A qualitative Study on Stress response and Coping of General Practitioners at the Beginning of Independent Duty

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Methods The study adopted qualitative research. We conducted in-depth interviews with 7 trainees who were undergoing standardized training courses for general practitioners and analyzed the obtained information using content analysis. Results We extracted three themes, stress and challenges, coping strategies, and the impact of being on duty on one's work or life, from the study. Conclusions The qualitative research revealed the psychological state experienced by general practitioners when faced with stresses and challenges, as well as effective coping strategies employed during the initial phase of independent duty. qualitative research the standardized training of general practitioners independent duty psychology Introduction With the development of society's economy and the transformation of the medical model, people are putting forward higher health care. The Political Bureau of the Communist Party of China Central Committee, on October 25, 2016, reviewed and approved the plan for a Healthy China 2030 [1] . The conference concluded that health is a necessary prerequisite for the overall development of the people and the foundation for the sustainable development of society. The plan is a general guideline document for promoting people's health in the coming 15 years; a brand-new picture of a healthy China is being drawn step by step. It stressed that we should focus on general practitioners and strengthen the construction of talents at the grassroots level. Moreover, we should improve the training system for residents and specialists and establish a training mechanism for high-level public health and clinical medicine personnel. General practitioners, also known as family physicians or family physicians, are the leading providers of health management services. General practitioners possess unique attitudes, skills, and knowledge that qualify them to provide continuous and comprehensive medical care, health maintenance, and prevention services to each family member. Most general practitioners work at the grassroots level. They can provide comprehensive medical services to a broader range of people through the "Bio-Psycho-Social model, "which is of great significance to national health protection. The first standardized resident training system was established in 1988 in Shanghai, China [2] . Since then, China has been learning from the standardized training system for residents in the United States and the United Kingdom. In 2013, guidance on the establishment of a standardized training system for residents was published by the National Health Commission of the People's Republic of China and other 7 departments, which pointed out that standardized training for resident physicians refers to medical graduates, who after completing formal medical education, receive systematic and standardized training in the training base as resident physicians, focusing on improving clinical abilities. At present, China has integrated with the foreign general practitioner training system, the training mode is "5 + 3", that is, first accept 5 years of undergraduate education in clinical medicine, and then accept 3 years of standardized training for residents or 3 years of postgraduate education for master's degree. The standardized training of general practitioners is the core of the general medical education system, the main way to cultivate qualified general practitioners, and an important stage of the transition from "medical student" to "junior doctor" identity, which has a profound impact on their career. It has been reported in the literature that general practitioners are stressed, and their negative impact on mental health can affect patients' medical experience [3–7] . The enormous pressure on GPs is related to their work environment, especially when acute infectious diseases occur [8] . Good work-life balance and contact with colleagues can reduce their stress [9] . How GPs felt on the first shift was not found in China. Therefore, it is of great significance to study all the experiences of trainees in the standardized training of general disciplines during the three-year training period. Methods 2.1 Recruitment and Sample The purposive sampling method was employed in this study. Initially, the researchers initiated telephone contact with the respondents to ascertain the location and schedule a face-to-face interview, followed by an individualized interview session in the subsequent week to provide an overview of the research context and explicitly clarify respondent expectations. Upon the willingness of participants to engage in subsequent semi-structured interviews, informed consent was obtained. The informed consent document delineated the research objectives, methodology, as well as inclusion and withdrawal criteria for potential subjects. Interviewers were trained personnel exhibiting homogeneity. The inclusion criteria: are (1) obtaining informed consent; (2) trainees who were taking standardized training courses for general practitioners in the hospital, and having the experience on independent duty during standardized residency training; and (3) being able to express the views clearly. The exclusion criteria: are (1) general practitioners who withdrew during the interview; and (2) general practitioners who didn't want to mention the on-duty experience. There were 7 subjects in this study, including 3 males and 4 females, aged 24–36 years old, with an average age of 28 years old. participants gender Age Working years Graduation time Marital status Qualification Children N1. male 27 3 July 2020 Unmarried Undergraduate / N2. female 26 3 July 2020 Unmarried Undergraduate / N3. female 36 11 July 2015 Married Junior college 1 N4. female 24 3 July 2020 Unmarried Undergraduate / N5. male 27 3 July 2020 Unmarried Undergraduate / N6. male 26 3 July 2020 Unmarried Undergraduate / N7. female 30 7 July 2016 Married Undergraduate 1 Appendix 1: The characteristics of the participants 2.2 Design 1. Have you been on independent duty during standardized residency training? 2. Could you describe what it was like on duty? 3. Could you describe the psychological state at the beginning of independent duty? 4. What did you feel the most challenge and pressure when you were on duty alone? 5. How did you overcome or relieve your stress or challenge? 