiencies if not careful." (Participant 3). Clinical anxiety during patient deterioration management Most patients admitted to the AICU are elderly or critically ill postoperative patients, with significant fluctuations in their condition. Doctors need to constantly monitor the patients they are responsible for, whether during working hours or off-duty. Interviewees expressed feeling frustrated and anxious when faced with deteriorating conditions or even death of patients in the early stages of their work. “Compared to the operating room, patients in the AICU generally have poorer conditions and the treatment effects are not as immediate as in surgery. Sometimes, using multiple treatment methods does not lead to improvement, which brings me a significant emotional impact and sense of defeat.” (Participant 11). “I felt extremely distressed when a senior lady was discharged from the AICU due to her family giving up on treatment for her severe illness. It led me to experience depression and fear about being responsible for treating high-risk patients.” (Participant 12). “Sometimes, patients' conditions can be extremely serious. Even after finishing work, I still fear that they may face a sudden life-threatening situation at night, impacting my sleep quality significantly.” (Participant 13). Stress from changing dutie s An anesthesiologist in the operating room typically manages a patient's surgical anesthesia and recovery period monitoring independently, with the time spent on managing a single patient usually not being very extensive. However, transitioning to working in the AICU requires participating in longer and more comprehensive patient monitoring and treatment, causing some interviewees to have difficulty adapting to this change in role and responsibilities in the short term. “I used to only manage one patient at a time in the operating room, but now I have to juggle multiple patients with more complex and variable conditions, often feeling overwhelmed and under immense psychological pressure." (Participant 1). “Despite having 9 years of work experience, my lack of experience in postoperative patient care and doctor-patient communication from working solely in anesthesia made me feel a lot of pressure at first.” (Participant 5). Impacts of research, administrative, and family roles Due to hospital management and incentive policies, doctors are required to not only focus on clinical work, but also to complete corresponding research and management tasks at times. The interviewees mentioned that in addition to coping with work stress, they also have to manage impacts from research, administration, and family. "The rotating shift schedule required in my role severely constrains my availability for childcare responsibilities, creating significant challenges in reconciling professional duties with family commitments." (Participant 2). “Promotion in professional title requires research achievements, but due to limited experience in critical care medicine, it is difficult to quickly initiate clinical research, which may hinder personal career development." (Participant 3). “As the primary care physician, I am always on call to return to work if a patient's condition deteriorates, even during my time off, which has made it difficult for me and my family to adjust.” (Participant 5). Positive psychological experiences The theme reveals that as work in the AICU progresses, anaesthetists begin to have positive psychological experiences, mainly in terms of a sense of purpose, professional fulfilment and technical/non-technical competence. Four sub-themes emerged: " sense of duty for AICU development", "increased sense of professional accomplishment", "enhanced professional capabilities", and "strengthened non-technical skills". Sense of duty for AICU development As healthcare professionals become more proficient in their work, they increasingly realize the important role that AICU plays in improving the quality and safety of perioperative care, and they take pride in contributing to the development of this emerging subspecialty. "Building an AICU represents a significant step in the advancement of anesthesiology towards perioperative medicine. Anesthesiologists are transitioning from working behind the scenes to taking on more visible and proactive roles. Despite the various challenges involved, I feel deeply honored and proud to be part of this important initiative." (Participant 2). "As I gradually recognized the significance of the AICU, I found my role extending beyond the boundaries of the operating room toward a more holistic scope. I am committed to improving my own competencies and contributing to the growth of this emerging sub-specialty." (Participant 7). "I took part in the creation of the AICU, and witnessing its ongoing growth and improvement has been deeply rewarding. The recognition of these efforts continues to motivate me." (Participant 14). Increased sense of professional accomplishment The interviewees shared that they felt genuinely proud when the patients they cared for were safely returned to the ward. The gratitude shown by patients and their families made their work feel even more meaningful. "It is truly rewarding to see patients improve after treatment. This sense of accomplishment encourages me to approach my work with greater positivity and motivation." (Participant 1). "Whenever I overcome a challenge, manage a complicated case, or help a critically ill patient recover, I feel an immense sense of accomplishment—one that feels even more fulfilling than completing anesthesia for a surgery." (Participant 10). "In the past, as an anesthesiologist, I rarely had the chance to speak with patients and their families, and they often knew little about what we do. Now, we talk more often—I see their smiles, hear their appreciation, and it fills me with pride and a deep sense of satisfaction." (Participant 15). Enhanced professional capabilities Compared to previous experience in surgical anesthesia, working in the AICU has not only enhanced anesthesiologists' theoretical knowledge and technical skills but also cultivated their critical care diagnostic and therapeutic thinking and abilities. "Previously, my anesthesia work was mainly centered on the intraoperative period, paying less attention to patient prognosis and rehabilitation. After gaining experience in the AICU, I now have a deeper insight into perioperative management, allowing me to consider patients more holistically and over the long term. I feel confident that my future work will be of better quality." (Participant 8). "I didn’t want my patients to get worse while under my care, so I had to put a lot of effort into learning critical care knowledge and skills that I hadn’t urgently needed before. Now, I can see that I’ve grown a great deal since I first began." (Participant 13). Strengthened non-technical skills "Almost all respondents reported having limited contact with patients and their families during their work in surgical anesthesia. In contrast, working in the AICU demands stronger communication skills with patients and families, as well as enhanced teamwork abilities. Consequently, the experience in the AICU has significantly improved many non-technical skills among healthcare professionals." "Previously, anesthesia in the operating room was mainly carried out by individuals, sometimes with help from assistants. In the AICU, however, assessing patients and developing treatment plans involve senior physician rounds, departmental or hospital-wide complex case discussions, and multidisciplinary consultations, all of which foster stronger team communication and collaboration." (Participant 2). "An elderly man was very nervous after surgery. After I comforted him, he gradually calmed down and thanked me. This experience made me realize that I can do better in providing humanistic care, which will be my focus moving forward." (Participant 13). "Previously, I had limited interaction with patients’ families in the operating room. Now, I regularly have to discuss treatment, care, rehabilitation, diet, and costs with them in detail, which has significantly improved my communication skills." (Participant 14). Diversified support facilitates role adaptation A social support system refers to the various forms of assistance an individual can receive from people around them, including practical help and emotional support from family and friends, as well as experiential advice from colleagues. The interviewee noted that having sufficient support helps them maintain a more positive mindset. Three sub-themes emerged: "self-support", " team support reinforcement" ,and " family support engagement". Self-support The interviewee indicated that when entering a relatively unfamiliar field or environment, they often experience various negative emotions, which they alleviate through emotional regulation, self-reflection, and continuous learning. “When I first joined the AICU, there were many unknowns that naturally made me anxious. To cope, I focused on calming down and studying carefully, filling my knowledge and skill gaps in my own way. As I learned more, my anxiety noticeably decreased.” (Participant 6). "Frequent night shifts, along with many patients in critical condition and the need to be constantly prepared for emergencies, put a lot of psychological pressure on me. This often leads to several days of poor sleep and feeling very exhausted. So, I try to spend my free time doing things I enjoy to relax and recharge." (Participant 7). "I relieve physical fatigue by resting. To cope with mental stress, I mainly use self-relaxation techniques to manage my worries." (Participant 10). “I will relieve work pressure through traveling, exercising, socializing with friends, and singing.” (Participant 11). Team support reinforcement Many interviewees emphasized that in the high-pressure environment of the AICU, stable team support is particularly important. This support provides healthcare workers with a sense of belonging and security, which effectively alleviates occupational stress. “Sometimes the senior doctor gives me lots of advice, and if I don’t do my job well, they even step in to help share the responsibility.” (Participant 8). “When I first got here, I felt a lot of pressure and was in a low mood. Talking, venting, joking, and