BackgroundPhysician well-being impacts both doctors and patients. In light of high rates of physician burnout, enhancing resilience is a priority. To inform effective interventions, educators need to understand how resilience develops during residency.MethodsA qualitative study using grounded theory examined the lived experience of resilience in residents. A cohort of obstetrics and gynecology residents were selected as a purposive, intensity sample.. Eighteen residents in all years of training participated in semi-structured interviews. A three-phase process of open coding, analytic coding and thematic analysis generated a conceptual model for resilience among residents.ResultsResilience among residents emerged as rooted in the resident’s calling to the work of medicine. Drive to overcome obstacles arose from personal identity and aspiration to professional ideals. Adversity caused residents to examine and cultivate coping mechanisms. Personal connections to peers and mentors as well as to patients and the work helped buffer the stress and conflicts that present. Resilience in this context is a developmental phenomenon that grows through engagement with uncertainty and adversity.ConclusionResilience in residents is rooted in personal and professional identity, and requires engagement with adversity to develop. Connections within the medical community, finding personal fulfillment in the work, and developing self-care practices enhance resilience.

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.

In this article, we explore the possibility of adding a new role to the clinical encounter: an illness doula. Even though research and education in medical humanities and narrative medicine have made improvements in humanizing healthcare, progress is slow and ongoing. There needs to be an intervention in the practice of healthcare now for people currently going through the system. An illness doula, like a birth doula, would facilitate and insure that attention is paid to the personal needs and desires of the patient in the present system. We envision illness doulas having the ability and availability to accompany the patient throughout the healthcare process, to help communicate with clinicians, and to ensure that patient preferences are understood and respected along the way. We discuss how this idea emerged through the clinical encounters of two of our authors, the possibilities and limitations of creating a new role for illness doulas, and the logistics of how to put this new role into play.

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Practice nurses can signpost patients with long-term conditions, dementia, and common mental health conditions to Reading Well Books on Prescription, as Annie Robinson explains