6. What did you think the experience had any influence on your work or life? 7. Was there anything else you would like to tell me? Appendix 2. The interview questions Results This study extracted three themes: stress and challenges, coping strategies, and the impact of being on duty on one's work or life. See Appendix 3 for details. Theme Sub-themes Stress and challenges i) Negative emotional reactions ii）The rescue of critical patients iii) Accepting new patients iv）The lack of clinical reasoning and the accountability of senior physicians v）Communication with family members of critically ill patients Coping strategies i) Accompanied and approved by the teachers ii) Communicating and discussing with colleagues iii) Working with senior nurses iv）Increasing the frequency of ward round v）Accumulating the knowledge The impact of being on duty on one's work or life i) Opportunity and Development ii) Improved communication and decision-making iii) Changed the perspective of family and friends on oneself iv）Leisure time decreased and the positive effect increased Appendix 3. Themes and sub-themes extracted from the analysis of the findings Stresses and Challenge Negative emotional reactions Many mentioned how emotionally stressed they felt at times, and the stress originated from negative emotional reactions, including anxiety, worry, discomfort, fear, and even breakdown. The timing of their shift is a determining factor. Only N5 was scheduled for duty following the teacher's evaluation and personal consideration. N1, N2, N4, and N7 were assigned to duty due to insufficient manpower in the department. Conversely, N3 and N6 were mandated to be on duty independently as part of their training program, with prior psychological preparation. N5 said, “I encountered significant pressure during my initial duty; however, it was manageable. Alongside nervousness, concern, and anxiety, I also embraced this opportunity for self-improvement.” N7 said, “Due to staff shortage in the department, I wasn't adequately prepared for my first duty assignment. Fearful of missing out on this opportunity if declined, I promptly accepted despite feeling apprehensive about my competence while on duty.” "Despite undergoing certain psychological preparation beforehand when admitting patients, I still found myself overwhelmed by panic and confusion," said N6. The rescue of critical patients The findings from N3, N4, and N7 revealed that critically ill patients experienced a sense of helplessness when their condition changed and harbored concerns about following incorrect medical advice, potentially leading to delayed rescue efforts. These fears were closely associated with their limited knowledge reserve in daily life. On the other hand, participants indicated in N5 that they possessed proficiency in the fundamental procedures of critical and severe patient care, enabling them to proactively prepare for verification processes without significant pressure. Specifically addressing the concern expressed in N4, " What made me feel the most challenge and pressure was the emergency when I was on duty alone, especially the rescue of critical patients because I had never experienced them before. I was particularly anxious that any errors on my part may contribute to delays in managing the patient's condition. Consequently, I found myself hesitant to make decisions and experience apprehension manifesting as physical unease." Accepting new patients N1, N3, and N6 expressed apprehension towards accepting new patients, particularly when faced with a high influx of patients simultaneously, which induced a sense of overwhelming urgency. The lack of clinical reasoning and the accountability of senior physicians N1 and N6 highlighted deficiencies in their comprehensive clinical knowledge, such as the management process for hospitalized patients, appropriate drug dosages, compatibility issues with liquids, diagnostic omissions, and errors, as well as advanced equipment utilization, like ventilator parameter adjustments. N6 said, "Reluctance to contact the second line staff is especially prominent during nighttime hours due to concerns about disturbing their rest or potentially eliciting impatience or negative evaluations from them." "When confronted with a large number of patients alone, I was unable to cope effectively; moreover, the greatest pressure arises when family members exert pressure for immediate treatment," said N1. Communication with family members of critically ill patients According to N3's account, communicating with families in critical situations poses significant challenges for him as a young doctor since his abilities were often questioned by family members-especially when multiple individuals surrounded him-which adds additional pressure and fear of miscommunication or inadequate explanations. 3.2 Coping Strategies Accompanied and approved by the teachers The N1, N2, N3, N5, and N7 emphasized the significance of encouraging and recognizing exceptional physicians, particularly those in teaching roles. N1 highlighted that being accompanied by a superior physician could alleviate tension, especially if the superior physician examined all patients prior to duty. When their diagnosis and treatment plan received approval from the superior physician, it enhanced their confidence on duty and effectively reduced work-related pressure. Communicating and discussing with colleagues N1, N4, N5, N6, and N7 emphasized the importance of increased communication with colleagues already on duty as a means to alleviate stress during their initial shift. N4 said, "I was used to asking them about their experiences on duty including challenges faced and effective strategies employed for learning purposes." Working with senior nurses N1, N2, and N7 indicated that collaborating with a senior nurse while on duty effectively alleviated their stress. N2 said "Engaging in communication with the nursing staff helped me gain a clearer understanding of the duties' processes and precautions. Some nurses promptly responded to my requests, reviewed my medical advice, and reminded me to rectify any identified errors, all of which significantly reduced the pressure I experienced during duty. I even believed that receiving support from nurses in the initial stages of duty was more crucial than that from the teachers. Increasing the frequency of ward round To enhance patient acceptance, N1, N2, and N7 expressed their intention to increase the frequency of rounds and engage in effective communication with patients. They believed that building trust through personalized care and attentiveness would alleviate duty-related pressure significantly. N1 said, "For certain patients, I may make more than 5 bedside visits in order to gather comprehensive information about the illness and tailor a personalized diagnosis and treatment plan. I have observed that the more meticulous I was, the greater trust was established and the better I retain cautionary measures." Accumulating the knowledge N3 and N5 expressed their commitment to enhancing their knowledge by reading more books, both domestic and foreign, studying diagnosis and treatment procedures in greater depth, and reviewing past cases to bolster their self-assurance. 