supporting each other with my colleagues helped me relieve stress and get back into a better mindset for work.” (Participant 10). Family support engagement The presence of family is indispensable. Interviewees noted that family members provide not only emotional support but also assist in balancing work and life, and their supportive attitudes have a direct influence on the interviewees. “One time, a postoperative patient suddenly had an acute stroke, and I had to rush to the hospital, missing my son’s birthday party. But my family didn’t blame me; they comforted me, and my son even saved his birthday cake for me. It’s their support that lets me work without any worries.” (Participant 2). “Sometimes when things get tough, I talk to my family, and they always comfort me. Without their support, I don’t think I could have gotten through the challenges at work.” (Participant 15). Needs and aspirations This theme reflects the respondents’ multifaceted needs and expectations for improvement concerning the challenges encountered in AICU work, with core issues centering on insufficient individual competencies, inadequate performance-based compensation, and deficiencies in departmental management. Three sub-themes emerged: "improved training", "higher remuneration", and "streamlined management". Improved training Respondents reported a lack of systematic training in critical care diagnostic and therapeutic thinking and skills prior to transferring to the AICU. In addition, the post-transfer learning model was relatively limited in approach, which contributed to the emergence of various issues during clinical practice. “Before I transferred to the AICU, I hadn’t gone through a structured training in critical care. I mostly learned by doing and through guidance from senior doctors. I think if I had received proper training in critical care diagnosis and treatment beforehand, I wouldn’t have felt so anxious at the start.” (Participant 7). “I’m a junior doctor, and the senior physician I follow isn’t very good at teaching and often just criticizes me. I think it would really help if those of us in training were matched with teachers who are more experienced and enthusiastic about teaching — that way, I could probably improve much faster.” (Participant 9). Higher remuneration As a newly established department, the AICU demands considerable time and dedication from its staff for its development. However, the interviewees reported a perceived imbalance between their workload and compensation, expressing a strong desire for improved remuneration. "Work in the AICU is much more demanding than in surgical anesthesia, yet the income is lower-possibly due to differences in evaluation criteria. I believe that performance-based compensation should take multiple factors into account and be adjusted more equitably. This would help enhance team motivation and strengthen our sense of professional identity." (Participant 1). "The AICU is a new area, and we all have to push ourselves out of our comfort zones and put in extra time and energy to keep up. But since the rewards haven’t really improved, I honestly think it’s hard to keep people from leaving." (Participant 4). Streamlined management Respondents reported that the high frequency of night shifts, heavy workload, and complex medical record documentation in the AICU have imposed considerable physical and psychological strain. They expressed hope that management would improve staffing allocation, streamline workflow, and strengthen employee support mechanisms. “Besides the attending doctors, most AICU physicians come from regular rotations in the anesthesiology department. Newcomers might not be fully competent yet, which could threaten the quality and safety of care. So, it’s suggested to keep the medical team relatively stable." (Participant 4). "I have a night shift about every 5 to 6 days on average, but it’s really wearing me down. I hope more staff can be added so the night shift rotation can be stretched out." (Participant 5). "Members in the AICU are not just colleagues but also friends. Having more team-building events can help build friendships, improve understanding, and make work go more smoothly." (Participant 7). Discussion Although some participants in this study expressed a sense of mission, professional achievement, and personal development from their work in the AICU, nearly all reported experiencing varying degrees of cognitive and skill lag, high stress, anxiety, and professional burnout during the initial months. These findings are consistent with those of previous studies [ 14 , 15 ]. The primary problems include: (1) Currently, there is a shortage of anesthesiologists in China with a background in critical care medicine. Insufficient training and outdated knowledge and skills prior to undertaking critical care responsibilities can lead to increased work-related stress and clinical risk. (2) The transition from surgical anesthesia to critical care diagnosis and treatment involves significant changes in work patterns and responsibilities. Coupled with limited external understanding and trust, and uncertain prospects for the discipline’s development, these challenges have contributed to a diminished sense of professional identity among medical personnel. (3) "As one of the youngest clinical subspecialties [ 16 ], the AICU remains in an exploratory phase regarding its scope of diagnosis and treatment, management systems, salary distribution, and evaluation and promotion mechanisms. This developmental stage may contribute to reduced levels of belonging and job satisfaction among medical staff. The establishment of the AICU was not solely aimed at enhancing the development of anesthesiology subspecialties, but more importantly, at leveraging the strengths of the discipline to reduce postoperative mortality and the incidence of surgery and anesthesia complications. It is widely recognized that medical quality and talent development are essential to the survival and growth of hospitals. Therefore, it is an urgent priority to accelerate the training of critical care professionals in anesthesiology through multiple coordinated approaches, in order to mitigate the pressure and risks caused by cognitive and skill gaps among medical staff. This study shows that most participants believe the primary reason for their lack of confidence, anxiety, and fear at work is insufficient knowledge and experience in the diagnosis and treatment of critical illnesses. In the early stages of their work, they not only need to manage critically ill patients with great caution, but also frequently determine the most appropriate medications, laboratory tests, and diagnostic procedures based on the patient’s condition—often resulting in significant psychological stress [ 17 ]. If such pressure is not alleviated in a timely manner, it may provoke or compound the occurrence of adverse medical events, resulting in substantial harm to patients, physicians, departments, and hospitals [ 18 ]. In this study, most participants expressed a strong desire for opportunities to acquire new knowledge and skills. They believed that the learning process and its outcomes could effectively alleviate work-related stress and enhance their work motivation, consistent with the findings of Jarvis H et al [ 19 ]. Therefore, it is recommended that management provide support for teaching and training, and accelerate addressing the shortage of talent reserves through multiple channels, including talent recruitment, overseas advanced training, and in-house development programs. As a training base for critical care medicine talents in the anesthesiology department, the AICU primarily emphasizes internal rotation-based training. Therefore, anesthesiologists should undergo foundational pre-employment training before transferring to the AICU, covering aspects such as the environment and equipment, institutional policies and procedures, technical skills and standards, clinical reasoning, and doctor-patient communication. Special emphasis should be placed on enhancing skills less commonly mastered by traditional anesthesiologists, including the rational use of antibiotics, prevention of deep vein thrombosis, nutritional support and rehabilitation exercises, bedside critical care ultrasound, and medical record documentation. This approach will help physicians rapidly adapt to their roles, reduce negative stress and risks, and better ensure medical quality and safety [ 20 ]. Managers should establish long-term goals for the cultivation of talents in anesthesiology and critical care medicine, and develop continuous training programs. These programs may include regularly scheduled chief rounds, professional development sessions, skills training, case discussions, academic presentations, and research lectures tailored to actual needs. Emphasizing the application of knowledge and fostering innovation can enhance physicians’ sense of professional accomplishment and job enthusiasm, ultimately cultivating a positive working and learning environment. Transitioning from surgical anesthesia to critical care diagnosis and treatment entails significant changes in the work environment, operational mode, responsibilities, and other aspects. According to Transition Shock Theory, medical personnel encounter challenges concerning responsibilities, roles, knowledge, and interpersonal communication. These challenges evoke physiological, psychological, and socio-cultural “shock” responses such as stress, distress, and burnout, which can subsequently increase negative attitudes, resistance to job transfer, requests for departmental reassignment, and even resignation [ 21 – 23 ]. Managers should clearly define the admission scope of the AICU according to the hospital’s actual conditions and reasonably formulate a comprehensive management system tailored for the AICU by referencing the existing regulations of the anesthesiology department and ICU. This will provide clear guidance and standardize clinical diagnostic and treatment practices for medical personnel, reduce ineffective communication, and minimize internal and external conflicts and frictions caused by ambiguous policies, unclear roles, and subjective biases. This study shows that understaffing, excessively frequent night shifts, and fatigue are common complaints