Transition to Residency at Large University Teaching Hospital in Egypt: A Qualitative Study of Surgical and Emergency Medicine Residents.

Background: The transition to residency (TTR) is a critical and challenging phase for medical graduates, particularly in specialties like surgery and emergency medicine (EM). There is limited research exploring the experiences of residents in resource-limited non-Western settings. Objective: To explore how surgical and EM residents at a university hospital in Egypt perceive, navigate, and respond to the multifaceted challenges of the TTR within a clinical environment characterised by limited resources and high demand. Methods: A qualitative descriptive study using directed content analysis, guided by Schlossberg's 4S transition framework, was conducted during the 2024-2025 academic year across multiple campuses within a large, university-affiliated hospital system in Egypt. Purposive maximum variation sampling was employed to include residents from various hospital locations, surgical specialties, and training levels. Semistructured interviews and focus groups were conducted by the primary researcher. All data were analyzed deductively using ATLAS.ti software. Results: A total of 20 residents from 4 Alexandria University hospitals participated in the study, including 10 general surgery residents (specializing in gastrointestinal/hepatic, head and neck, ophthalmology, and orthopaedic surgery) and 10 EM residents. Data were collected through 12 semistructured interviews and 2 focus groups, each with 4 residents. Transition experiences were heterogeneous and shaped by gender and workforce dynamics. High physician turnover and staffing shortages in tertiary care settings increased the pressure on residents in their early roles. Organizational, peer, and family support were key in overcoming these challenges. Conclusions: In resource-constrained settings like Egypt, individual and systemic factors shape the TTR.