3.3 The impact of being on duty on one's work or life Opportunity and Development Except for N6, all the other six people reported that their clinical skills had improved. N2 said "In terms of clinical practice, the teaching faculty has provided me with ample space and opportunities for hands-on experience. For instance, I have been able to personally perform procedures such as chest punctures and abdominal punctures under the guidance of experienced instructors, while always respecting patient preferences. And My clinical skills have been improved." "The director allowed me to take responsibility for the patients as the bedside clinician because I hold a medical doctor practicing license and doctor qualification. Under the guidance of the teaching, I can master well the diagnosis and treatment process of common diseases in the department. And also cultivated the clinical ideation", said N4. Improved communication and decision-making Seven participants reported enhanced skills in communication and decision-making. N5 said that during my duty hours, I conducted multiple ward rounds, effectively communicated with patients and their families, and promptly made decisions during emergencies. These experiences significantly bolstered my proficiency in both communication and decision-making abilities. Changed the perspective of family and friends on oneself Following independent duty, my clinical expertise and communication skills had significantly advanced, greatly benefiting my subsequent professional endeavors. In everyday life, owing to the rapid enhancement of my specialized knowledge, I was able to provide valuable professional guidance to my loved ones, thereby altering their perception of me. They now viewed me as an authentic medical practitioner, instilling a subtle sense of pride within myself. Furthermore, it had bolstered my professional identity. Leisure time decreased and positive effects increased Despite a significant reduction in their spare time due to increased duty hours for preparation, N1 and N5 experienced heightened positive emotions towards both work and life after successfully treating and gaining recognition from the patient. Limitations Despite the saturated sample size of this study, the participants were GPs in the same session who lived in the same dormitory building and met frequently, and some information was exchanged, which may have led to the incompleteness of the results. However, this study was objective when collecting data to ensure the objectivity and reliability of the data. At the same time, during the interview process, we also tried to guide the doctors to express their own unique opinions and experiences, to avoid being influenced by the group's opinions. Despite the limitations of this study, we believe that its conclusion still has some reference value. Conclusion The transition from medical student to junior doctor has always been considered a significant rite of passage [4] . The research confirms that the transition is frequently experienced as very challenging and stressful [10] . The main task of school days is to learn knowledge from textbooks. However, after graduation, they became junior doctor, who were lack of clinical experience and were capable of doing a large volume of work in the department and had to undertake the significant responsibility of maintaining health and saving lives. Meanwhile, some shared the growth as a general practitioner during the cycle around the department. They mentioned that they did learn so much from doing the job. Since 2015, standardized training for resident physicians has been fully implemented in China, aiming to cultivate medical professionals with a robust foundation, extensive knowledge, exceptional skills, and high-quality standards to meet the demands of medical science, technology, and healthcare development. With the continuous increase in national financial investment and the gradual expansion of trainee numbers, its effectiveness is progressively becoming evident by providing more individuals with opportunities for further education while enhancing the clinical proficiency of resident training physicians. Simultaneously, it has fortified hospital faculties and nurtured an increased pool of talented resident physicians for our nation and society. Studies have shown that general practitioners have a positive effect on patients, their family members, and caregivers [11, 12] . GPs must improve their expertise to deal with all kinds of problems at work [13, 14] . Medical authorities focus on GP stressors and provide support [14, 15] . This study explores stress and challenges, coping strategies, and the impact of being on duty on one's work or life that Chinese GPs face during their first duty. This paper explores the pressures and challenges that Chinese GPs face during their first duty And analyses how they can gradually adapt and overcome these difficulties in practice. The first time on duty is a serious challenge for every general practitioner. They face not only a busy pace of work but also a comprehensive test of professional knowledge, communication skills, and resilience. In this process, GPs are often under great psychological pressure to ensure the safety and satisfaction of patients while dealing with various emergencies that may arise. However, it is these pressures and challenges that motivate GPs to learn and progress. They attend professional training, consult senior doctors accumulate experience, and gradually improve their professional ability and coping ability by accumulating experience in practice. At the same time, they also learned how to adjust their mentality and keep calm and rational, to better cope with various challenges at work. In addition to individual efforts, GPs also need support from hospitals and society. Hospitals can establish a better training system to provide more learning opportunities and resources for general practitioners; society can strengthen their recognition and respect for their work and enhance their sense of professional honor and belonging. Declarations Ethics approval and consent to participate Ethical clearance had been granted to the authors prior to the study by the Medical Ethics Committee of Hanzhong Central Hospital and the ethical code is 202410. All methods were performed according to the guidelines and regulations of qualitative research. The transcripts were coded without the participants’ names, and numbers were used in all publications and dissemination of findings. Consent for publication Not applicable. Availability of data and materials The data and materials used for analysis and conclusion are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding There are no sources of funding for this project. Authors contributions Weina Bian and Yue Zhang contributed equally to this work and wrote the main manuscript text, Qinghua Zheng and Hongwei Yang undertook the design of the subject, Jieling He undertook the data analysis, Nina Ma and Guang Chen were responsible for data collection and