among respondents, which not only impair work efficiency but also cause physical and mental harm [ 24 , 25 ]. It is essential to fully consider multiple factors and reasonably allocate human resources while ensuring the quality and safety of medical care. For example, staff scheduling should avoid assigning low-seniority or newly transferred medical personnel to work alone. Emphasis should be placed on pairing senior staff with junior staff, and experienced critical care practitioners with those less experienced, to help employees gain experience and alleviate stress, while also reducing medical risks. In addition, this study demonstrates that poor doctor-patient communication and impaired team collaboration reduce doctors’ professional fulfillment and sense of belonging. This not only leads to decreased job satisfaction and professional burnout [ 26 , 27 ], but also increases the risk of medical errors. By regularly holding medical quality and safety meetings, multidisciplinary seminars, organizational meetings, and case-sharing sessions, mutual understanding and respect among teams and team members can be enhanced. These activities also facilitate problem analysis, conflict resolution, and consensus building. This study indicates that the needs of anesthesiologists entering the AICU primarily focus on learning and training, workload, salary and benefits, employee support, and career development. According to the Perceived Organizational Support Theory, when employees receive recognition, respect, a sense of belonging, and emotional support, they are more likely to strive to contribute to organizational goals, while significantly enhancing their well-being as well as work efficiency and quality [ 28 – 30 ]. Therefore, managers should offer practical support across multiple aspects to address the aforementioned needs. Try to provide rich learning resources and fair learning opportunities, while ensuring funding and treatment. Handling a large workload within a limited time places a heavy burden on doctors, potentially causing information overload, burnout, and negative emotional states. This can impair their clinical decision-making ability and ultimately affect patient health [ 31 ]. Administrators should optimize workflows and streamline unnecessary examinations, treatments, and paperwork, enabling doctors to concentrate their efforts on providing better patient care. Transitioning from the operating room to the AICU for the first time inevitably requires stepping out of one’s comfort zone and even enduring skepticism. When income does not match the workload, negative emotions are more likely to develop [ 32 ]. Therefore, performance evaluation and compensation should comprehensively consider factors such as job characteristics, working hours, pressure, and risks, while balancing salary disparities within the anesthesiology department. When necessary, adjustments or additional compensation through a “critical care position allowance” may better contribute to team stability. Strengthen education on professional mission, and support and encourage healthcare workers to engage in AICU-related research projects, the application of new technologies, and teaching and training activities, thereby promoting coordinated development of individuals and disciplines. Regularly hold organizational meetings to promptly collect employees’ feedback, suggestions, and expectations, actively addressing negative emotions and resolving internal and external conflicts. Strengthen departmental culture by organizing team-building activities, social service events, and other initiatives to enhance employees’ sense of belonging, foster better internal relationships, reduce occupational burnout, and improve job satisfaction. AICU should also strengthen its publicity and external communication, enhance academic influence and social visibility, clarify its development vision, and elevate doctors’ professional identity. Strengths and limitations The number of hospitals in China that are establishing or planning to establish AICU is likely to continue growing. Our research team is attentive not only to the potential benefits of this transition but also to the associated risks and challenges. We hope that this qualitative study, conducted in a top-tier tertiary public hospital in China, will offer valuable insights for hospital administrators elsewhere. Due to the inherent limitations of qualitative research, the views expressed by the participants may not be representative of all anesthesiologists working in AICU, and the findings may not be broadly generalizable across different hospital settings. In future research, incorporating doctors from multiple hospitals across different regions as interviewees may help generate more comprehensive insights and robust findings. Conclusion In conclusion, the development of AICU in China remains in its early stages. Hospital administrators should focus on enhancing medical quality and safety, as well as promoting high-quality institutional development. It is essential to recognize the practical challenges and psychological pressures faced by anesthesiologists transitioning into AICU roles, and to provide comprehensive support that addresses their legitimate needs. By doing so, hospitals can help improve their job competence, strengthen their professional identity and sense of belonging, thereby facilitating the sustainable and effective development of AICU in the future. Declarations Acknowledgements We sincerely thank all the healthcare workers who took part in this study. Authors’ contributions C.J.Y.，D.K. and G.L. conceived the ideas for the research. C.J.Y.，D.K, G.L., X.L. ,C.Y.X.,W.L.,and X.L collected the data. C.J.Y. and D.K. analysed the data. C.J.Y. led the writing with the help of D.K. All authors critically revised the manuscript for important intellectual content. All authors have approved the final version of the article. Author details 1 Zhejiang Chinese Medicine University, Hangzhou 310053,China; 2 Department of Anesthesiology and Pain Medicine，Affiliated Hospital of Jiaxing University，Jiaxing 314001，China； 3 Jiaxing University School of Medicine, Jiaxing 314001. 1 Graduate School of Zhejiang University of Chinese Medicine, China Hangzhou ; 2 Department of Anesthesiology and Pain Medicine，Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing)，China Jiaxing； 3 Medical College of Jiaxing University, China Jiaxing. Funding This research was generously supported by the Zhejiang Province Traditional Chinese Medicine Science and Technology Project (2024ZL1081), the Jiaxing University SRT Project (8517241006). Availability of data and materials The datasets generated and analysed during this study are not publicly available to protect the participant’confidentiality. However, the Chinese version of the datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Affiliated Hospital of Jiaxing University (2024-LY-740) and was registered in the Chinese Clinical Trial Registry (ChiCTR2500096590). Written informed consent was obtained from all participants prior to their involvement in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Fang EF, Schenkel JA, Wu C, Long Q et al. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev. 2020;64:101174. Fang EF, Scheibye-Knudsen M, Jahn HJ, et al. A research agenda for aging in China in the 21st century. Ageing Res Rev. 2015;24(Pt B):197–205. 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Anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China: a cross-sectional observational study. BMJ Open. 2022;12(6):e051934. Jin Z, Sugiyama D, Higo F, et al. Efficacy of Pericapsular Nerve Group (PENG) block in preoperative rehabilitation (Prehabilitation) for patients with femoral neck fractures: study protocol for a randomized, placebo-controlled, double-blinded trial. BMC Anesthesiol. 2024;24(1):436. Chen S, Guo Z, Wei X, et al. Efficacy of preemptive intercostal nerve block on recovery in patients undergoing video-assisted thoracic lobectomy. J Cardiothorac Surg. 2023;18(1):168. Lim EJ, Koh WU, Kim H, et al. Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture. J Clin Med. 2021;10(16):3586. National Health Commission of the People's Republic of China. Guidelines for the Development of Medical Service Capacity in Anesthesiology Departments (Trial). Beijing;2019. 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Obciążenie pracą i radzenie sobie ze stresem a stan zdrowia pracowników systemu państwowego ratownictwa medycznego w kontekście work–life balance [Workload and coping with stress and the health status of emergency medical staff in the context of work-life balance]. Med Pr. 2020;71(5):587–93. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6864401","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485663199,"identity":"ebff86d4-e96a-4893-8b39-b31da8a351ca","order_by":0,"name":"Junyang Chu","email":"","orcid":"","institution":"Zhejiang Chinese Medicine University","correspondingAuthor":false,"prefix":"","firstName":"Junyang","middleName":"","lastName":"Chu","suffix":""},{"id":485663200,"identity":"6e6acee3-0f27-47a8-a1e0-4470339449d5","order_by":1,"name":"Lin Gao","email":"","orcid":"","institution":"Zhejiang Chinese Medicine University","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Gao","suffix":""},{"id":485663201,"identity":"0296e280-f6a3-4a3a-8801-e2923a8a8113","order_by":2,"name":"Lei Xie","email":"","orcid":"","institution":"Zhejiang Chinese Medicine University","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Xie","suffix":""},{"id":485663202,"identity":"944c27a9-1b02-47b3-b96f-0e38ff940ef3","order_by":3,"name":"Hanqi Zhang","email":"","orcid":"","institution":"Jiaxing University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hanqi","middleName":"","lastName":"Zhang","suffix":""},{"id":485663204,"identity":"f04fa994-56bb-4818-9656-df502ae61686","order_by":4,"name":"Lei Wang","email":"","orcid":"","institution":"Jiaxing University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Wang","suffix":""},{"id":485663206,"identity":"0a76d1f9-5194-4f8f-8a36-0b990246ed9f","order_by":5,"name":"Yixuan Chen","email":"","orcid":"","institution":"Jiaxing University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yixuan","middleName":"","lastName":"Chen","suffix":""},{"id":485663208,"identity":"1d65cf08-1c13-47c9-b2a4-a16d2b4c8b02","order_by":6,"name":"Kang