Eligible participants for this study included the facilitators for BREW Rounds and current or recently graduated UBC anesthesia residents who had previously attended at least one BREW Round. Residents typically rotate through BCCH twice in residency, in 4-, 6-, or 8-week blocks, during their junior residency year 2 (R2) and their senior residency year 4 (R4); residents may also have a placement at BCCH during their transition-to-practice (TTP) at the end of residency year 5. The facilitator was recruited through email, and residents were recruited by either invitation to participate via email or a Research Electronic Data Capture (REDCap) survey [16] that they completed at the end of their rotation.

Participants were made aware that the study was being conducted to better understand BREW Rounds and that interviewers were not involved with their management, supervision, or assessment. Once an eligible participant expressed interest in the interview, their email address was added to the BREW interview electronic consent (eConsent) database on REDCap and an eConsent form was generated. Research staff coordinated a Zoom interview time and date via email.

An invitation outlining the premise of the study and a link to a REDCap survey (see Multimedia Appendix 1) was created by the research team and sent to staff anesthesiologists at BCCH by the Principal Investigator (ZB) via a departmental email distribution list.

The interviews followed a semistructured format with a preestablished interview script (see Multimedia Appendix 2). At the start of each interview, the lead interviewer introduced all parties and assured participants that there were no right or wrong answers, that none of the interviewers had experienced BREW Rounds firsthand, that the conversation was confidential, and that the interviewing investigators were not involved in managing, supervising, or assessing the residents or BREW Rounds facilitators. Data collection began after confirming their interest to participate and verbal confirmation of consent to record the interview. Interviews lasted approximately 45 minutes and were ended at the interviewers’ discretion that all topics had been covered and the interviewee had no further contributions. Each interview was conducted by 2 or 3 investigators from the Pediatric Anesthesia Research Team: N West (male, Clinical Research Coordinator, 13 y experience) conducted 9 interviews; JL (female, Clinical Research Assistant, 1 y experience) conducted 11 interviews; N Wang (female, Anesthesia Clinical Fellow) conducted 7 interviews; and MW (female, Clinical Research Assistant, 1 y experience) conducted 2 interviews.

The investigators had an existing working relationship with the BREW Rounds’ facilitator who participated in the study; N West had previously worked with the TTP resident on a quality improvement project; N Wang had worked in the same clinical setting as the resident participants. No other participants had any existing relationship with the investigators, although they may have encountered them during their placement at the hospital.

We used the Zoom software to automatically transcribe the recorded audio from the interviews. Two investigators (MW and JL) deidentified the participant’s Zoom ID, cleaned, and validated the transcript files with reference to the interview recording.

After the initial invitation email was sent out, reminders were sent to staff through signal messages (two times) and emails (two times), and the survey was closed after 14 days once we felt that no further responses would be received.

Analysis followed a qualitative descriptive approach [17,18] based on thematic content analysis. Interview transcripts were analyzed using NVivo R1 (version 1.7.2 Lumivero) to construct themes using both a conventional content analysis method [19], in which initial coded themes were identified by one researcher before discussion with the team, and directed content analysis to confirm whether and how our data aligned with the preconceived theme of “community-building”; this process was conducted iteratively (see below). We aimed to continue recruitment until we reached sufficient information depth and breadth, and all interested groups were sufficiently represented, that is, we had achieved a balance of junior, senior, and facilitator participants.

MW first watched all interviews that they had not attended to become familiarized with the ideas discussed in each conversation. Using the auto-transcribed files from the Zoom software in conjunction with the interview recordings, the raw files were deidentified, formatted, and validated. The validated transcripts were read in-depth once more during initial thematic charting, in which main themes and subthemes were coded and refined based on the frequency, depth of discussion, and perceived importance of topics by MW. The updated themes were reviewed with N West, N Wang, and JL and finalized to best represent the captured concepts. The data were then recoded using the updated themes to improve its accuracy into each respective theme that was established.

The quotes used for this manuscript were chosen based on what was thought to best capture each finalized theme or subtheme, as well as keeping a balance of representing all interview participants’ ideas. Sample quotes associated with its description can be recognized as italic font, with credit to the deidentified participant type and/or number at the end. The quotes were preserved to their original transcription to the furthest extent. Finally, the themes, their descriptions, and representative quotes were verified with one of the resident interview participants and the BREW facilitator.