Shumin Qin prepared search strategies. In a word, all authors read and reviewed the final manuscript. All authors approved the final manuscript. Acknowledgment The authors thank the seven general practitioners for sharing their experiences. Thanks to Dr. Mary O'Rourke, Dr. William Evans, Dr. Catherien Browne, and Dr. Anna Marie Greene, for their selfless teaching. All the doctors work in the MUNSTER TECHNOLOGICAL UNIVERSITY, Ireland. Thanks to each of the authors for their efforts. Author’s information WEINA BIAN, Email: [email protected] YUE ZHANG, Email: [email protected] JIELING HE, Email： [email protected] HONGWEI YANG, Email: [email protected] NINA MA, Email： [email protected] GUANG CHEN, Email： [email protected] SHUMIN QIN, Email： [email protected] QINGHUA ZHENG,Email: [email protected] References DONG B, ZOU Z, SONG Y, et al. Adolescent Health and Healthy China 2030: A Review[J]. Journal of Adolescent Health, 2020,67(5): S24-S31. ZHU J, LI W, CHEN L. Doctors in China: Improving quality through modernization of residency education[J]. The Lancet, 2016,388(10054): 1922-1929. FENG J, JIANG H, SHEN X, et al. Occupational stress and associated factors among general practitioners in China: a national cross-sectional study[J]. BMC Public Health, 2022,22(1). PEDERSEN A F, VEDSTED P. Burnout, coping strategies and help-seeking in general practitioners: a two-wave survey study in Denmark[J]. BMJ Open, 2022,12(2): e51867. Job Satisfaction and Its Associated Factors Among General Practitioners in China[Z]. KALETA F O, KRISTENSEN C B, DUNCAN M, et al. Cognitive mechanisms and resilience in UK-based general practitioners: cross-sectional findings[J]. Occupational Medicine, 2023,73(2): 91-96. DEGEN L, LINDEN K, SEIFRIED-DÜBON T, et al. Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVEjob)[J]. International Journal of Environmental Research and Public Health, 2021,18(18): 9458. SOTOMAYOR-CASTILLO C, NAHIDI S, LI C, et al. General practitioners’ knowledge, preparedness, and experiences in managing COVID-19 in Australia[J]. Infection, Disease & Health, 2021,26(3): 166-172. CHESHIRE A, RIDGE D, HUGHES J, et al. Influences on GP coping and resilience: a qualitative study in primary care[J]. British Journal of General Practice, 2017,67(659): e428-e436. PITKALA K H, MANTYRANTA T. Professional socialization revised: medical students' own conceptions related to the adoption of the future physician's role--a qualitative study[J]. Medical Teacher, 2009,25(2): 155-160. WANGLER J, JANSKY M. Support, needs and expectations of family caregivers regarding general practitioners – results from an online survey[J]. BMC Family Practice, 2021,22(1). PETER S, VOLKERT A M, PFAFF H, et al. General Practitioners’ Perspectives on General and Specialized Palliative Home Care in North Rhine, Germany: An Explorative Focus Group Study[J]. American Journal of Hospice and Palliative Medicine®, 2021,38(1): 32-38. BUGAJ T J, VALENTINI J, MIKSCH A, et al. Work strain and burnout risk in postgraduate trainees in general practice: an overview[J]. Postgrad Med, 2020,132(1): 7-16. JOHNSSON L, NORDGREN L. The voice of the self: a typology of general practitioners' emotional responses to situational and contextual stressors[J]. Scandinavian journal of primary health care, 2022,40(2): 289-304. MATHEW S, MASH R. Exploring the beliefs and attitudes of private general practitioners towards national health insurance in Cape Town, South Africa[J]. Afr J Prim Health Care Fam Med, 2019,11(1): e1-e10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Submission checks completed at journal 18 Jun, 2024 First submitted to journal 12 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The Political Bureau of the Communist Party of China Central Committee, on October 25, 2016, reviewed and approved the plan for a Healthy China 2030\u003csup\u003e[1]\u003c/sup\u003e. The conference concluded that health is a necessary prerequisite for the overall development of the people and the foundation for the sustainable development of society. The plan is a general guideline document for promoting people's health in the coming 15 years; a brand-new picture of a healthy China is being drawn step by step. It stressed that we should focus on general practitioners and strengthen the construction of talents at the grassroots level. Moreover, we should improve the training system for residents and specialists and establish a training mechanism for high-level public health and clinical medicine personnel.\u003c/p\u003e \u003cp\u003eGeneral practitioners, also known as family physicians or family physicians, are the leading providers of health management services. General practitioners possess unique attitudes, skills, and knowledge that qualify them to provide continuous and comprehensive medical care, health maintenance, and prevention services to each family member. Most general practitioners work at the grassroots level. They can provide comprehensive medical services to a broader range of people through the \"Bio-Psycho-Social model, \"which is of great significance to national health protection. The first standardized resident training system was established in 1988 in Shanghai, China\u003csup\u003e[2]\u003c/sup\u003e. Since then, China has been learning from the standardized training system for residents in the United States and the United Kingdom. In 2013, guidance on the establishment of a standardized training system for residents was published by the National Health Commission of the People's Republic of China and other 7 departments, which pointed out that standardized training for resident physicians refers to medical graduates, who after completing formal medical education, receive systematic and standardized training in the training base as resident physicians, focusing on improving clinical abilities. At present, China has integrated with the foreign general practitioner training system, the training mode is \"5\u0026thinsp;+\u0026thinsp;3\", that is, first accept 5 years of undergraduate education in clinical medicine, and then accept 3 years of standardized training for residents or 3 years of postgraduate education for master's degree. The standardized training of general practitioners is the core of the general medical education system, the main way to cultivate qualified general practitioners, and an important stage of the transition from \"medical student\" to \"junior doctor\" identity, which has a profound impact on their career. It has been reported in the literature that general practitioners are stressed, and their negative impact on mental health can affect patients' medical experience\u003csup\u003e[3\u0026ndash;7]\u003c/sup\u003e. The enormous pressure on GPs is related to their work environment, especially when acute infectious diseases occur\u003csup\u003e[8]\u003c/sup\u003e. Good work-life balance and contact with colleagues can reduce their stress\u003csup\u003e[9]\u003c/sup\u003e. How GPs felt on the first shift was not found in China. Therefore, it is of great significance to study all the experiences of trainees in the standardized training of general disciplines during the three-year training period.