Deng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYBACxgYgwXPAhoefv4E0LWkykjMOkGIVz4HDNgYNCUSqZp6RnfzhzZnzPAYMBxg/fMwhxmE9ZzcYzrlxm8ecuYFZcuY2YrS0925I5vlwm8ey4QAbMy9RWpp5Nxzm+XCOx+BAArFa2ns3NvPcOECKlp6zmxnnnEnmkZxxsJk4vxjOyN384c0xO3t+/uaDHz4SpaUBYWEDTlUoQJ44ZaNgFIyCUTCiAQCNejsj9IDVAwAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Jiaxing University","correspondingAuthor":true,"prefix":"","firstName":"Kang","middleName":"","lastName":"Deng","suffix":""}],"badges":[],"createdAt":"2025-06-10 15:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6864401/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6864401/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86970123,"identity":"53513bdc-5cd0-4941-9434-2c3aa30e7139","added_by":"auto","created_at":"2025-07-17 18:44:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":892619,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6864401/v1/c08f97ae-dc40-4825-b0d5-db1712cfabad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"New practices bring new challenges: the psychological experiences and needs of anesthesiologists transitioning to work in the AICU","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobal population ageing continues to accelerate, posing substantial challenges across societal dimensions. This demographic shift exerts particularly acute pressure on healthcare systems. China, hosting 20% of the global geriatric population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], faces intensified healthcare challenges. This demographic shift has precipitated a marked rise in perioperative critical care demands, with current general ICU capacity proving inadequate. The lessons learned from COVID-19 have encouraged governments worldwide to prioritize the expansion of reserves for critical care beds [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In recent years, the Chinese government has been encouraging the construction of more specialized ICUs to address the shortage of critical care beds.\u003c/p\u003e\u003cp\u003eIn history, the development of anesthesiology and critical care medicine are closely intertwined. In 1959, Dr. Max Harry Weil officially established the first ICU in the United States at the University of Southern California Medical Center, which was then managed by the Department of Anesthesiology [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the United States, anesthesiologists who wish to practice critical care medicine must complete an additional 1-year fellowship in critical care medicine and pass the certification exam administered by the American Board of Anesthesiology in order to obtain the necessary qualifications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOver recent decades, China has experienced rapid surgical volume growth alongside a persistent anesthesiologist deficit [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. To prioritize surgical services, ICU in most hospitals\u0026mdash;except for a few\u0026mdash;are no longer managed by anesthesiologists. Prolonged disengagement from critical care practice has led to attrition of relevant clinical competencies among anesthesiologists. Nevertheless, anesthesiology and intensive care medicine retain fundamental synergies in both theoretical frameworks and technical applications. Some key techniques mastered by anesthesiologists, such as regional nerve block techniques, are essential foundations for achieving multimodal pain management and accelerated postoperative recovery [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition, critically ill patients may benefit from a period of continued monitoring and treatment by an anaesthesiologist following surgery to maintain continuity of care. In this context, in December 2019, the National Health Commission issued Document No. 884, which explicitly recommended the establishment of Anesthesia Intensive Care Unit (AICU) in qualified hospitals. The aim was to ensure the safety of post-anesthesia patients and improve medical quality. AICU is intended to provide focused care for elderly patients, those with severe preoperative or intraoperative complications, and patients requiring vital organ system support and intensive management after major surgeries [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, in the past, anaesthesiologists' work was mostly confined to intraoperative and short postoperative periods, and they lacked experience in managing critically ill patients for long periods of time. The change in scope, target, content, and mode of work could potentially have a serious impact on their physical and mental well-being.\u003c/p\u003e\u003cp\u003eThe purpose of this research is to interview anesthesiologists entering the AICU extensively, to gain insights into their work experiences and requirements, with the goal of providing recommendations for managers to implement corresponding intervention measures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThis study utilized the phenomenological research method in qualitative research, employing one-on-one semi-structured in-depth interviews to collect data, as it allows for exploring and gaining a deeper understanding of participants' genuine psychological experiences and needs.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSampling and recruitment\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews with 15 anaesthesiologists entering AICU work at Jiaxing University Hospital from 27 January 2025 to 30 March 2025 were conducted using purposive sampling. Inclusion criteria: (1) Respondents were certified to practice and had at least 2 years of experience in anaesthesiology; (2) Respondents were first-time transfers to work in the AICU and lasted more than 3 months; (3) Willing to participate in the study and agree to share their psychological experiences. The exclusion criteria were as follows: (1) Interns and trainees; (2) Individuals who refuse to sign the informed consent form; (3) Those who cannot engage in normal communication or have a mental illness; (4) Those who drop out midway. Affiliated Hospital of Jiaxing University, a comprehensive public hospital, has 1700 beds and performs up to 40,000 surgeries annually. Participants characteristics were provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThree interviewers conducted semi-structured in-depth interviews, all of whom had received training in qualitative research and psychological counseling, and were proficient in interview techniques. The interview time for each respondent will range from 45 to 60 minutes. Based on the research objectives, a systematic literature review was conducted, followed by in-depth consultations with clinical experts to develop a preliminary interview protocol. Cognitive pre-testing was subsequently performed with three purposively sampled anesthesiologists meeting the inclusion criteria to refine the interview framework. Following the pre-interview results, the interview outline was adjusted to produce the official interview guide (provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).Choose a quiet, comfortable, and private lounge or meeting room for the interview location. The interviewer prepares the interview location and relevant materials in advance, adjusts the lighting and temperature to create a safe and relaxing environment, making the interviewee feel comfortable. Following written informed consent acquisition, semi-structured interviews were conducted employing active listening techniques with deliberate pauses. Non-directive probes and participant verification were strategically deployed to minimize interviewer influence while ensuring audiotaped data integrity through full audio recording. Data saturation is reached when no new information can be collected.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Ethics Committee of Jiaxing University Affiliated Hospital (2024-LY-740) and registered in the Chinese Clinical Trial Registry (ChiCTR2500096590,ཛ2025-01-26 ཝ) .All procedures were performed in accordance with the Declaration of Helsinki. This research received written consent from the participants, provided a detailed explanation of the research purpose, methods, significance, and privacy protection measures to the interviewees before the interviews, and obtained signed informed consent.\u003c/p\u003e\n\u003ch3\u003eData analysis and rigo\u003c/h3\u003e\n\u003cp\u003eAfter each interview, the audio recording will be transcribed into text within 24 hours and manually calibrated by two researchers. Import the interview data into Nvivo software and analyze the data based on Colaizzi's 7-step analysis method [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].The steps are as follows: (1) Read through all the interview data carefully to form an overall impression;(2) Analyzing important statements from an application professional perspective is significant༛(3) Encode meaningful recurring viewpoints.༛(4) Group similar topics and descriptions together༛(5) Giving a thorough description༛(6) Distinguishing similar perspectives; (7) Should there be any doubts, verify with the respondent.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup 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status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAssociate Chief Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAssociate Chief Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttending Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaster's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor's Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResident Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInterview guide\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat changes have you experienced in your role and responsibilities after transitioning from the Department of Anesthesiology to the AICU? How has this transition affected you personally and professionally?\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat challenges did you encounter after transitioning to work in the AICU ? How did you address or overcome them?\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrompt\u003c/b\u003e: Medical equipment? Therapeutic drugs? Invasive procedures? Auxiliary examinations༟\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow do your emotions respond to changes in a patient's condition or to patient death?