Reclaiming Values-Driven Education: An Exploration of Medical Trainees’ Values Open Access

Well-being is an essential consideration for modern professions. This is especially true of medicine where, despite the fulfilling potential of its practice, 25% to 60% of physicians across specialties report experiencing burnout.¹  Prominent among affected physicians are medical trainees whose self-doubt, mistreatment by often overworked and underappreciated mentors, reckoning with health care inequities, and other early career challenges have raised questions of the values and intended outcomes of medicine.^2,3  This sentiment was amplified by the COVID-19 pandemic wherein already unsure and potentially compulsive medical trainees assumed longer hours and more significant personal risk than their non-medical peers, who instead saw shifts to work-from-home and otherwise boundary-protected careers.^1,2 

Values-based medical practice has been discussed as a path to reclaiming meaning in medicine. Values in this context represent broadly defined, intrinsic motivations that can influence specific goals. It has been documented that physicians whose personal values were not in line with their work, especially when overworked, were prone to cynicism and exhaustion.³  This dissonance of personal values and workplace values can deteriorate a “calling” into an otherwise uninspiring occupation.²  On the contrary, as elaborated by the self-determination theory, satisfaction can be kindled by autonomous values and choices driving behaviors.⁴  When personal values carry into the workplace, it is easier to be one’s self. When leadership shares their constituents’ values, there is a sense of belonging.

Thus, focused work on defining personal values will be essential for actualizing more fulfilling medical education and practice.^1,2  This article highlights one such discussion of medical trainees’ values and reflects on their implications for the future of medical education and the health care system.

The Accreditation Council for Graduate Medical Education (ACGME) has 3 councils that advise its Board of Directors. One of these councils, the Council of Review Committee Residents (CRCR), is composed of a trainee member from each of the ACGME’s 34 specialty review committees, designees from the ACGME’s 2 other advisory councils, and the Board’s resident representatives from the American Medical Association and the American Osteopathic Association. The CRCR’s resultant unique and diverse perspective on medical education and practice is invaluable for analysis of issues facing medical trainees.

The CRCR explored the topic of trainee values through a modified appreciative inquiry design during its May 2024 meeting. This employed a 4-pronged, constructive discussion format including: (1) “discovery,” appreciating the best of a present circumstance; (2) “dream,” considering the potential; (3) “design,” attempting to envision a balanced reality from the dreamed potential; and (4) “destiny,” creating actionable steps to actualizing the desired reality. The CRCR’s discovery phase involved a lecturette highlighting the impact values have on identity and behaviors, differentiating values from goals, virtues, and roles, and explaining how values might shift significance in various domains of life (eg, workplace versus personal relationships). After establishing this background, each committee member was asked to prioritize their most important workplace values from a provided list (Figure, Panel A). This list was then discussed in iteratively larger groups (Figure, Panel B) until a consensus “top 5” was achieved by the CRCR (Figure, Panel C). The remaining discussion considered implementation of these consensus values into aspects of residency training programs (dream phase), a strengths, weaknesses, opportunities, threats (SWOT) analysis of the present medical education system (design phase), and actionable steps the ACGME and other stakeholders might undertake to help realize a new ideal (destiny phase). While elements of each portion of this discussion yielded informative results, the purpose of this article is to explain the prioritized values identified during the discovery phase.

Service was among the most commonly discussed values, which the CRCR more broadly defined as accountable and honest care of patients, self, and others. As physicians, service is at the core of our profession and has remained a primary motivator for providers across generations.^5,6 

Yet, the CRCR noted important differences between trainee-valued service and workplace-actualized service. The present academic workplace is often characterized by an imbalance of educational and employment related responsibilities wherein trainees find themselves working on administrative tasks that move patients through an overwhelmed medical system rather than interacting with and learning from patients directly.⁷  This frequently involves assumption of tasks that may not promote practice at trainees’ level of licensure such as patient appointment scheduling, administrative record keeping, and interfacing with health care adjacent industries (eg, insurance providers). Such tasks are known to contribute to physician dissatisfaction while detracting from patient-facing time, and trainees find these tasks negatively impacting their education more than their program directors realize.^8,9  The CRCR did, however, recognize how such tasks could enhance education if balanced with patient-facing responsibilities. For instance, appointment scheduling could demonstrate the complexity of a patient’s care course, record keeping engages patients’ narratives and interprovider communication, and conversations with insurance providers promote skills in patient advocacy.

The CRCR encouraged a shift by educational programs toward more trainee-directed, patient-facing activities. Additionally, the CRCR recognized a need for trainees to shift away from a dichotomous service-versus-education mentality. If balanced and patient-centered, service can promote meaningful educational experiences that develop well-rounded, competent, and empathetic physicians.

