Residency is designed to produce highly skilled physicians that can execute under pressure. But as expectations for safety, quality and documentation have shifted, many health systems are reexamining whether traditional training structures unintentionally undermine the very clinicians they aim to prepare.
During a recent Becker’s Hospital Review webinar sponsored by Marvin Behavioral Health, leaders from Stanford (Calif.) University School of Medicine and Grand Blanc, Mich.-based McLaren Health Care discussed how hospitals are embedding resident well-being into graduate medical education. The conversation underscored a central tension: While training structures are designed to promote patient safety and clinical excellence, they can unintentionally intensify stress, isolation and mental health risk for residents.
Below are four key takeaways from the discussion.
Note: Quotes have been edited for length and clarity.
1. Sleep deprivation and workload amplify emotional strain
Even with increased awareness of physician burnout, residency remains defined by high workloads and chronic sleep disruption. Mickey Trockel, MD, PhD, director of evidence-based innovation at the Stanford University School of Medicine WellMD Center, said insufficient sleep directly affects residents’ ability to regulate emotion during challenging clinical situations.
“When residents are not getting enough sleep, they’re more likely to experience more intense emotions when exposed to the kinds of traumatic circumstances that they’re helping people with,” Dr. Trockel said.
He explained that sleep deprivation weakens the brain’s regulatory pathways, making it harder to process distressing events. Residents frequently care for patients on “their very worst days,” and when sleep loss compounds those experiences, the psychological toll can escalate.
Work intensity has also evolved. Patients are generally more acute, documentation demands have shifted to EHRs and time pressures have increased. And while the 80-hour workweek limit — established in 2003 by the Accreditation Council for Graduate Medical Education — was designed to preserve time for basic self-care, Dr. Trockel noted that it did not account for time needed to sustain personal relationships. This omission has measurable consequences. Research cited by Dr. Trockel suggests that strain on personal relationships experienced by residents has a strong correlation with burnout.
2. Perfectionism and contingent self-worth drive distress
Both panelists emphasized that many mental health challenges in residency are rooted in culture, not individual weakness.
Dr. Trockel described a pattern of “low self-valuation,” in which residents become harder on themselves than they would be on others. Over time, striving for clinical perfection can evolve into contingent self-worth — where mistakes feel like personal failures rather than opportunities for growth.
“When I make a mistake in pursuit of perfect medical practice, then that feels entirely unacceptable…it’s more of a feeling of ‘I am a mistake,'” he said, describing how errors can feel fixed and permanent rather than correctable.
Robert Flora, MD, chief academic officer and vice president of academic affairs at McLaren Health Care, said his system has worked to counter this dynamic by prioritizing psychological safety. No resident is placed on academic probation without his review, a safeguard intended to ensure fairness and context.
At McLaren, health psychologists have been embedded into residency programs. Residents are also assessed early on for risk factors such as extreme perfectionism and given access to structured coaching during the first year of training.
3. Isolation is increasing — even in highly interactive roles
Despite constant interaction with patients and care teams, physicians report higher levels of isolation than many other professions. Panelists attributed part of this to the evolution of care delivery.
EHRs have reduced informal peer interaction, and documentation demands often tether residents to computer screens. Dr. Trockel shared an example of a radiology program that improved well-being by reconnecting radiologists with patients during positive cancer scan discussions. This simple intervention helped restore meaning and human connection.
Broader societal shifts also play a role. Declining trust in institutions and heightened polarization have reduced psychological safety for open dialogue in clinical spaces. As Dr. Trockel noted, conversations that once felt routine among trainees now feel riskier, contributing to emotional distance.
4. Trust and word of mouth determine whether residents seek care
While most training programs now offer mental health resources, utilization depends on trust, accessibility and cultural acceptance.
Dr. Flora said peer advocacy has been critical at McLaren. During orientation, residents lead panel discussions about their experiences and openly share how they have used available mental health services.
“The stigma is gone,” he said, noting utilization rates between 30% and 50% among residents.
Dr. Trockel echoed that peer endorsement is the most powerful driver of engagement. Still, even with peer endorsements, structural barriers to access can remain. Residents may hesitate to leave clinical duties for appointments, fearing they will burden colleagues. Leaders, the panelists agreed, must actively create coverage solutions and reinforce that seeking care is both acceptable and expected.
The discussion concluded with a broader reflection: The shift toward normalized mental healthcare in medicine reflects generational change, expanded research on burnout and lessons learned during the COVID-19 pandemic. As Dr. Trockel put it, well-being support should function like a construction worker’s hard hat — essential protective equipment in a high-risk profession.
The message from Dr. Trockel and Dr. Flora was clear: Resident well-being cannot be an add-on. It must be designed into the structure of training itself.
Marvin was founded by physicians who experienced residency mental health gaps firsthand and built infrastructure specifically for graduate medical education. More than 300 programs—including Harvard South Shore, Jefferson Health, Cedars-Sinai, and Wayne State—use Marvin to meet ACGME 2026 requirements.
Marvin’s model provides structural confidentiality (zero institutional visibility into individual care), 24/7/365 access to licensed clinicians, healthcare-specific clinical expertise (therapists trained in moral injury, shift work, hierarchical dynamics), in-network with 99% of commercial plans (eliminating resident out-of-pocket costs), and aggregate outcome data demonstrating functional systems to site visitors.
Learn more: https://www.meetmarvin.com/