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat strategies do you use to manage work pressure and negative emotions?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat do you think are the current challenges in AICU operations? What recommendations would you make to AICU managers?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow would you describe your sense of professional accomplishment and belonging while working in the AICU?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe thematic analysis was concluded with 12 sub-themes under four themes. The four themes are negative psychological experiences, positive psychological experiences, multidimensional support systems enhanced role adjustment, and needs and aspirations.\u003c/p\u003e\n\u003ch3\u003eNegative psychological experiences\u003c/h3\u003e\n\u003cp\u003eThis topic describes the negative psychology that anesthesiologists experience when transitioning to work in the AICU due to various issues. Four sub-themes emerged: \"challenges from cognitive and skill delays\", \"clinical anxiety during patient deterioration management\", \"stress from changing duties\", and \"impacts of research, administrative, and family roles\".\u003c/p\u003e\n\u003ch3\u003eChallenges from cognitive and skill delays\u003c/h3\u003e\n\u003cp\u003eThe majority of anesthesiologists reported a clinically significant discrepancy between their perioperative management expertise (e.g, hemodynamic optimization, anesthetic protocols) and the multidimensional competencies required in AICU. This competence gap\u0026mdash;characterized by deficits in critical care diagnostics, therapeutic decision-making, and emergency response experience\u0026mdash;manifested as diminished clinical confidence, maladaptive avoidance behaviors, and professional disengagement within the AICU setting.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We managed a case of abdominal compartment syndrome wherein multimodal interventions to reduce intra-abdominal pressure yielded suboptimal therapeutic response. We doubted our ability to handle such a complex condition.\u0026rdquo; (Participant 2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;At first, I was unfamiliar with pharmacotherapeutic management of anticoagulants, antimicrobials, and nutritional support protocols\u003c/em\u003e, \u003cem\u003ecoupled with technical inefficiency in essential critical care procedures including thoracentesis, open tracheostomy, and therapeutic bronchoscopy. When faced with sudden situations, I feel very flustered and under a lot of pressure, often needing to seek help from attending intensivists and specialist doctors.\" (Participant 7).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I need to keep learning constantly to meet the demands of my job, but the learning process does bring a lot of pressure and anxiety, especially when I have to grasp a large amount of knowledge in a short period of time, I feel overwhelmed.\" (Participant 10).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;In contrast to surgical anesthesia, AICU requires extensive documentation work with strict quality standards. Anesthesiologists frequently lack adequate training, leading to potential case deficiencies if not careful.\" (Participant 3).\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eClinical anxiety during patient deterioration management\u003c/h2\u003e\u003cp\u003eMost patients admitted to the AICU are elderly or critically ill postoperative patients, with significant fluctuations in their condition. Doctors need to constantly monitor the patients they are responsible for, whether during working hours or off-duty. Interviewees expressed feeling frustrated and anxious when faced with deteriorating conditions or even death of patients in the early stages of their work.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Compared to the operating room, patients in the AICU generally have poorer conditions and the treatment effects are not as immediate as in surgery. Sometimes, using multiple treatment methods does not lead to improvement, which brings me a significant emotional impact and sense of defeat.\u0026rdquo; (Participant 11).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I felt extremely distressed when a senior lady was discharged from the AICU due to her family giving up on treatment for her severe illness. It led me to experience depression and fear about being responsible for treating high-risk patients.\u0026rdquo; (Participant 12).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes, patients' conditions can be extremely serious. Even after finishing work, I still fear that they may face a sudden life-threatening situation at night, impacting my sleep quality significantly.\u0026rdquo; (Participant 13).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStress from changing dutie\u003c/b\u003es\u003c/p\u003e\u003cp\u003eAn anesthesiologist in the operating room typically manages a patient's surgical anesthesia and recovery period monitoring independently, with the time spent on managing a single patient usually not being very extensive. However, transitioning to working in the AICU requires participating in longer and more comprehensive patient monitoring and treatment, causing some interviewees to have difficulty adapting to this change in role and responsibilities in the short term.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I used to only manage one patient at a time in the operating room, but now I have to juggle multiple patients with more complex and variable conditions, often feeling overwhelmed and under immense psychological pressure.\" (Participant 1).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Despite having 9 years of work experience, my lack of experience in postoperative patient care and doctor-patient communication from working solely in anesthesia made me feel a lot of pressure at first.\u0026rdquo; (Participant 5).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eImpacts of research, administrative, and family roles\u003c/h2\u003e\u003cp\u003eDue to hospital management and incentive policies, doctors are required to not only focus on clinical work, but also to complete corresponding research and management tasks at times. The interviewees mentioned that in addition to coping with work stress, they also have to manage impacts from research, administration, and family.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The rotating shift schedule required in my role severely constrains my availability for childcare responsibilities, creating significant challenges in reconciling professional duties with family commitments.\" (Participant 2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Promotion in professional title requires research achievements, but due to limited experience in critical care medicine, it is difficult to quickly initiate clinical research, which may hinder personal career development.\" (Participant 3).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;As the primary care physician, I am always on call to return to work if a patient's condition deteriorates, even during my time off, which has made it difficult for me and my family to adjust.\u0026rdquo; (Participant 5).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePositive psychological experiences\u003c/h2\u003e\u003cp\u003eThe theme reveals that as work in the AICU progresses, anaesthetists begin to have positive psychological experiences, mainly in terms of a sense of purpose, professional fulfilment and technical/non-technical competence. Four sub-themes emerged: \" sense of duty for AICU development\", \"increased sense of professional accomplishment\", \"enhanced professional capabilities\", and \"strengthened non-technical skills\".\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSense of duty for AICU development\u003c/h2\u003e\u003cp\u003eAs healthcare professionals become more proficient in their work, they increasingly realize the important role that AICU plays in improving the quality and safety of perioperative care, and they take pride in contributing to the development of this emerging subspecialty.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Building an AICU represents a significant step in the advancement of anesthesiology towards perioperative medicine. Anesthesiologists are transitioning from working behind the scenes to taking on more visible and proactive roles. Despite the various challenges involved, I feel deeply honored and proud to be part of this important initiative.\" (Participant 2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"As I gradually recognized the significance of the AICU, I found my role extending beyond the boundaries of the operating room toward a more holistic scope. I am committed to improving my own competencies and contributing to the growth of this emerging sub-specialty.\" (Participant 7).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I took part in the creation of the AICU, and witnessing its ongoing growth and improvement has been deeply rewarding. The recognition of these efforts continues to motivate me.\" (Participant 14).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eIncreased sense of professional accomplishment\u003c/h2\u003e\u003cp\u003e The interviewees shared that they felt genuinely proud when the patients they cared for were safely returned to the ward. The gratitude shown by patients and their families made their work feel even more meaningful.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"It is truly rewarding to see patients improve after treatment. This sense of accomplishment encourages me to approach my work with greater positivity and motivation.\" (Participant 1).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Whenever I overcome a challenge, manage a complicated case, or help a critically ill patient recover, I feel an immense sense of accomplishment\u0026mdash;one that feels even more fulfilling than completing anesthesia for a surgery.\" (Participant 10).