More Than a Social Hour: Residency Retreats for Core Skill-Building and Professional Identity Formation

Technical Summary: Residency Retreats for Core Skill-Building and Professional Identity Formation

Problem Statement
Residency retreats in graduate medical education (GME) have historically functioned primarily as social events designed to foster peer connection and physician well-being. While existing literature acknowledges their role in community building and wellness, there is a significant gap in utilizing these retreats to address educational deficits or to systematically support Professional Identity Formation (PIF). PIF is defined as the gradual process by which physicians internalize the values and norms of the medical profession, shaping their thinking, feeling, and sense of belonging. Although PIF is recognized as a fundamental goal of medical education, residency programs often lack intentional, systematic curricula to support this transformation, particularly during critical developmental transitions (e.g., intern to junior resident, junior to senior resident). Furthermore, current curricula often fail to explicitly address how sociopolitical events and institutional contexts influence a trainee's internalization of professional values.

Methodology
The authors, representing the University of California, San Francisco (UCSF) Internal Medicine Residency Program, applied Kern's six-step approach to curriculum development to transform their annual retreats from social gatherings into structured educational venues. The program, comprising 185 internal medicine residents, utilized the following steps:

1. Problem Identification and General Needs Assessment: The team analyzed institutional and program-level outcomes using GME surveys, MedHub evaluations, and residency-specific surveys. They also examined external contextual factors, including sociopolitical events and health policy changes.
2. Targeted Needs Assessment: Data was synthesized from direct resident feedback, town halls, and suggestion boxes. Chief residents played a critical role in identifying educational needs based on their recent experiences and feedback from near-peers.
3. Learning Objectives and Educational Strategies: Specific learning objectives were developed to target identified program gaps. The curriculum engaged faculty champions, chief residents, and resident leaders to design content. Formats were selected to align with knowledge and skill-based objectives, including didactics, small groups, and community service.
4. Implementation: The program secured institutional support for protected academic time, clinical coverage, and funding. Retreats evolved from one-hour sessions integrated into didactics to half-day, class-wide sessions. Coverage models included peer coverage, moonlighting, and schedule adjustments to ensure full participation.
5. Evaluation and Feedback: Post-retreat qualitative evaluations were conducted to assess content relevance, speaker effectiveness, and the attainment of learning objectives. These surveys, developed by chief residents and program leadership, informed iterative curriculum revisions.

The curriculum was tailored to specific developmental stages and affinity groups. Key retreats included:

• R1 Leadership Launch: Focused on team management, code leadership, and psychological safety.
• R2 Reflection Retreat: Focused on team management, triage, supervision, and career planning.
• Anti-Racism Symposium (ARS): Focused on systemic change, community partnerships, and narrative medicine.
• Women in Leadership Development (WiLD): Focused on negotiation, imposter syndrome, mentorship, and authentic leadership for women-identifying residents and allies.

Key Contributions
The paper outlines a framework for integrating PIF into residency retreats by aligning them with Kern's curriculum development model. The primary contributions include:

• Structural Transformation: Demonstrating how retreats can be re-engineered from social events into venues for core skill-building and PIF.
• Contextual Integration: Showing how retreat content can be adapted to address specific sociopolitical contexts (e.g., the COVID-19 pandemic, the "White Coats for Black Lives" movement) to help trainees navigate their professional identities within broader societal frameworks.
• Curriculum Examples: Providing specific examples of sessions that target PIF domains such as socialization within communities of practice, internalizing professional values, role modeling, self-reflection, and resilience. Examples include "Back to the Bedside," "Code Blue Leadership Pearls," and "Solidarity Coalition" workshops.
• Implementation Strategy: Detailing the logistical requirements for success, including the necessity of institutional support for protected time and clinical backfill.

Results
Through the application of this framework, the UCSF program successfully identified areas requiring growth and tailored the retreat curriculum to incorporate PIF content. The implementation resulted in:

• Responsive Curriculum: The ability to rapidly adapt content to current events, such as adding crisis leadership and guideline adaptation sessions during the pandemic, or anti-racism frameworks following national social movements.
• Iterative Improvement: Continuous refinement of retreats based on resident feedback. Specific responsive changes included adding board preparation content to the R2 retreat, triage sessions to the R1 retreat, and negotiation workshops to the WiLD retreat.
• Integration: Retreats are now embedded within the residency program structure, valued as essential spaces for skill development, PIF, and camaraderie.

Significance and Claims
The authors claim that their work demonstrates how residency retreats can be intentionally designed to support Professional Identity Formation without adding undue burden to an already stretched curriculum. By using intentional curricular design, elements of PIF can be naturally integrated into existing structures. The paper argues that retreats provide a unique "protected time" and a sense of psychological safety, creating an ideal environment for residents to reflect on their evolving roles and clarify their emerging professional identities.

The significance of this model lies in its potential to be adapted by other programs to incorporate PIF into other curriculum activities, such as morning reports, noon conferences, and outpatient didactics. The authors acknowledge that barriers to adaptation exist, including clinical coverage, competing curricular needs, and the requirement for institutional support and funding. They conclude that while PIF is a crucial component of trainee development extending beyond technical skills, structured retreats offer a viable mechanism to facilitate this internalization of professional values and norms.