The discussion group also prioritized growth, valuing an inner drive to question and explore. Personal growth is a process by which individuals gain awareness and understanding of themselves resulting in changes in feelings, attitudes, or behaviors and leading to improved effectiveness, health, or well-being.^10-12  The perception of personal growth has been well demonstrated to be an essential part of psychological well-being.¹³  Accordingly, it has also been shown to promote physician satisfaction.^14,15  Yielding high amounts of such personal growth during GME training has been associated with programmatic support and facilitation of time for reflection.¹² 

During the CRCR’s conversations, trainees specifically mentioned the need to better align with the principle of medicine as a “lifelong learning process.” Trainees discussed that values-based education driven by growth would shift from the goal of “knowing it all” to prioritizing a sustained curiosity and the skills to continually improve. Further, such programs would embrace the growth mindset—promoting a psychologically safe environment for seeking help, constant learning, and time for trainee self-reflection. Trainees believed this reframing would decrease burnout, perfectionism, and imposter syndrome within their learning cohorts.

Connection is a crucial element that instills purpose in the medical profession and fosters empathetic, patient-centered care. Throughout discussion, trainees across the specialties recalled impactful encounters with patients that ignited their budding scientific curiosity into a zealous pursuit of medical education. Sharing in patients’ experiences promotes reciprocal trust and a mutually valuable patient-physician relationship. Such connections have also been shown to facilitate clinically effective and emotionally supportive care, leading to improved patient adherence to treatment and better health outcomes.¹⁶ 

CRCR members also considered how meaningful connections with other learners, mentors, program leaders, and the interdisciplinary workforce influence educational experiences and future practice patterns. Studies have linked these peer and mentor relationships to reduced burnout, higher job satisfaction, and greater resilience among medical professionals.¹⁷  The CRCR thus felt that programs, the ACGME, employers, and other health care entities should embrace opportunities to develop “soft skills,” such as empathetic communication, interpersonal relationship building, and conflict resolution for all leadership roles.

Finally, trainees emphasized the power of a connection to oneself and a higher power, both in a religious and spiritual sense. Trainees appreciated the expanse of medical science while also recognizing that it is not omniscient or omnipotent. Namely, trainees felt it important to admit that they and medicine are fallible with shortcomings. Some trainees added that such conscious practice helped them better understand themselves and fulfill their life and occupational purpose.

Ultimately, by prioritizing compassionate connection to others, self, and a higher power, trainees can contribute to lasting, collaborative care teams.

The CRCR highly regarded a workplace value of equity, encompassing subthemes such as inclusiveness and respect. Beyond technical and instrumental support from GME, they emphasized a need for opportunities to engage in diversity, equity, and inclusion (DEI) initiatives, explore social justice issues, and connect with their communities. Trainees also expressed an importance of feeling acknowledged and celebrated in all their diverse, intersecting identities, thereby fostering a more inclusive and supportive learning environment.

Health equity is sought through active participation in the reduction of health disparities. From the CRCR’s perspective, pursuing health equity is crucial for the medical community. Trainees can play a vital role in reducing disparities by evaluating their biases to promote more equitable care. Other lauded tenants for the pursuit of equity were cultural humility and care for underserved populations. Increasing diversity within the medical workforce, particularly in underrepresented groups, further promotes a sense of belonging for providers and patients alike, thus meeting these goals and benefiting all.^18-21  Fortunately, guiding resources are already beginning to support equitable recruitment, representation, and integration in training programs and patient care.^22-25 

Health, encompassing both mental and physical well-being, was a key value identified by the CRCR. They noted that the well-being of their patients was both a central value and goal of an ideal education. The CRCR also recognized that maintaining self-care is crucial to both modeling appropriate preventive health measures and providing care for patients. Moreover, training programs that prioritized trainee well-being enabled their learners to more fully engage in patient-physician relationships and high-quality care.¹ 

Medical education today, however, often separates and opposes the health of the patient and their providers. As previously discussed, long hours, the assumption of high personal risk, the imbalanced demands of employment over educational responsibilities, and the common practice of requiring other trainee coverage to allow personal care can prevent engagement with educational initiatives and well-being resources.^1-3,7-9  Residency programs incorporating health as a core value might instead create systems for trainee wellness such as psychological health resources, physical fitness opportunities, and days for personal care that do not come at the expense of patient well-being or other trainees’ time. Prioritizing a balance between valuing patient and also physician health could prove pivotal for graduation of capable and engaged providers empowered to advocate for their own well-being as a means of contributing to improved collective health outcomes.