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"In the past, as an anesthesiologist, I rarely had the chance to speak with patients and their families, and they often knew little about what we do. Now, we talk more often\u0026mdash;I see their smiles, hear their appreciation, and it fills me with pride and a deep sense of satisfaction.\" (Participant 15).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eEnhanced professional capabilities\u003c/h2\u003e\u003cp\u003eCompared to previous experience in surgical anesthesia, working in the AICU has not only enhanced anesthesiologists' theoretical knowledge and technical skills but also cultivated their critical care diagnostic and therapeutic thinking and abilities.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Previously, my anesthesia work was mainly centered on the intraoperative period, paying less attention to patient prognosis and rehabilitation. After gaining experience in the AICU, I now have a deeper insight into perioperative management, allowing me to consider patients more holistically and over the long term. I feel confident that my future work will be of better quality.\" (Participant 8).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I didn\u0026rsquo;t want my patients to get worse while under my care, so I had to put a lot of effort into learning critical care knowledge and skills that I hadn\u0026rsquo;t urgently needed before. Now, I can see that I\u0026rsquo;ve grown a great deal since I first began.\" (Participant 13).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStrengthened non-technical skills\u003c/h2\u003e\u003cp\u003e\"Almost all respondents reported having limited contact with patients and their families during their work in surgical anesthesia. In contrast, working in the AICU demands stronger communication skills with patients and families, as well as enhanced teamwork abilities. Consequently, the experience in the AICU has significantly improved many non-technical skills among healthcare professionals.\"\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Previously, anesthesia in the operating room was mainly carried out by individuals, sometimes with help from assistants. In the AICU, however, assessing patients and developing treatment plans involve senior physician rounds, departmental or hospital-wide complex case discussions, and multidisciplinary consultations, all of which foster stronger team communication and collaboration.\" (Participant 2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"An elderly man was very nervous after surgery. After I comforted him, he gradually calmed down and thanked me. This experience made me realize that I can do better in providing humanistic care, which will be my focus moving forward.\" (Participant 13).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Previously, I had limited interaction with patients\u0026rsquo; families in the operating room. Now, I regularly have to discuss treatment, care, rehabilitation, diet, and costs with them in detail, which has significantly improved my communication skills.\" (Participant 14).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eDiversified support facilitates role adaptation\u003c/h2\u003e\u003cp\u003eA social support system refers to the various forms of assistance an individual can receive from people around them, including practical help and emotional support from family and friends, as well as experiential advice from colleagues. The interviewee noted that having sufficient support helps them maintain a more positive mindset. Three sub-themes emerged: \"self-support\", \" team support reinforcement\" ,and \" family support engagement\".\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eSelf-support\u003c/h2\u003e\u003cp\u003e The interviewee indicated that when entering a relatively unfamiliar field or environment, they often experience various negative emotions, which they alleviate through emotional regulation, self-reflection, and continuous learning.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I first joined the AICU, there were many unknowns that naturally made me anxious. To cope, I focused on calming down and studying carefully, filling my knowledge and skill gaps in my own way. As I learned more, my anxiety noticeably decreased.\u0026rdquo; (Participant 6).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Frequent night shifts, along with many patients in critical condition and the need to be constantly prepared for emergencies, put a lot of psychological pressure on me. This often leads to several days of poor sleep and feeling very exhausted. So, I try to spend my free time doing things I enjoy to relax and recharge.\" (Participant 7).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I relieve physical fatigue by resting. To cope with mental stress, I mainly use self-relaxation techniques to manage my worries.\" (Participant 10).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I will relieve work pressure through traveling, exercising, socializing with friends, and singing.\u0026rdquo; (Participant 11).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTeam support reinforcement\u003c/h2\u003e\u003cp\u003eMany interviewees emphasized that in the high-pressure environment of the AICU, stable team support is particularly important. This support provides healthcare workers with a sense of belonging and security, which effectively alleviates occupational stress.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes the senior doctor gives me lots of advice, and if I don\u0026rsquo;t do my job well, they even step in to help share the responsibility.\u0026rdquo; (Participant 8).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I first got here, I felt a lot of pressure and was in a low mood. Talking, venting, joking, and supporting each other with my colleagues helped me relieve stress and get back into a better mindset for work.\u0026rdquo; (Participant 10).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eFamily support engagement\u003c/h2\u003e\u003cp\u003eThe presence of family is indispensable. Interviewees noted that family members provide not only emotional support but also assist in balancing work and life, and their supportive attitudes have a direct influence on the interviewees.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;One time, a postoperative patient suddenly had an acute stroke, and I had to rush to the hospital, missing my son\u0026rsquo;s birthday party. But my family didn\u0026rsquo;t blame me; they comforted me, and my son even saved his birthday cake for me. It\u0026rsquo;s their support that lets me work without any worries.\u0026rdquo; (Participant 2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes when things get tough, I talk to my family, and they always comfort me. Without their support, I don\u0026rsquo;t think I could have gotten through the challenges at work.\u0026rdquo; (Participant 15).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eNeeds and aspirations\u003c/h2\u003e\u003cp\u003eThis theme reflects the respondents\u0026rsquo; multifaceted needs and expectations for improvement concerning the challenges encountered in AICU work, with core issues centering on insufficient individual competencies, inadequate performance-based compensation, and deficiencies in departmental management. Three sub-themes emerged: \"improved training\", \"higher remuneration\", and \"streamlined management\".\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eImproved training\u003c/h2\u003e\u003cp\u003eRespondents reported a lack of systematic training in critical care diagnostic and therapeutic thinking and skills prior to transferring to the AICU. In addition, the post-transfer learning model was relatively limited in approach, which contributed to the emergence of various issues during clinical practice.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Before I transferred to the AICU, I hadn\u0026rsquo;t gone through a structured training in critical care. I mostly learned by doing and through guidance from senior doctors. I think if I had received proper training in critical care diagnosis and treatment beforehand, I wouldn\u0026rsquo;t have felt so anxious at the start.\u0026rdquo; (Participant 7).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m a junior doctor, and the senior physician I follow isn\u0026rsquo;t very good at teaching and often just criticizes me. I think it would really help if those of us in training were matched with teachers who are more experienced and enthusiastic about teaching \u0026mdash; that way, I could probably improve much faster.\u0026rdquo; (Participant 9).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eHigher remuneration\u003c/h2\u003e\u003cp\u003eAs a newly established department, the AICU demands considerable time and dedication from its staff for its development. However, the interviewees reported a perceived imbalance between their workload and compensation, expressing a strong desire for improved remuneration.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Work in the AICU is much more demanding than in surgical anesthesia, yet the income is lower-possibly due to differences in evaluation criteria. I believe that performance-based compensation should take multiple factors into account and be adjusted more equitably. This would help enhance team motivation and strengthen our sense of professional identity.\" (Participant 1).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The AICU is a new area, and we all have to push ourselves out of our comfort zones and put in extra time and energy to keep up. But since the rewards haven\u0026rsquo;t really improved, I honestly think it\u0026rsquo;s hard to keep people from leaving.\" (Participant 4).\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eStreamlined management\u003c/h2\u003e\u003cp\u003eRespondents reported that the high frequency of night shifts, heavy workload, and complex medical record documentation in the AICU have imposed considerable physical and psychological strain. They expressed hope that management would improve staffing allocation, streamline workflow, and strengthen employee support mechanisms.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Besides the attending doctors, most AICU physicians come from regular rotations in the anesthesiology department. Newcomers might not be fully competent yet, which could threaten the quality and safety of care. So, it\u0026rsquo;s suggested to keep the medical team relatively stable.