Survey data were exported from REDCap to an Excel Microsoft (Redmond, WA) file. Likert-scale statement responses were grouped into five categories: strongly disagree, disagree, neutral, agree, strongly agree. Response choices for each statement were recorded as a frequency and a percentage. Survey comments were categorized based on their content.

This study was reviewed and approved by the UBC/Children’s and Women’s Health Center of British Columbia Ethics Board (H22-03516). The initial application with semistructured interviews was approved on January 25, 2023. An amendment was made to include the staff survey, which was approved on September 10, 2024.

Participants who were recruited and expressed interest in our project were sent a Research Ethics Board–approved invitation outlining the premise and aim of the study, as well as what participation entailed. Semistructured interview participants then signed a REDCap eConsent form prior to setting up any interview details.

Consent was implied for staff anesthesiologists who filled out the survey.

Interviews were not anonymous to the research team as they were conducted over Zoom, but transcripts were later deidentified. Any personal information provided was protected by the privacy law in British Columbia, the Freedom of Information and Protection of Privacy Act. We collected this information under section 26 (e) of Freedom of Information and Protection of Privacy Act.

Staff survey responses were anonymous to the research team unless participants included any identifiable information in their free-text responses.

A CAD $50 (equivalent to approximately US $37) Starbucks gift card was sent to resident participants who joined the interview. There was no compensation for completing the staff survey.

These highlight the importance of including structured wellness programs, such as facilitated peer discussions into resident curriculums, which accords with other evaluations of similar programs within anesthesiology and other specialties [14,20-23]. We compared each of the main themes that we constructed from our interview transcripts with prior research.

Residents who have participated in peer discussion groups aimed at improving wellness appreciated being able to share their experiences and stressors, as well as hearing the challenges of others [14]. One of our interviewed residents voiced the concern of being vulnerable to seniors, and two others expressed anxiety around feeling “unsafe” in different situations during BREW Rounds. Creating a safe environment in which participants feel comfortable to share their experiences is essential and may be harder to achieve with a mix of junior and senior participants. This idea was well developed in a qualitative exploration of a peer discussion group for an emergency medicine residency program in California [21]; the investigators identified subthemes related to the “more experienced other,” with junior members being encouraged to share their own experiences after seeing their senior colleagues expressing vulnerability and finding comfort in knowing that senior colleagues had encountered similar challenges during their early training.

Staff from previous studies also show similar attitudes toward residency peer discussion programs. Program directors who responded to a survey by Chakravarti et al [20] recognized the importance of resident well-being and agreed that physician and resident wellness directly affects patient care. Although surveyed staff in our department did not think residents’ clinical skills would be improved by attending BREW Rounds, some of the residents we interviewed expressed an increase in their clinical knowledge from topics discussed during the sessions. Furthermore, a previous survey of BREW participants reported that 70% thought the program benefitted their clinical care [13]. While most staff understood the purpose of BREW Rounds, they were not aware of the content of discussions because of the agreed-upon confidential nature of the rounds.

The space created for residents in BREW Rounds may also be contributing to the feelings of camaraderie and interconnectedness within their peer group. The sense of community gained by our resident participants from BREW Rounds was echoed in a study at the West Virginia School of Medicine, in which residents expressed the importance of social connectedness between themselves and their peers [22], which may be a particularly relevant issue for anesthesiology residents [7]. Similarly, Jain et al [21] found that residents who participated in a peer discussion group felt less isolated and felt a stronger sense of belonging within their cohort.

Existing research suggests that residents believe mentorship is a key factor in supporting their well-being [20]. Trainees who are mentored have increased achievements and satisfaction in their career overall [24,25]. We found that as a part of our initial goal of improving resident well-being through BREW Rounds, many residents appreciated the mentorship opportunities they obtained from the weekly sessions. In a 3-year curriculum plan aimed to improve wellness in anesthesia residency, Thornton et al [14] found that the most common positive feedback from residents was the small-group discussions, particularly with seniors and faculty. Furthermore, another study found that residents viewed the peer support program in the emergency medicine program to be more of a mentorship opportunity rather than a solution to burnout [21].