The disconnect between physician and workplace values, and associated lack of autonomy, is driving physicians away from medicine.²⁶  Consideration of this multispecialty trainee values discussion in program development can aid in the creation of patient- and learner-centered opportunities that foster competent and fulfilled physicians. As described above, there are areas for growth in individual mindsets along with changes to system structure and culture that can bring these values to fruition. If training programs are designed accordingly, skill development is likely to expand beyond acquisition of medical knowledge to include soft skills that reclaim the humanity of medicine.²⁷  Values exploration might also impact recruitment as programs shift to values-based selection processes that support these notions.^24,28 

During this exercise, the CRCR also considered how these values may endure as compared to both prior and future generations of physicians. They noted values such as “service” and “connection” would likely resonate across generations given their fundamental place in medical practice. One survey demonstrated that most physicians wished they could spend more time with patients and do more to help them stay well.²⁹  Obversely, “equity” and “health”—at least as they pertain to the trainees’ experience—were thought to be newer priorities that may not have had a voice in prior generations’ practice environments. The CRCR emphasized that society’s awareness and prioritization, especially in the wake of the COVID-19 pandemic, has likely shaped present trainee values and will hopefully lead to continual growth within medicine. Equity and health, when blended with the enduring values of service and connection, were believed to promote activism, justice, inclusivity, and overall improved well-being of both patients and providers.

Equally noteworthy is an exploration of which values were not favored by trainees. As previously discussed, “knowledge” was not prioritized by the group, as “growth” took its place given the expansive and constantly evolving landscape of modern medicine. Also not represented were values such as “independence,” “solitude,” or “success,” which suggests that medical trainees desire a collaborative and collectively beneficial environment. Trainees also did not emphasize “thrift” or other monetary values. This could be interpreted both positively, in that trainees were not ultimately driven by financial gain, but also negatively, in that cost-consciousness of health care delivery remains undervalued within a health care system that spends more than any other developed nation in the world.³⁰  Importantly, as a podcast by Dr Rosenbaum also highlighted, the valuation of profit remains an impactful dissonance between trainees and many of their institutions and future employers.³¹ 

Overall, realigning physician, training program, and clinical workplace values can certainly contribute to improved physician well-being, learning environments, mentor-mentee and patient-physician relationships, and patient satisfaction and outcomes.

A primary assumption for this exercise suggests that representative values, were they ideally aligned, might create circumstances that help physicians thrive. However, there are inevitable limitations which could hamper external validity of the committee’s consensus.

Each resident is conditioned to their personal training environment, narrowing the scope of their experiences. Further, limited consideration of program size variation, the greater populations served, and the non-academic environment could have created cognitive biases. Notably, CRCR members are academically inclined, often using personal time to attend ACGME endeavors, which does not mirror the majority of trainees’ experiences. In the necessarily limited time delegated to this exercise, it may have been difficult to ensure maximal understanding of the appreciative inquiry process (see discussion format). It is also difficult to ensure value consolidation was scientifically consistent within the subgroups. Differing learning styles, assorted trainee personalities, and the amount of shared influences from society within each group are additional considerations for variation in the process. Finally, the CRCR’s diverse and specialty-representative cohort may not fully exemplify the greater 158 000 residents from ACGME-accredited programs.³²  For instance, family medicine and internal medicine account for 30% of all residents, yet have only one CRCR representative each, just as smaller specialties representing only 0.2% of residents.³³ 

Nevertheless, though scientific rigor demands addressing sources of possible bias and validity consideration, this exercise yielded consensus and overwhelmingly positive feedback from the group.

Through an appreciative inquiry-based discussion, a multispecialty group of medical trainees identified 5 essential workplace values: service, growth, connection, equity, and health. While many of these align with values held by physicians across generations, certain values were not previously given attention and remain underrepresented in modern academic medicine. As our field continues to evolve, further exploration of workplace values and reconciliation of the dissonance between provider and system values will be quintessential to the preservation of the house of medicine. The CRCR hopes that sharing this exercise and the resultant values might encourage others’ values explorations, facilitate cross-generational connection and conversation, and spark intentional program and health care system reform.

The authors would like to acknowledge all CRCR members for contributing to the meaningful discussion that inspired this work, and extend a special thanks to Amy Beane, Kimberly Son, Kristin Rohn, and Timothy Brigham for helping design and moderate this enlightening endeavor.

The ACGME News and Views section of JGME includes data reports, initiatives, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University, the US Department of Defense, or the US Government.