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Physician resilience: a grounded theory study of obstetrics and gynaecology residents
Author(s) -
Winkel Abigail F,
Robinson Annie,
Jones AubrieAnn,
Squires Allison P
Publication year - 2019
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/medu.13737
Subject(s) - grounded theory , thematic analysis , context (archaeology) , psychological resilience , psychology , clarity , credibility , qualitative research , medical education , nursing , social psychology , medicine , sociology , political science , paleontology , social science , biochemistry , chemistry , law , biology
Objective Enhancing physician resilience has the promise of addressing the problem of burnout, which threatens both doctors and patients and increases in residents with each year of training. Programmes aimed at enhancing physician resilience are heterogeneous and use varied targets to measure efficacy, because there is a lack of clarity regarding this concept. A more robust understanding of how resilience is manifested could enhance efforts to create and measure it in physicians in training. Methods A qualitative study used grounded theory methodology to analyse semi‐structured interviews with a purposive, intensity sample of obstetrics and gynaecology residents in an urban academic health centre. Longitudinal engagement through two sets of interviews 3‐6 months apart allowed for variations in season and context. Thematic saturation was achieved after enrollment of 18 residents representing all 4 years of postgraduate training. A three‐phase coding process used constant comparison, reflective memos and member checking to support the credibility of the analysis. Results A conceptual model for resilience as a socio‐ecological phenomenon emerged. Resilience was linked to professional identity and purpose served to root the individual and provide a base of support through adversity. Connections to others inside and outside medicine were essential to support developing resilience, as was finding meaning in experiences. The surrounding personal and professional environments had strong influences on the ability of individuals to develop personal resilience. Conclusions Physician resilience in this context emerged as a developmental phenomenon, influenced by individual response to adversity as well as surrounding culture. This suggests that both programmes teaching individual skills as well as systematic and cultural interventions could improve a physician's capacity to thrive.