Intensive care unit clinical environments are characterized by high acuity, clinical uncertainty, and care of critically ill patients. These workplace conditions create sustained occupational demands on trainees. During residency, physicians must adapt not only to clinical complexity but also to stressors related to their life stage and training progression. Excessive stress in residents can impair clinical performance and may negatively affect patient outcomes, making it important to identify factors that shape how residents experience stress during ICU rotations.
This study aimed to identify which baseline psychological characteristics and personal factors, measured prior to an ICU rotation, are associated with residents’ stress levels across a three-week clinical rotation. The analysis focused on whether pre-rotation measures of stress, burnout, affect, depression, anxiety, personality traits, social support, and conflict predict stress trajectories recorded during the rotation.
The authors conducted a secondary data analysis of 54 ICU residents who completed a three-week clinical rotation. Prior to the rotation, participants completed validated measures of baseline constructs including perceived stress, two dimensions of burnout (exhaustion and disengagement), positive and negative affect, depressive symptoms, trait anxiety, personality traits, perceived social support, and interpersonal conflict.
During the rotation, stress was assessed twice daily. To estimate associations between baseline factors and stress across time, the investigators used generalized estimating equations (GEE), an analytic approach suitable for repeated measures and correlated observations. The analysis compared stress trajectories across postgraduate year (PGY) levels and examined which baseline psychological variables predicted higher or lower stress during the rotation.
Compared with PGY-1 residents, PGY-2 and PGY-3 residents reported lower daily stress across the three-week rotation. This finding indicates that level of training was associated with differences in perceived stress during ICU work, with more advanced trainees experiencing lower average stress in this sample.
Several baseline psychological measures were associated with stress during the rotation. Higher baseline trait anxiety predicted higher reported stress across the rotation. Similarly, greater baseline negative affect was associated with higher stress during the ICU rotation.
By contrast, some baseline measures were not significantly related to stress in this analysis. Baseline depression, reported social support, and measures of conflict were not significantly associated with stress trajectories during the rotation according to the reported results.
Personality traits demonstrated distinct relationships with stress. Higher agreeableness at baseline predicted lower stress across the rotation, while higher conscientiousness predicted higher stress. These divergent associations suggest that different personality dimensions may either buffer against or amplify perceived stress in ICU settings.
An unexpected association emerged for burnout dimensions: baseline burnout due to exhaustion was associated with lower reported stress during the rotation. In contrast, burnout due to disengagement showed no significant association with stress. The authors report this counterintuitive finding but do not provide mechanistic explanations in the abstract; further details were not reported in the source abstract.
The study demonstrates that baseline psychological profiles meaningfully shape resident experiences of stress during ICU rotations. Observable differences by postgraduate year, and the predictive associations of trait anxiety, negative affect, and specific personality traits (agreeableness and conscientiousness), indicate that individual factors measured before clinical training can identify residents at higher or lower risk of elevated stress.
These findings suggest opportunities for residency programs to consider pre-rotation screening or assessment of psychological risk factors. Identifying trainees who are more likely to experience high stress could inform targeted supports such as mentorship, resilience training, access to psychological services, or tailored supervision strategies. The authors note that awareness of individual differences in stress responses may help supervisors foster supportive learning environments and promote open conversations about well-being during demanding clinical rotations.
In plain terms, the analysis of 54 residents over a three-week ICU rotation found several resident characteristics associated with how stressed they felt during the rotation. More senior residents (PGY-2 and PGY-3) reported less daily stress than PGY-1s. Higher baseline trait anxiety and negative affect predicted more stress during the rotation. Personality traits were linked to stress in opposing ways: agreeableness was linked to lower stress, while conscientiousness was linked to higher stress. Baseline burnout from exhaustion was unexpectedly linked to lower reported stress, whereas burnout from disengagement, depression, social support, and conflict were not significant predictors in this dataset.
Residency programs may use these insights to develop broadly accessible well-being initiatives and to consider how individual resident characteristics relate to experiences during intensive clinical rotations. Potential supports mentioned include mentorship programs, resilience training, and psychological support to enhance both trainee well-being and patient safety.
Note: The source abstract reports the study design, sample size (n = 54), measures, and principal findings but does not provide full methodological details, effect sizes, or subgroup analyses in the abstract text. Those details were not reported in the source abstract provided here.