\" (Participant 4).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I have a night shift about every 5 to 6 days on average, but it\u0026rsquo;s really wearing me down. I hope more staff can be added so the night shift rotation can be stretched out.\" (Participant 5).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Members in the AICU are not just colleagues but also friends. Having more team-building events can help build friendships, improve understanding, and make work go more smoothly.\" (Participant 7).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough some participants in this study expressed a sense of mission, professional achievement, and personal development from their work in the AICU, nearly all reported experiencing varying degrees of cognitive and skill lag, high stress, anxiety, and professional burnout during the initial months. These findings are consistent with those of previous studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The primary problems include: (1) Currently, there is a shortage of anesthesiologists in China with a background in critical care medicine. Insufficient training and outdated knowledge and skills prior to undertaking critical care responsibilities can lead to increased work-related stress and clinical risk. (2) The transition from surgical anesthesia to critical care diagnosis and treatment involves significant changes in work patterns and responsibilities. Coupled with limited external understanding and trust, and uncertain prospects for the discipline\u0026rsquo;s development, these challenges have contributed to a diminished sense of professional identity among medical personnel. (3) \"As one of the youngest clinical subspecialties [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], the AICU remains in an exploratory phase regarding its scope of diagnosis and treatment, management systems, salary distribution, and evaluation and promotion mechanisms. This developmental stage may contribute to reduced levels of belonging and job satisfaction among medical staff.\u003c/p\u003e\u003cp\u003eThe establishment of the AICU was not solely aimed at enhancing the development of anesthesiology subspecialties, but more importantly, at leveraging the strengths of the discipline to reduce postoperative mortality and the incidence of surgery and anesthesia complications. It is widely recognized that medical quality and talent development are essential to the survival and growth of hospitals. Therefore, it is an urgent priority to accelerate the training of critical care professionals in anesthesiology through multiple coordinated approaches, in order to mitigate the pressure and risks caused by cognitive and skill gaps among medical staff. This study shows that most participants believe the primary reason for their lack of confidence, anxiety, and fear at work is insufficient knowledge and experience in the diagnosis and treatment of critical illnesses. In the early stages of their work, they not only need to manage critically ill patients with great caution, but also frequently determine the most appropriate medications, laboratory tests, and diagnostic procedures based on the patient\u0026rsquo;s condition\u0026mdash;often resulting in significant psychological stress [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. If such pressure is not alleviated in a timely manner, it may provoke or compound the occurrence of adverse medical events, resulting in substantial harm to patients, physicians, departments, and hospitals [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this study, most participants expressed a strong desire for opportunities to acquire new knowledge and skills. They believed that the learning process and its outcomes could effectively alleviate work-related stress and enhance their work motivation, consistent with the findings of Jarvis H et al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, it is recommended that management provide support for teaching and training, and accelerate addressing the shortage of talent reserves through multiple channels, including talent recruitment, overseas advanced training, and in-house development programs. As a training base for critical care medicine talents in the anesthesiology department, the AICU primarily emphasizes internal rotation-based training. Therefore, anesthesiologists should undergo foundational pre-employment training before transferring to the AICU, covering aspects such as the environment and equipment, institutional policies and procedures, technical skills and standards, clinical reasoning, and doctor-patient communication. Special emphasis should be placed on enhancing skills less commonly mastered by traditional anesthesiologists, including the rational use of antibiotics, prevention of deep vein thrombosis, nutritional support and rehabilitation exercises, bedside critical care ultrasound, and medical record documentation. This approach will help physicians rapidly adapt to their roles, reduce negative stress and risks, and better ensure medical quality and safety [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Managers should establish long-term goals for the cultivation of talents in anesthesiology and critical care medicine, and develop continuous training programs. These programs may include regularly scheduled chief rounds, professional development sessions, skills training, case discussions, academic presentations, and research lectures tailored to actual needs. Emphasizing the application of knowledge and fostering innovation can enhance physicians\u0026rsquo; sense of professional accomplishment and job enthusiasm, ultimately cultivating a positive working and learning environment.\u003c/p\u003e\u003cp\u003eTransitioning from surgical anesthesia to critical care diagnosis and treatment entails significant changes in the work environment, operational mode, responsibilities, and other aspects. According to Transition Shock Theory, medical personnel encounter challenges concerning responsibilities, roles, knowledge, and interpersonal communication. These challenges evoke physiological, psychological, and socio-cultural \u0026ldquo;shock\u0026rdquo; responses such as stress, distress, and burnout, which can subsequently increase negative attitudes, resistance to job transfer, requests for departmental reassignment, and even resignation [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Managers should clearly define the admission scope of the AICU according to the hospital\u0026rsquo;s actual conditions and reasonably formulate a comprehensive management system tailored for the AICU by referencing the existing regulations of the anesthesiology department and ICU. This will provide clear guidance and standardize clinical diagnostic and treatment practices for medical personnel, reduce ineffective communication, and minimize internal and external conflicts and frictions caused by ambiguous policies, unclear roles, and subjective biases. This study shows that understaffing, excessively frequent night shifts, and fatigue are common complaints among respondents, which not only impair work efficiency but also cause physical and mental harm [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is essential to fully consider multiple factors and reasonably allocate human resources while ensuring the quality and safety of medical care. For example, staff scheduling should avoid assigning low-seniority or newly transferred medical personnel to work alone. Emphasis should be placed on pairing senior staff with junior staff, and experienced critical care practitioners with those less experienced, to help employees gain experience and alleviate stress, while also reducing medical risks. In addition, this study demonstrates that poor doctor-patient communication and impaired team collaboration reduce doctors\u0026rsquo; professional fulfillment and sense of belonging. This not only leads to decreased job satisfaction and professional burnout [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], but also increases the risk of medical errors. By regularly holding medical quality and safety meetings, multidisciplinary seminars, organizational meetings, and case-sharing sessions, mutual understanding and respect among teams and team members can be enhanced. These activities also facilitate problem analysis, conflict resolution, and consensus building.\u003c/p\u003e\u003cp\u003eThis study indicates that the needs of anesthesiologists entering the AICU primarily focus on learning and training, workload, salary and benefits, employee support, and career development. According to the Perceived Organizational Support Theory, when employees receive recognition, respect, a sense of belonging, and emotional support, they are more likely to strive to contribute to organizational goals, while significantly enhancing their well-being as well as work efficiency and quality [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Therefore, managers should offer practical support across multiple aspects to address the aforementioned needs. Try to provide rich learning resources and fair learning opportunities, while ensuring funding and treatment. Handling a large workload within a limited time places a heavy burden on doctors, potentially causing information overload, burnout, and negative emotional states. This can impair their clinical decision-making ability and ultimately affect patient health [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Administrators should optimize workflows and streamline unnecessary examinations, treatments, and paperwork, enabling doctors to concentrate their efforts on providing better patient care. Transitioning from the operating room to the AICU for the first time inevitably requires stepping out of one\u0026rsquo;s comfort zone and even enduring skepticism. When income does not match the workload, negative emotions are more likely to develop [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Therefore, performance evaluation and compensation should comprehensively consider factors such as job characteristics, working hours, pressure, and risks, while balancing salary disparities within the anesthesiology department. When necessary, adjustments or additional compensation through a \u0026ldquo;critical care position allowance\u0026rdquo; may better contribute to team stability. Strengthen education on professional mission, and support and encourage healthcare workers to engage in AICU-related research projects, the application of new technologies, and teaching and training activities, thereby promoting coordinated development of individuals and disciplines. Regularly hold organizational meetings to promptly collect employees\u0026rsquo; feedback, suggestions, and expectations, actively addressing negative emotions and resolving internal and external conflicts. Strengthen departmental culture by organizing team-building activities, social service events, and other initiatives to enhance employees\u0026rsquo; sense of belonging, foster better internal relationships, reduce occupational burnout, and improve job satisfaction. AICU should also strengthen its publicity and external communication, enhance academic influence and social visibility, clarify its development vision, and elevate doctors\u0026rsquo; professional identity.