Residents from the University of Michigan partaking in a similar program stated that having the choice for level of participation increased their comfort and was appreciated [23]. Although it is mandatory for the residents to be let out from their clinical duties at 3 PM once a week, residents at BCCH are not obligated to attend BREW Rounds. The University of Michigan researchers acknowledged that lack of time spent for self-care and free time can contribute to burnout [23]. This highlights the importance of having protected time for BREW Rounds, combined with optional attendance, so that residents are free to attend if they wish to do so. All participants who were interviewed had positive associations and feedback for the snacks, which seemed to contribute greatly to the success of BREW Rounds. Residents from other studies also mentioned the importance of food as an incentive for engagement and to improve overall well-being [21-23].

Although Jain et al [21] evaluated a program with alumni as facilitators instead of an external, trained professional, similar themes of comfort, sense of belonging, and vulnerability were identified. Compared to the residents of our study who discussed the importance of having an external facilitator, their residents preferred talking to those with a similar background, stating they were able to understand the niche hardships they experience. Although not trained in anesthesia, our BREW facilitators have worked in the hospital setting for many years and have a high level of exposure to issues experienced by different specialists during their clinical care. Furthermore, in line with our facilitator’s interview, the primary responsibility of the facilitator is to keep the conversation safe and contribute perspective to the issues and concerns raised [21].

When we asked residents what they thought of expanding the BREW Rounds to fellows, or even staff anesthesiologists, as participants or facilitators, most thought that including those who are higher on the career ladder would take away from the safe space that BREW Rounds currently affords. On the contrary, other researchers have reported that having alumni and staff join peer discussions can be seen more positively by the residents [14,21]. Most residents and some staff agreed that BREW Rounds, in the same format or similar, should be expanded to other institutions. While the initial motivation for BREW Rounds was based on the idea that a pediatric anesthesia rotation was potentially more stressful for trainees than other anesthesia environments, this idea was not borne out by the comments of our participants, who felt that other settings have their own challenges and would benefit from the BREW approach.

Four residents we interviewed mentioned a concern about the impact of growing cohort size, stating that it may be harder for everyone to have a chance to speak up at BREW Rounds. The ideal number of participants in BREW Rounds may be different for each individual. However, further consideration may be required in larger residency programs; participants deemed our typical BREW session group size (typically 3‐4) to be adequate or even optimal but had concerns that benefit would be lost for some participants in larger groups of 8‐10 or more. A descriptive analysis of free-text comments in the feedback obtained from over 500 obstetrics and gynecology residents following the implementation of a wellness curriculum in the United States suggested that small group size was considered important to facilitate engagement [26]. A recent qualitative study of resident peer reflection sessions in the Netherlands determined that 5‐7 was an optimal group size to ensure both depth of experience and safety for participants [27], which is consistent with our findings.

Previous research highlights the negativity that can sometimes arise during peer discussions in the clinical setting [21]. This was also mentioned in our interviews, notably by the facilitator, who had received this feedback directly during the first year of BREW Rounds. Residents seemed to prefer informal peer discussion like BREW Rounds compared to formalized career improvement lessons surrounding topics such as conflict management, leadership, and communication [14].

There were discrepancies between resident interview comments and staff survey responses. In particular, some residents felt strongly that BREW Rounds had a positive impact on their clinical skills (see Theme 1), echoing a finding from our previous survey, which demonstrated reduced self-efficacy concerns following the BREW intervention, with 70% of participants reporting that their clinical care had benefitted [13]. On the other hand, in the present survey, only 2/16 (13%) staff believed BREW Rounds benefitted residents’ clinical skills. This may be partly due to different interpretations of “clinical skills” (activities involved in “hands-on” patient care vs broader professional capabilities, such as patient communication, leadership, and team management) but may also be due to the confidentiality surrounding BREW Rounds, which means that staff may be unaware that BREW topics include clinical scenarios and peer-to-peer teaching. Furthermore, staff may not have considered the strong evidence for an association between clinician well-being and clinical performance [28]. Educating staff on the general themes commonly discussed at BREW Rounds and the correlation between well-being and the development of clinical or professional skills may help to achieve departmental support. Our BREW facilitator recently presented at our departmental rounds on this topic. Ongoing outreach on the goals and content of the program, while maintaining confidentiality of individual conversations, could strengthen buy-in from interested parties and ensure its continuation.