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Recruitment and Sample\u003c/h2\u003e \u003cp\u003eThe purposive sampling method was employed in this study. Initially, the researchers initiated telephone contact with the respondents to ascertain the location and schedule a face-to-face interview, followed by an individualized interview session in the subsequent week to provide an overview of the research context and explicitly clarify respondent expectations. Upon the willingness of participants to engage in subsequent semi-structured interviews, informed consent was obtained. The informed consent document delineated the research objectives, methodology, as well as inclusion and withdrawal criteria for potential subjects. Interviewers were trained personnel exhibiting homogeneity.\u003c/p\u003e \u003cp\u003eThe inclusion criteria: are (1) obtaining informed consent; (2) trainees who were taking standardized training courses for general practitioners in the hospital, and having the experience on independent duty during standardized residency training; and (3) being able to express the views clearly.\u003c/p\u003e \u003cp\u003eThe exclusion criteria: are (1) general practitioners who withdrew during the interview; and (2) general practitioners who didn't want to mention the on-duty experience.\u003c/p\u003e \u003cp\u003eThere were 7 subjects in this study, including 3 males and 4 females, aged 24\u0026ndash;36 years old, with an average age of 28 years old.\u003c/p\u003e \u003c/div\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eparticipants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003egender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eWorking years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eGraduation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eQualification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003eChildren\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.942307692307692%\" valign=\"top\"\u003e\n \u003cp\u003eN7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.775641025641026%\" valign=\"top\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eJuly 2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.55128205128205%\" valign=\"top\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33974358974359%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAppendix 1: The characteristics of the participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Design\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e1. Have you been on independent duty during standardized residency training?\u003c/p\u003e\n \u003cp\u003e2.\u0026nbsp;Could you describe what it was like on duty?\u003c/p\u003e\n \u003cp\u003e3. Could you describe the psychological state at the beginning of independent duty?\u003c/p\u003e\n \u003cp\u003e4. What did you feel the most challenge and pressure when you were on duty alone?\u003c/p\u003e\n \u003cp\u003e5.\u0026nbsp;How did you overcome or relieve your stress or challenge?\u003c/p\u003e\n \u003cp\u003e6.\u0026nbsp;What did you think the experience had any influence on your work or life?\u003c/p\u003e\n \u003cp\u003e7. Was there anything else you would like to tell me?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAppendix 2. The interview questions\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study extracted three themes: stress and challenges, coping strategies, and the impact of being on duty on one\u0026apos;s work or life. See Appendix 3 for details.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.95245641838352%\" valign=\"top\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.04754358161648%\" valign=\"top\"\u003e\n \u003cp\u003eSub-themes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.95245641838352%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eStress and challenges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.04754358161648%\" valign=\"top\"\u003e\n \u003cp\u003ei) Negative emotional reactions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eii）The rescue of critical patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eiii) Accepting new patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eiv）The lack of clinical reasoning and the accountability of senior physicians\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ev）Communication with family members of critically ill patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.95245641838352%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eCoping strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.04754358161648%\" valign=\"top\"\u003e\n \u003cp\u003ei) Accompanied and approved by the teachers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eii) Communicating and discussing with colleagues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eiii) Working with senior nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eiv）Increasing the frequency of ward round\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ev）Accumulating the knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.95245641838352%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eThe impact of being on duty on one\u0026apos;s work or life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.04754358161648%\" valign=\"top\"\u003e\n \u003cp\u003ei) Opportunity and Development\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eii) Improved communication and decision-making\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eiii) Changed the perspective of family and friends on oneself\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eiv）Leisure time decreased and the positive effect increased\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAppendix 3. Themes and sub-themes extracted from the analysis of the findings\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStresses and Challenge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNegative emotional reactions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany mentioned how emotionally stressed they felt at times, and the stress originated from negative emotional reactions, including anxiety, worry, discomfort, fear, and even breakdown. The timing of their shift is a determining factor. Only N5 was scheduled for duty following the teacher\u0026apos;s evaluation and personal consideration. N1, N2, N4, and N7 were assigned to duty due to insufficient manpower in the department. Conversely, N3 and N6 were mandated to be on duty independently as part of their training program, with prior psychological preparation.