Unfolding insights about resilience and its coping strategies by medical academics and healthcare professionals at their workplaces: A thematic qualitative analysis

Unfolding insights about resilience and its coping strategies by medical academics and healthcare professionals at their workplaces: A thematic qualitative analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unfolding insights about resilience and its coping strategies by medical academics and healthcare professionals at their workplaces: A thematic qualitative analysis Salman Yousuf Guraya, Jacqueline Maria Dias, Mohamed Ahmed Eladl, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5033621/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Feb, 2025 Read the published version in BMC Medical Education → Version 1 posted 12 You are reading this latest preprint version Abstract Background Health care professionals (HCPs) and medical and health academics (MHAs) strive to maintain and promote population health through evidence-based medical education and practice. At their workplaces, due to the demanding nature of work, HCPs and MHAs face substantial degree of physiological, psychological, and physical stress including burnout. Resilience has therefore become a fundamental necessity in the medical field. Our research aimed to acquire an in-depth comprehension of how HCPs and MHAs understand, cultivate, and sustain resilience when confronted with challenges and stressors at their workplaces. Methods We reviewed the existing corpus of literature on resilience, stressors, and coping strategies and followed an iterative process of deliberations for the development of a questionnaire. It was validated by content experts and was piloted on a small group of MHAs of the University of Sharjah (UoS) and HCPs from different hospitals of the United Arab Emirates to test its relevance, clarity of items, internal consistency, and inter-observer validity. The validated questionnaire was then used for in-depth interviews on HCPs and MHAs. Lastly, we adopted the Braun and Clarke 6-stage thematic model for qualitative data analysis. Results Our study recorded insights of 170 participants; 69 MHAs and 101 HCPs. Through an inductive thematic analysis of responses, three overarching themes with sub-themes emerged; cognitive mastery (cognitive appraisal and problem-solving abilities), affective well-being (gratification from professional efficacy and social support), and conative efficiency (proactive approaches and introspection and reflection). Other main findings highlighted stress-related factors, realistic expectations, personal well-being and work-life balance. MHAs were concerned about academic output and research, while HCPs were stressed about patient care, delivery of services, and workload. These constructs showcase an intricate interplay between cognitive mastery, affective well-being, and conative efficiency. Conclusion The findings of our study bestow valuable insights into the dynamic nature of resilience in the medical profession. The synergies and dissimilarities in work-life balance, personal productivity, and job-specific stressors among HCPs and MHAs demand a well-structured resilience program. The themes of cognitive mastery, affective well-being, and conative efficiency are interconnected and can help foster work-life balance and personal well-being of HCPs and MHAs to improve their resilience. Stressors resilience health care professionals medical and health academics resilience work-life balance Figures Figure 1 Background The medical and health sciences sector is distinguished by its unique set of challenges, complexity, and vital functions in the society ( 1 ) ( 2 ). Healthcare professionals (HCPs) and medical and health academics (MHAs) including doctors, scientists, and educators, and physicians from diverse medical disciplines play pivotal role in maintaining and enhancing human health by providing quality heathcare services and excellence in medical education ( 2 , 3 ). The demanding nature of healthcare systems and medical academics leds to physiological, psychological, or even burnout in MHAs and HCPs ( 4 ). Considering the work-specific challenges, resilience has become a fundamental necessity not only for human well-being but also for the application of modern expertise, the sustainability of healthcare systems, and the quality of healthcare administration ( 5 ). Resilience is a dynamic and multifaceted entity with mental, physiological, and behavioral components. It is not only about overcoming struggles, but also about learning, growing, and thriving amidst stress-provolking environment ( 6 ). The ability to tolerate and recover from the adverse effects of anxiety and nervousness can have a significant impact on the quality of patient care, research outcomes, and overall well-being in the medical and health sciences ( 7 ). Moreover, stress has a significant impact on the overall ability and job satisfaction of medical professionals ( 8 ). Though a lack of resilience is not the only factor which can potentially lead to work-related stress. Resilience has extended its reach into a variety of professional fields, including healthcare and academics. In the context of medical and health sciences, resilience is crucial not just for professionals but also for researchers and patients. To maintain standard patient care, encourage innovation, and sustain the long-term prospects of healthcare systems, the potential to withstand the demands of the medical and health sciences is considered essential ( 9 , 10 ). HCPs encounter a multitude of inventive and profound obstacles and stressors. Long working hours, emotional toll of patient care, life-or-death circumstances, and the ongoing necessity for continuing education to be abreast with the rapidly expanding medical knowledge are the main challenges which HCPs frequently face ( 11 ). MHAs balance research, teaching, and community service responsibilities while often facing the strain of securing research grants and publishing in prestigious journals ( 12 – 14 ). Furthermore they are required to confront the high expectations for productivity, including obtaining grant funding, conducting experiments, and providing excellence in teaching and community services ( 2 ). Additionally, MHAs and HCPs are confronted with the administrative burdens of healthcare systems and institutions ( 3 , 4 , 9 ). These factors adevesely affect the performance HCPs and MHAs and its imperative to understand that resilience can overcome some of these challenges and not all. The gravity of the challenges faced by HCPs and MLAs should not be underestimated. Stress, burnout, and, in some cases, mental health issues, can potentially lead to significant consequences. These