The Drivers and Barriers of Clinical Health Professions Student Flourishing: An Integrative Review

To determine the drivers and barriers to flourishing for clinical health professions students through a review of peer-reviewed literature.

Articles were analyzed in Scopus, PubMed, and EBSCOHost and hand-searched education journals through May 2024 describing flourishing among clinical health professions students. Whittemore and Knafl's integrative approach was used, and quality was assessed by the Mixed Methods Appraisal Tool.

The 26 articles included medical (14/26, 53.8%), pharmacy (8/26, 30.8%), physician assistant (3/26, 11.5%), and nurse anesthetist (1/26%, 3.8%) students. Results were framed by the Social Ecological Model. Individual drivers included meaningful work, feeling valued, and pride in overcoming challenges, while barriers included feelings of self-sacrifice to achieve success. Intrinsic factors were both drivers and barriers (eg, positive affect was positively correlated with flourishing). Interpersonal drivers included feelings of belonging, social relationships, and mentorship, while scheduling conflicts was a barrier. Organizational drivers included integrated wellness efforts and faculty buy-in, while barriers included inadequate recovery time between demanding tasks, required participation in activities perceived to have individual low-value, and resource inaccessibility/insufficiency. There was a deficit in the exploration of the impact of communities, public policy, and race and/or ethnicity on flourishing.

Limitations include possible exclusion of relevant articles due to search term and database selection. Students, faculty, and programs are cocreators of environments that promote or thwart flourishing. Educators can intentionally create learning environments that promote flourishing through increasing student autonomy, implementing community-building activities, and developing individual values in the context of training.