Appreciating Appreciation: Residents' Experience Feeling Valued Differently as Learners, Physicians, and Employees.

Purpose: Cultures of wellness, defined as shared norms, values, attitudes, and behaviors that promote personal and professional growth and well-being, are robust determinants of professional fulfillment and professional performance. A major and largely overlooked aspect of a culture of wellness in medicine is residents' perceived appreciation or experience of feeling valued. Considering the pressing workforce and retention challenges that residency programs face, this study addressed the following research questions: How does appreciation at work manifest in the eyes of residents and how do residents perceive appreciation in relation to their professional fulfillment and performance?

Method: Guided by an interpretative phenomenological approach, this qualitative study purposively sampled 12 residents from different specialties, training years, regions in the Netherlands, and genders. Residents' individual experiences with appreciation at work were explored in semistructured interviews conducted between October 2022 and March 2023. Thematic analysis was used for data analysis.

Results: Residents perceived appreciation as "being seen and heard" and further described how appreciation at work manifested using 3 narratives. As learners, residents felt appreciated when their competencies were acknowledged and supervisors created room for individual growth. As physicians or colleagues, residents felt appreciated when they experienced meaningful patient contact, high levels of collegiality, and self-appreciation through successes at work. As employees, residents felt appreciated when their (extra) efforts were noticed, they were properly facilitated in their work and training, and their well-being was prioritized. Residents said that receiving appreciation boosted their mental health, self-confidence, professional commitment, and professional fulfillment, thereby benefiting their performance and the quality of patient care they deliver.

Conclusions: Appreciation at work is important for residents and manifests itself within the narratives of learner, physician or colleague, and employee. Which narrative is foregrounded depends on context, but regardless feeling "seen and heard" at work is crucial for residents' fulfillment and performance.