\u003c/p\u003e\n\u003cp\u003eN5 said, \u0026ldquo;I encountered significant pressure during my initial duty; however, it was manageable. Alongside nervousness, concern, and anxiety, I also embraced this opportunity for self-improvement.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN7 said, \u0026ldquo;Due to staff shortage in the department, I wasn\u0026apos;t adequately prepared for my first duty assignment. Fearful of missing out on this opportunity if declined, I promptly accepted despite feeling apprehensive about my competence while on duty.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u0026quot;Despite undergoing certain psychological preparation beforehand when admitting patients, I still found myself overwhelmed by panic and confusion,\u0026quot; said N6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe rescue of critical patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from N3, N4, and N7 revealed that critically ill patients experienced a sense of helplessness when their condition changed and harbored concerns about following incorrect medical advice, potentially leading to delayed rescue efforts. These fears were closely associated with their limited knowledge reserve in daily life. On the other hand, participants indicated in N5 that they possessed proficiency in the fundamental procedures of critical and severe patient care, enabling them to proactively prepare for verification processes without significant pressure. Specifically addressing the concern expressed in N4, \u0026quot;\u0026nbsp;What made me feel the most challenge and pressure was the emergency when I was on duty alone, especially the rescue of critical patients because I had never experienced them before. I was particularly anxious that any errors on my part may contribute to delays in managing the patient\u0026apos;s condition. Consequently, I found myself hesitant to make decisions and experience apprehension manifesting as physical unease.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccepting new patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN1, N3, and N6 expressed apprehension towards accepting new patients, particularly when faced with a high influx of patients simultaneously, which induced a sense of overwhelming urgency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe lack of clinical reasoning and the accountability of senior physicians\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN1 and N6 highlighted deficiencies in their comprehensive clinical knowledge, such as the management process for hospitalized patients, appropriate drug dosages, compatibility issues with liquids, diagnostic omissions, and errors, as well as advanced equipment utilization, like ventilator parameter adjustments. N6 said, \u0026quot;Reluctance to contact the second line staff is especially prominent during nighttime hours due to concerns about disturbing their rest or potentially eliciting impatience or negative evaluations from them.\u0026quot; \u0026quot;When confronted with a large number of patients alone, I was unable to cope effectively; moreover, the greatest pressure arises when family members exert pressure for immediate treatment,\u0026quot; said N1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunication with family members of critically ill patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to N3\u0026apos;s account, communicating with families in critical situations poses significant challenges for him as a young doctor since his abilities were often questioned by family members-especially when multiple individuals surrounded him-which adds additional pressure and fear of miscommunication or inadequate explanations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Coping Strategies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccompanied and approved by the teachers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe N1, N2, N3, N5, and N7 emphasized the significance of encouraging and recognizing exceptional physicians, particularly those in teaching roles. N1 highlighted that being accompanied by a superior physician could alleviate tension, especially if the superior physician examined all patients prior to duty. When their diagnosis and treatment plan received approval from the superior physician, it enhanced their confidence on duty and effectively reduced work-related pressure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunicating and discussing with colleagues\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN1, N4, N5, N6, and N7 emphasized the importance of increased communication with colleagues already on duty as a means to alleviate stress during their initial shift. N4 said, \u0026quot;I was used to asking them about their experiences on duty including challenges faced and effective strategies employed for learning purposes.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorking with senior nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN1, N2, and N7 indicated that collaborating with a senior nurse while on duty effectively alleviated their stress. N2 said \u0026quot;Engaging in communication with the nursing staff helped me gain a clearer understanding of the duties\u0026apos; processes and precautions. Some nurses promptly responded to my requests, reviewed my medical advice, and reminded me to rectify any identified errors, all of which significantly reduced the pressure I experienced during duty. I even believed that receiving support from nurses in the initial stages of duty was more crucial than that from the teachers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncreasing the frequency of ward round\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo enhance patient acceptance, N1, N2, and N7 expressed their intention to increase the frequency of rounds and engage in effective communication with patients. They believed that building trust through personalized care and attentiveness would alleviate duty-related pressure significantly.\u003c/p\u003e\n\u003cp\u003eN1 said, \u0026quot;For certain patients, I may make more than 5 bedside visits in order to gather comprehensive information about the illness and tailor a personalized diagnosis and treatment plan. I have observed that the more meticulous I was, the greater trust was established and the better I retain cautionary measures.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccumulating the knowledge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN3 and N5 expressed their commitment to enhancing their knowledge by reading more books, both domestic and foreign, studying diagnosis and treatment procedures in greater depth, and reviewing past cases to bolster their self-assurance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 The impact of being on duty on one\u0026apos;s work or life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOpportunity and Development\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcept for N6, all the other six people reported that their clinical skills had improved. N2 said \u0026quot;In terms of clinical practice, the teaching faculty has provided me with ample space and opportunities for hands-on experience. For instance, I have been able to personally perform procedures such as chest punctures and abdominal punctures under the guidance of experienced instructors, while always respecting patient preferences. And My clinical skills have been improved.