L. Christophe 1 , P. Arnaud, P. Eliane 1 , A. Anne-franc Ëoise 1 ; 1 University Hospitals of Geneva. Dep Int Medicine, Geneva, Switzerland OBJECTIVES: The first years of professional activity are critical for doctors in training. However, little is known about the difficulties encountered by residents. METHODS: We put the following open question to 24 consecutive residents in a structured one year training in internal medecine: «Please, identify 2 to 3 major difficulties/concerns related to your practice of medicine within this hospital». Each resident gave confidential written answers. These were coded into 8 categories by content analysis by 3 researchers. RESULTS: Characteristics of the residents were: female: 37% , mean age: 28 2.2 years, mean duration of postgraduate training: 2.5 1.3 years. The total number of answers was 122, with an average of 5.1 1.3 per resident. 93% of the residents expressed difficulties in their relationships with their colleagues or felt not adequately supervised. 63% judged that they were not respected or recognized by senior staff. 63% admitted feelings of severe disarray and helplessness in dealing with patients. 58% complained about work overload. 50% felt burdened by the intensity of emotional investment and responsibility towards patients. Finally, 16% admitted fearing for their professional future and only 8% cited lack of theoretical knowledge about the diseases they were dealing with. Four answers did not fit into the 8 above categories. CONCLUSION: Most of the interviewed residents in training expressed major difficulties within their professional relationships. Feelings of inadequate practical and relational training by medical school, of lack of recognition by senior staff, and of work pressure and overload were common. These elements challenge the organisation/coaching in our institution and should lead us to improve our teaching. METHODS: Internal medicine residents are exposed to curriculum in cancer prognosis using several instructional strategies including didactic/lecture, small group case discussions, roleplaying and debriefing actual patient encounters. Additionally, some of the residents participate in an elective block rotation in end-of-life issues providing them with more intensive exposure by following patients in our hospice program. Along with relevant reading assignments for background, residents review sample case studies of terminally ill patients at latter stages of illness. After learning a system of estimating prognosis they discuss how this information may be used to design care plans so that the therapies that are most appropriate in light of known prognosis are chosen. Residents review basic principles of communicating with patients about prognosis and end-of-life issues that they then implement in role playing exercises. RESULTS: Formative and summative evaluation methods are utilized to assess progress toward the objectives. These include individual faculty preceptor assessments of residents caring for terminally ill patients, knowledge and attitude questionnaires regarding end-of-life issues, scenarios highlighting communication issues, and resident self-assessment. In addition, roleplays are rated on several criteria and feedback is given to residents in a post session briefing.