Navigating rural medical training: mapping the landscape of resident physician wellbeing using critical realist...

Family Medicine residents in rural training programs experience a unique set of challenges and rewards, including professional isolation, resource limitations, and increased autonomy. These contextual features deeply influence their personal and professional wellbeing or wellness. The purpose of the study was to map the landscape of wellness resources and initiatives for resident physicians in rural Alberta.

Using a critical realist lens, this study followed a qualitatively-driven sequential explanatory mixed methods design collecting both quantitative (survey) and qualitative (interview) data. Family Medicine residents were invited to complete a survey that collected their demographic data and information about their wellness practices. Follow-up interviews using a semi-structured guide were conducted with residents and preceptors in rural clinical sites. Interviews were coded by at least two members of the research team independently. Discrepancies in coding were discussed until consensus was achieved. The context, mechanism, and outcome (CMO) configurations were applied to Bhaskar's laminated systems model (LSM) to describe the interpretation and integration of both data sources.

27 rural family residents participated in an online survey, with 7 participating in semi-structured interviews. An additional 7 rural preceptors were interviewed to examine resident wellness from their perspective. Most residents reported positive experiences and adequate support from their programs. However, frequent stress and burnout remained a concern for over one-third of residents. Community integration and participation was reported as integral to maintaining wellness for residents, with preceptors leveraging mentoring relationships as a way to support resident wellness.

The findings allow medical educators to recognize the systemic and relational conditions that promote resident wellness and support resilience. This could potentially encourage the design of interventions that are attuned to the layered structure of reality, targeting not only individual coping strategies (e.g., self-care) but more importantly structural and systemic reforms, institutional continuity, and relational support systems.