J Educ Eval Health Prof.  2015;12:3. 10.3352/jeehp.2015.12.3.

Health-related quality of life and happiness within an internal medicine residency training program: a longitudinal follow-up study

  • 1Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. abhasnee.sob@mahidol.ac.th
  • 2Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.


While undergoing a hospital residency training program, residents often suffer anxiety and stress. This study aims to evaluate the change in health-related quality of life and happiness among internal medicine residents, and identify prognostic factors.
Thirty-eight residents in the Ramathibodi Hospital internal medicine training program completed the World Health Organization Quality of Life-BREF and happiness Measures questionnaires at three time points: commencement, day 100, and the end of the second year of training. Confidence, expectations, anxiety, and general health were rated. Analyses were performed with mixed linear regression.
Financial problems were reported for 16 residents (42.1%). At baseline, most residents had moderate-to-very high confidence, expectations, and general health but also moderate-to-very high anxiety. The health-related quality of life score was highest in the social domain followed by the environmental, psychological, and physical domains. Their psychological, physical, social, and environmental scores significantly decreased after enrollment. Their happiness and general health scores were significantly reduced after enrollment. The training program duration was negatively associated with all domains. Residents with greater confidence had higher health-related quality of life scores in the physical, psychological, and environmental domains. Moreover, their general health was positively associated with the social and environmental domains.
A reduction in health-related quality of life and happiness under the internal medicine residency program is reported. High confidence and good physical health may counterbalance the decline in health-related quality of life and happiness.


Anxiety; Follow-up studies; Internship and residency; Linear models; Quality of life

MeSH Terms

Follow-Up Studies*
Internal Medicine*
Internship and Residency*
Linear Models
Quality of Life*
World Health Organization


1. Irvine EJ. Quality of life: measurement in inflammatory bowel disease. Scand J Gastroenterol Suppl. 1993; 199:36–39.
2. Compton WC. Measures of mental health and a five factor theory of personality. Psychol Rep. 1998; 83:371–381. http://dx.doi.org/10.2466/pr0.83.5.371-381.
3. Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002; 136:384–390. http://dx.doi.org/10.7326/0003-4819-136-5-200203050-00011.
4. Heller FR. Restriction of duty hours for residents in internal medicine: a question of quality of life but what about education and patient safety? Acta Clin Belg. 2008; 63:363–371. http://dx.doi.org/10.1179/acb.2008.076.
5. Macedo PC, Citero Vde A, Schenkman S, Nogueira-Martins MC, Morais MB, Nogueira-Martins LA. Health-related quality of life predictors during medical residency in a random, stratified sample of residents. Rev Bras Psiquiatr. 2009; 31:119–124. http://dx.doi.org/10.1590/s1516-44462009000200007.
6. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998; 28:551–558. http://dx.doi.org/10.1017/s0033291798006667.
7. Saxena S, Carlson D, Billington R; The WHOQOL Group; World Health Organisation quality of life. The WHO quality of life assessment instrument (WHOQOL-Bref): the importance of its items for cross-cultural research. Qual Life Res. 2001; 10:711–721.
8. Fordyce MW. A review of research on the happiness measures: a sixty second index of happiness and mental health. Soc Indic Res. 1988; 20:355–381. http://dx.doi.org/10.1007/bf00302333.
9. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009; 302:1294–1300. http://dx.doi.org/10.1001/jama.2009.1389.
10. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011; 306:952–260. http://dx.doi.org/10.1001/jama.2011.1247.
11. Cohen JS, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ. 2005; 5:21.
12. Msaouel P, Keramaris NC, Tasoulis A, Kolokythas D, Syrmos N, Pararas N, Thireos E, Lionis C. Burnout and training satisfaction of medical residents in Greece: will the European Work Time Directive make a difference? Hum Resour Health. 2010; 8:16. http://dx.doi.org/10.1186/1478-4491-8-16.
13. Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgrad Med. 2012; 124:241–249. http://dx.doi.org/10.3810/pgm.2012.07.2583.
Full Text Links
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr