'I've been here before, but never looked at the ceiling': Narratives of medical trainees who took illness-based...

Medical training is commonly imagined as a linear, uninterrupted progression, yet many trainees experience illness that necessitates a leave of absence (LOA). Illness-based leaves may be especially fraught given stigma, opaque processes and training cultures that prioritise endurance. Little is known about how trainees experience illness and illness-based leaves.

We conducted a narrative inquiry using Riessman's narrative analysis framework. Canadian physicians who had taken an illness-based LOA during medical school or residency were recruited nationwide. Semi-structured, in-depth interviews were completed between December 2022 and July 2023, audio-recorded, and transcribed verbatim. Analysis was inductive and iterative, examining narrative content and structure to understand participants' meaning-making and shifting positioning within their stories. Rigour was supported through reflexive practice, collaborative team analysis and Criteria for Reporting Qualitative Research (COREQ)-informed reporting.

Seven participants shared the stories of their illness-based leaves because of diverse conditions (including rheumatologic disease, malignancy, mental illness, traumatic brain injury and a movement disorder). Narratives followed common threads: (1) identity disruption, as illness fractured self-concepts built on competence and grit and shifted trainee identities from clinician to patient; (2) loss of narrative control with shifting protagonists, as administrative and service demands shaped decisions and timelines, often intensifying vulnerability; (3) isolation and perceived illegitimacy, compounded by cohort separation, stigma and the need to justify both 'visible' and 'invisible' illness; (4) misalignment between individual needs and structural expectations, marked by unclear processes, limited accommodations, and reliance on informal workarounds or external advocacy; and (5) meaning-making and purpose-greater humanism and advocacy-coexisting with residual disillusionment when systems remained unchanged.

Illness-based leaves in medical training are narrated as profound identity disruptions, shaped by structural rigidity and cultural expectations of uninterrupted productivity. Training programmes should develop transparent, compassionate leave and accommodation processes, normalise vulnerability within professional identity formation and incorporate trainees' voices into policy to better support learners who become ill. This will retain the perspectives they bring to patient care and teaching.