\u0026quot; \u0026quot;The director allowed me to take responsibility for the patients as the bedside clinician because I hold a medical doctor practicing license and doctor qualification. Under the guidance of the teaching, I can master well the diagnosis and treatment process of common diseases in the department. And also cultivated the clinical ideation\u0026quot;, said N4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImproved communication and decision-making\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeven participants reported enhanced skills in communication and decision-making. N5 said that during my duty hours, I conducted multiple ward rounds, effectively communicated with patients and their families, and promptly made decisions during emergencies. These experiences significantly bolstered my proficiency in both communication and decision-making abilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanged the perspective of family and friends on oneself\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing independent duty, my clinical expertise and communication skills had significantly advanced, greatly benefiting my subsequent professional endeavors. In everyday life, owing to the rapid enhancement of my specialized knowledge, I was able to provide valuable professional guidance to my loved ones, thereby altering their perception of me. They now viewed me as an authentic medical practitioner, instilling a subtle sense of pride within myself. Furthermore, it had bolstered my professional identity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure time decreased and positive effects increased\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite a significant reduction in their spare time due to increased duty hours for preparation, N1 and N5 experienced heightened positive emotions towards both work and life after successfully treating and gaining recognition from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the saturated sample size of this study, the participants were GPs in the same session who lived in the same dormitory building and met frequently, and some information was exchanged, which may have led to the incompleteness of the results. However, this study was objective when collecting data to ensure the objectivity and reliability of the data. At the same time, during the interview process, we also tried to guide the doctors to express their own unique opinions and experiences, to avoid being influenced by the group\u0026apos;s opinions. Despite the limitations of this study, we believe that its conclusion still has some reference value.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe transition from medical student to junior doctor has always been considered a significant rite of passage\u003csup\u003e\u0026nbsp;[4]\u003c/sup\u003e. The research confirms that the transition is frequently experienced as very challenging and stressful\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[10]\u003c/sup\u003e. The main task of school days is to learn knowledge from textbooks. However, after graduation, they became junior doctor, who were lack of clinical experience and were capable of doing a large volume of work in the department and had to undertake the significant responsibility of maintaining health and saving lives. Meanwhile, some shared the growth as a general practitioner during the cycle around the department. They mentioned that they did learn so much from doing the job. Since 2015, standardized training for resident physicians has been fully implemented in China, aiming to cultivate medical professionals with a robust foundation, extensive knowledge, exceptional skills, and high-quality standards to meet the demands of medical science, technology, and healthcare development. With the continuous increase in national financial investment and the gradual expansion of trainee numbers, its effectiveness is progressively becoming evident by providing more individuals with opportunities for further education while enhancing the clinical proficiency of resident training physicians. Simultaneously, it has fortified hospital faculties and nurtured an increased pool of talented resident physicians for our nation and society. Studies have shown that general practitioners have a positive effect on patients, their family members, and caregivers\u003csup\u003e[11, 12]\u003c/sup\u003e. GPs must improve their expertise to deal with all kinds of problems at work\u003csup\u003e[13, 14]\u003c/sup\u003e. Medical authorities focus on GP stressors and provide support\u003csup\u003e[14, 15]\u003c/sup\u003e. This study explores stress and challenges, coping strategies, and the impact of being on duty on one\u0026apos;s work or life that Chinese GPs face during their first duty. This paper explores the pressures and challenges that Chinese GPs face during their first duty And analyses how they can gradually adapt and overcome these difficulties in practice. The first time on duty is a serious challenge for every general practitioner. They face not only a busy pace of work but also a comprehensive test of professional knowledge, communication skills, and resilience. In this process, GPs are often under great psychological pressure to ensure the safety and satisfaction of patients while dealing with various emergencies that may arise. However, it is these pressures and challenges that motivate GPs to learn and progress. They attend professional training, consult senior doctors accumulate experience, and gradually improve their professional ability and coping ability by accumulating experience in practice. At the same time, they also learned how to adjust their mentality and keep calm and rational, to better cope with various challenges at work. In addition to individual efforts, GPs also need support from hospitals and society. Hospitals can establish a better training system to provide more learning opportunities and resources for general practitioners; society can strengthen their recognition and respect for their work and enhance their sense of professional honor and belonging.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance had been granted to the authors prior to the study by the Medical Ethics Committee of Hanzhong Central Hospital and the ethical code is 202410. All methods were performed according to the guidelines and regulations of qualitative research.