\u003c/p\u003e\u003cp\u003eStrengths and limitations\u003c/p\u003e\u003cp\u003eThe number of hospitals in China that are establishing or planning to establish AICU is likely to continue growing. Our research team is attentive not only to the potential benefits of this transition but also to the associated risks and challenges. We hope that this qualitative study, conducted in a top-tier tertiary public hospital in China, will offer valuable insights for hospital administrators elsewhere. Due to the inherent limitations of qualitative research, the views expressed by the participants may not be representative of all anesthesiologists working in AICU, and the findings may not be broadly generalizable across different hospital settings. In future research, incorporating doctors from multiple hospitals across different regions as interviewees may help generate more comprehensive insights and robust findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the development of AICU in China remains in its early stages. Hospital administrators should focus on enhancing medical quality and safety, as well as promoting high-quality institutional development. It is essential to recognize the practical challenges and psychological pressures faced by anesthesiologists transitioning into AICU roles, and to provide comprehensive support that addresses their legitimate needs. By doing so, hospitals can help improve their job competence, strengthen their professional identity and sense of belonging, thereby facilitating the sustainable and effective development of AICU in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the healthcare workers who took part in this study.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eC.J.Y.，D.K. and G.L. conceived the ideas for the research. C.J.Y.，D.K, G.L., X.L. ,C.Y.X.,W.L.,and X.L collected the data. C.J.Y. and D.K. analysed the data. C.J.Y. led the writing with the help of D.K. All authors critically revised the manuscript for important intellectual content. All authors have approved the final version of the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthor details\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eZhejiang Chinese Medicine University, Hangzhou 310053,China; \u003csup\u003e2\u003c/sup\u003eDepartment of Anesthesiology and Pain Medicine，Affiliated Hospital of Jiaxing University，Jiaxing 314001，China；\u003csup\u003e3\u003c/sup\u003eJiaxing University School of Medicine, Jiaxing 314001.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eGraduate School of Zhejiang University of Chinese Medicine, China Hangzhou ; \u003csup\u003e2\u003c/sup\u003eDepartment of Anesthesiology and Pain Medicine，Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing)，China \u0026nbsp;Jiaxing；\u003csup\u003e3\u003c/sup\u003e Medical College of Jiaxing University, China Jiaxing.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was generously supported by the Zhejiang Province Traditional Chinese Medicine Science and Technology Project (2024ZL1081), the Jiaxing University SRT Project (8517241006).\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during this study are not publicly available to protect the participant\u0026rsquo;confidentiality. However, the Chinese version of the datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Affiliated Hospital of Jiaxing University (2024-LY-740) and was registered in the Chinese Clinical Trial Registry (ChiCTR2500096590). Written informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFang EF, Schenkel JA, Wu C, Long Q et al. 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Obciążenie pracą i radzenie sobie ze stresem a stan zdrowia pracownik\u0026oacute;w systemu państwowego ratownictwa medycznego w kontekście \u003cem\u003ework\u0026ndash;life balance\u003c/em\u003e [Workload and coping with stress and the health status of emergency medical staff in the context of work-life balance]. Med Pr. 2020;71(5):587\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anesthesiologist, AICU, Psychological experiences, Needs","lastPublishedDoi":"10.21203/rs.3.rs-6864401/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6864401/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe global population aging continues to accelerate, also posing significant challenges to Chinese society. The growing geriatric population has substantially increased demand for critical care beds, compelling governmental initiatives to expand specialized Intensive Care Unit (ICU) capacity in addressing this deficit. The establishment of an Anesthesia Intensive Care Unit (AICU) in a comprehensive hospital has effectively alleviated the pressure on the general ICU. However, anesthesiologists have historically lacked sustained experience in prolonged critical care management, as their work was mostly limited to intraoperative and postoperative care management. The change in scope, target, content, and mode of work may have an impact on their physical and mental well-being. This qualitative study employs phenomenological interviewing with AICU anesthesiologists to systematically explore their lived clinical experiences and needs. The findings will provide references for managers to develop appropriate intervention measures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis phenomenological qualitative study was conducted at Jiaxing University Affiliated Hospital, a tertiary academic medical center in Zhejiang Province, China. We conducted semi-structured interviews with 15 anesthesiologists working in the AICU from January 27, 2025, to March 30, 2025. Participants were recruited through purposive sampling. Interviews lasted 45\u0026ndash;60 minutes, with data saturation determined when no new information emerged. Interview data were analyzed using Colaizzi's seven-step phenomenological method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFour core themes with twelve subthemes emerged from the analysis: (1) Negative psychological experiences, including sub-themes of \"Challenges from cognitive and skill delays\", \"clinical anxiety during patient deterioration management\", \"stress from changing duties\", and \"impacts of research, administrative, and family roles\";(2) Positive psychological experiences, including sub-themes of \" sense of duty for AICU development \", \"increased sense of professional accomplishment\", \"enhanced professional capabilities\", and \"strengthened non-technical skills\"༛(3) Diversified support facilitates role adaptation, including sub-themes of \"self-support\", \" team support reinforcement\" ,and \" family support engagement\"(4) Needs and aspirations, including sub-themes of \"improved training\", \"higher remuneration\", and \"streamlined management\".\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe transition of anesthesiologists to roles in the AICU is a complex and demanding process. This highlights the importance of hospital and departmental management in addressing the psychological challenges and needs faced by healthcare professionals during this shift. Efforts should be made to strengthen training, refine management systems, ensure equitable compensation, and foster a sense of professional identity and belonging. Such measures are essential for improving staff well-being and, ultimately, enhancing the quality of care.\u003c/p\u003e","manuscriptTitle":"New practices bring new challenges: the psychological experiences and needs of anesthesiologists transitioning to work in the AICU","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 18:36:32","doi":"10.21203/rs.3.rs-6864401/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"140544275156240501146129343571409219104","date":"2026-05-14T05:26:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-13T00:21:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76249800507100306627749380060782458891","date":"2026-05-13T00:11:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-25T17:30:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4371853819094806198091408895016311866","date":"2025-07-29T09:29:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T08:41:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T07:17:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-18T17:08:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-18T14:31:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-06-18T14:28:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35882cf6-0f87-4d84-aab7-52d03e8855d3","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"140544275156240501146129343571409219104","date":"2026-05-14T05:26:24+00:00","index":104,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-13T00:21:08+00:00","index":103,"fulltext":""},{"type":"reviewerAgreed","content":"76249800507100306627749380060782458891","date":"2026-05-13T00:11:15+00:00","index":102,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-17T18:36:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 18:36:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6864401","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6864401","identity":"rs-6864401","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}