Structural Determinants of Health-Related Quality of Life in Internal Medicine Residents: An Ethnographic Study

Abstract

Introduction: There is limited qualitative evidence in the global medical literature regarding the quality of life of medical residents. Objective: To understand the meanings of health-related quality of life (HRQoL) among internal medicine residents in Medellín, Colombia, in 2024. Methods: An ethnographic study was conducted with 12 internal medicine residents selected through theoretical sampling. In-depth interviews, participant observation, and field diaries were employed. The hermeneutic analysis was based on coding, categorization, conceptual sorting, and semantic relationships. Methodological rigor was ensured through reflexivity, triangulation, credibility, and auditability. Results: The concept of HRQoL encompasses both physical and mental health aspects, as well as the structural elements of the training process that emerged as determinants of HRQoL. These factors were grouped into three categories: meanings of HRQoL among residents which includes subcategories such as family life, leisure, income, and recognition; individual, institutional, and healthcare system determinants affecting HRQoL, and the impacts of residency associated with lifestyle changes, including poor sleep quality, high consumption of energy drinks, smoking, poor nutrition, sedentary behavior, and worsened physical and mental health. Conclusion: The HRQoL of medical residents is negatively affected by healthcare system structures, such as limited residency positions, faculty profiles, high tuition, and low compensation. These stressors lead to unhealthy coping strategies, including poor sleep, diet, and limitation of social interactions, risking residents’ health and compromising patient care quality. It is recommended that regulatory and institutional changes be made to improve the HRQoL for this population.