Starting a residency program can be an anxious transition for any new clinician. Before entering the operating room, first-year anesthesiology residents may struggle to feel that they belong in a new setting.
A study by Yale School of Medicine’s Department of Anesthesiology published in the Journal of Education in Perioperative Medicine explores how first-year anesthesiology residents use a unique toolset to find where they fit into a new medical community.
Nicholas Cormier, MD, assistant professor of anesthesiology and lead author of the study, has been through this experience. Cormier completed his residency in 2024 and a head and neck anesthesiology fellowship in 2025, both at Yale. He knows there are several steps new anesthesiology residents can take to find their place, which helps during the shift from medical student to clinician.
“When I started my anesthesia residency, it was during the COVID-19 pandemic. It was a time when we had masks and respirators on, and the only thing exposed was our eyes,” says Cormier. “All those things that make residency a time of camaraderie, like social gatherings and going out together, were all kind of erased.”
The study describes a belongingness journey with four stages:
- Stepping into liminality: “I’m in surgery, but I’m not a surgery resident, or medicine, but I’m not a medicine person … it’s always standing in that middle spot,” says one study participant.
- Cohesion with or without contact: “I think with orientation, we were all kind of always together versus now we’re all kind of scattered … [Our class] was extremely cohesive at that time and … I still feel like we’re still cohesive in that sense, even though we don’t see each other that often,” says one intern.
- Purpose-driven belonging: "There’s an anesthesia lens that you can put on when you’re in every rotation … I think it could serve as like a tether almost to the [anesthesia] department,” suggested one intern.
- Self-actualization: “It’s the feeling of warm sunshine on a cold winter morning ... I have this glow on my face … It felt like I had arrived,” an intern commented as the end of their first year approached.
In most cases, interns did not experience these stages all at once but slowly adjusted to the new roles and environments. By developing their sense of belonging gradually, interns found a sense of stability during a time of uncertainty.
Cormier and the research team conducted one-on-one interviews with anesthesiology residents to get a better understanding of how they felt in their first year. Multiple study participants mentioned repeated phrases such as “otherness” and “imposter syndrome.”
Interns complete one clinical year before starting dedicated anesthesiology training, which can feel like limbo—or what the study calls liminality—before they focus directly on anesthesiology. This first year includes broad exposure to several different departments, including internal medicine, general surgery, and surgery subspecialties.
“You’re not in medical school anymore. You’re not in your full profession yet. You’re in this in-between zone,” says Cormier. “Being in that in-between zone is destabilizing. So, being able to put words to it and name what we’re feeling, is important.”
During this time, residents must learn to develop that initial community while distanced from many of their fellow interns. Residents built a sense of community through department events and activities organized via group text conversations.
Anesthesiology interns described feeling a stronger sense of belonging when they were able to find purpose in their work. They found that each rotation was useful, and would help their future anesthesiology careers, no matter the department.
When residents are part of a community of practice, they feel connected and tend to share a common goal with those around them. In these communities, residents start to form a sense of belonging and identity that is important for long-lasting confidence and purpose. It can impact motivation and performance. However, that feeling isn’t always automatic.
Cormier plans to use these findings to create a professional development curriculum for future anesthesiology interns, focused on each tool they use in their individual belongingness journeys.
With a better understanding of first-year anesthesiology resident experiences, the medical education team can better tailor their approach to meet interns where they’re at.
“Yes, the skills are important, the knowledge is important, all of those things are important,” says Cormier. “But I think the prerequisite to acquiring all those things is a sense of belongingness. You can’t thrive, you can’t learn, you can’t do any of those things if you don’t have that prerequisite first.”