\u0026nbsp;The transcripts were coded without the participants\u0026rsquo; names, and numbers were used in all publications and dissemination of findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials used for analysis and conclusion are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no sources of funding for this project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWeina Bian and Yue Zhang contributed equally to this work and wrote the main manuscript text, Qinghua Zheng and Hongwei Yang undertook the design of the subject, Jieling He undertook the data analysis, Nina Ma and Guang Chen were responsible for data collection and Shumin Qin prepared search strategies. In a word, all authors read and reviewed the final manuscript. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the seven general practitioners for sharing their experiences. Thanks to Dr. Mary O\u0026apos;Rourke, Dr. William Evans, Dr. Catherien Browne, and Dr. Anna Marie Greene, for their selfless teaching. All the doctors work in the MUNSTER TECHNOLOGICAL UNIVERSITY, Ireland. Thanks to each of the authors for their efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWEINA BIAN, Email:[email protected]\u003c/p\u003e\n\u003cp\u003eYUE ZHANG, Email: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJIELING HE, Email：[email protected]\u003c/p\u003e\n\u003cp\u003eHONGWEI YANG, Email: [email protected]\u003c/p\u003e\n\u003cp\u003eNINA MA, Email：[email protected]\u003c/p\u003e\n\u003cp\u003eGUANG CHEN, Email：[email protected]\u003c/p\u003e\n\u003cp\u003eSHUMIN QIN, Email：[email protected]\u003c/p\u003e\n\u003cp\u003eQINGHUA ZHENG,Email:[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDONG B, ZOU Z, SONG Y, et al. Adolescent Health and Healthy China 2030: A Review[J]. Journal of Adolescent Health, 2020,67(5): S24-S31.\u003c/li\u003e\n\u003cli\u003eZHU J, LI W, CHEN L. Doctors in China: Improving quality through modernization of residency education[J]. The Lancet, 2016,388(10054): 1922-1929.\u003c/li\u003e\n\u003cli\u003eFENG J, JIANG H, SHEN X, et al. Occupational stress and associated factors among general practitioners in China: a national cross-sectional study[J]. BMC Public Health, 2022,22(1).\u003c/li\u003e\n\u003cli\u003ePEDERSEN A F, VEDSTED P. Burnout, coping strategies and help-seeking in general practitioners: a two-wave survey study in Denmark[J]. BMJ Open, 2022,12(2): e51867.\u003c/li\u003e\n\u003cli\u003eJob Satisfaction and Its Associated Factors Among General Practitioners in China[Z].\u003c/li\u003e\n\u003cli\u003eKALETA F O, KRISTENSEN C B, DUNCAN M, et al. Cognitive mechanisms and resilience in UK-based general practitioners: cross-sectional findings[J]. Occupational Medicine, 2023,73(2): 91-96.\u003c/li\u003e\n\u003cli\u003eDEGEN L, LINDEN K, SEIFRIED-D\u0026Uuml;BON T, et al. Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVEjob)[J]. International Journal of Environmental Research and Public Health, 2021,18(18): 9458.\u003c/li\u003e\n\u003cli\u003eSOTOMAYOR-CASTILLO C, NAHIDI S, LI C, et al. General practitioners\u0026rsquo; knowledge, preparedness, and experiences in managing COVID-19 in Australia[J]. Infection, Disease \u0026amp; Health, 2021,26(3): 166-172.\u003c/li\u003e\n\u003cli\u003eCHESHIRE A, RIDGE D, HUGHES J, et al. Influences on GP coping and resilience: a qualitative study in primary care[J]. British Journal of General Practice, 2017,67(659): e428-e436.\u003c/li\u003e\n\u003cli\u003ePITKALA K H, MANTYRANTA T. Professional socialization revised: medical students\u0026apos; own conceptions related to the adoption of the future physician\u0026apos;s role--a qualitative study[J]. Medical Teacher, 2009,25(2): 155-160.\u003c/li\u003e\n\u003cli\u003eWANGLER J, JANSKY M. Support, needs and expectations of family caregivers regarding general practitioners \u0026ndash; results from an online survey[J]. BMC Family Practice, 2021,22(1).\u003c/li\u003e\n\u003cli\u003ePETER S, VOLKERT A M, PFAFF H, et al. General Practitioners\u0026rsquo; Perspectives on General and Specialized Palliative Home Care in North Rhine, Germany: An Explorative Focus Group Study[J]. American Journal of Hospice and Palliative Medicine\u0026reg;, 2021,38(1): 32-38.\u003c/li\u003e\n\u003cli\u003eBUGAJ T J, VALENTINI J, MIKSCH A, et al. Work strain and burnout risk in postgraduate trainees in general practice: an overview[J]. Postgrad Med, 2020,132(1): 7-16.\u003c/li\u003e\n\u003cli\u003eJOHNSSON L, NORDGREN L. The voice of the self: a typology of general practitioners\u0026apos; emotional responses to situational and contextual stressors[J]. Scandinavian journal of primary health care, 2022,40(2): 289-304.\u003c/li\u003e\n\u003cli\u003eMATHEW S, MASH R. Exploring the beliefs and attitudes of private general practitioners towards national health insurance in Cape Town, South Africa[J]. Afr J Prim Health Care Fam Med, 2019,11(1): e1-e10.\u003c/li\u003e\n\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-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"qualitative research, the standardized training of general practitioners, independent duty, psychology","lastPublishedDoi":"10.21203/rs.3.rs-4573142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4573142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aims to explore the challenges and stresses encountered by general practitioners during standardized residency training while on independent duty, as well as identify effective coping strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study adopted qualitative research. We conducted in-depth interviews with 7 trainees who were undergoing standardized training courses for general practitioners and analyzed the obtained information using content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe extracted three themes, stress and challenges, coping strategies, and the impact of being on duty on one's work or life, from the study.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe qualitative research revealed the psychological state experienced by general practitioners when faced with stresses and challenges, as well as effective coping strategies employed during the initial phase of independent duty.\u003c/p\u003e","manuscriptTitle":"A qualitative Study on Stress response and Coping of General Practitioners at the Beginning of Independent Duty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-08 17:41:15","doi":"10.21203/rs.3.rs-4573142/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2024-06-18T11:10:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-06-13T02:57:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"69dd2877-348e-46ac-b370-c2ce766da27a","owner":[],"postedDate":"July 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-11-20T05:23:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-08 17:41:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4573142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4573142","identity":"rs-4573142","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}