concerns can affect the well-being of MHAs and HCPs which, in turn, can adversely impact patient care, research outcomes, and the quality of medical education ( 15 ). However, some of these these challenges can be partially or completely counterbalanced by resilience, which empowers individuals to withstand and excel in the face of hardship. Resilient professionals are more equipped to handle the pressures of their roles, adapt to new circumstances, and sustain their passion and effectiveness in their work ( 16 ). Moreover, they are more likely to make positive contributions to their communities, benefiting both their colleagues and the patients they serve ( 17 ). Various interventions have been developed to support and enhance the well-being of HCPs and MHAs in fostering their resilience at work environment ( 18 ). In this perspective, there is concrete evidence that cognitive behavioral therapy is effective in resolving negative thought patterns and equips individuals with coping techniques to deal with stress and difficulties ( 19 , 20 ). Meditations, stress reduction programs and other mindfulness-based interventions have become more well-known.due to their potential to enhance consciousness and emotional stability ( 21 – 23 ). Peer support programs provide a sense of community and connection by allowing HCPs to express their ideas and empower one another ( 24 , 25 ). Furthermore, training programs emphasizing emotional intelligence and communication skills have been shown to enhance social communication within the healthcare team as well as with patients ( 26 , 27 ). Collectively, these interventions help HCPs and MHAs to become more psychologically resilient, allowing them to deal with the challenges of their professions with better adaptation, emotional stability, and a long-term dedication to their critical work ( 19 ). Despite an established role of resilience, there is a proliferation of research which indicates a significant rise in work-place based stress and burnout in the medical field ( 28 ). This might be attributed to the emergence of new stressors particularly COVID and long COVID syndrome, but also due to the changing dynamics of healthcare systems and medical academia ( 29 – 31 ). There is a gross scarcity of qualitative research on the insights of MHAs and HCPs about resilience in the recent past which could shed light on their experiences and plausablibe remedies in coping with workplace based stressors. Therefore, this study thoroughly investigated the diverse range of stressors experienced by MHAs and HCPs as they navigate their professional careers in clinical and academic settings. Our research aimed to determine an in-depth understanding of the strategies by HCPs and MHAs to comprehend, nurture, and sustain resilience when confronted with challenges and stressors at their workplaces. Methodology Study design and settings Driven by the overarching objectives, this inductive qualitative study delved into the insights of HCPs of eight hospitals in the Northern Emirates and Dubai at the United Arab Emirates (UAE) and MHAs of the University of Sharjah (UoS). The research aimed to acquire an in-depth comprehension of how HCPs and MHAs approach, cultivate, and sustain resilience when confronted with challenges and stressors at their workplaces. The study sought to address three questions: 1) how do HCPs and MHA define resilience?; 2) what are the challenges posed by workplace stressors and the coping strategies to deal with them?; and 3) to compare and contrast the strategies through which HCPs and MHAs develop and sustain resilience when facing challenges and stressors in their respective workplaces. The UoS has four colleges in the medical cluster; College of Medicine (CoM), College of Dental Medicine (CDM), College of Health Sciences (CHS), and College of Pharmacy (CoP). All medical and health colleges run several programs with the primary goal of graduating students with professional competence and skills essential for each discipline. In practice there are no dedicated faculty development, training or educational courses that can target and enhance resilience or help them to develop their stress coping strategies. This study was conducted on MHAs of the four medical and health clleges of UoS (professors, associate professors, and assistant professors) and HCPs of egitht hospitals in the Northern Emirates and Dubai states of UAE. Study questionnaire For our study, we adopted the questionnaire developed by O’Dowd et al ( 32 ) ( Supplementary 1 ). The questionnaire contains eight open-ended questions about the definition of resilience, major challenges that can affect physical health and job satisfaction, staratgeies which can keep physicians and academics healthy, coping strategies to be resilient in stressful workplace, and a free-text answer for other areas which were not covered in the questions. Recruitment of the participants and data collection For this qualitative study, we invited HCPs of the selected hospitals and UoS MHAs through emails via a blurb about the research and registration link. This selection of cohort from the clinical disciplines and medical academia offered a distinct opportunity to compare the stressors and coping strategies of the partipants from context-specific areas of the same primary field of medicine. Participants' information leaflets were sent to the registered participants. The researchers then arranged on-site meetings with the participants depending on their convenience and availability. An interview guide was administered to all registered participants before the structured interviews. Finally, structured face-to-face interviews were conducted as the primary method of data collection. Each interview lasted up to approximately 15 minutes. The research design was characterized by open-ended interview questions that encouraged participants to share their perceptions. An informed consent was obtained from all participants before the distribution of the questionnaire during the semi-structured interviews. Data analysis This study adopted an inductive analytical approach to unravel the multifaceted experiences of the MHAs and HCPs in navigating workplace stressors and cultivating their resilience. The interview responses were categorized and analysed on excel sheets using the Braun and Clarke six-stage thematic analysis framework ( 33 ). This process included familiarization of the data, initial codes generation, searching for themes, reviewing the themes followed by defining and naming the themes to the production of the final report. Initially, an iterative process of reading, re-reading, and transcribing the data noting down the main points was utilized. Later, coding and the organization of key points across the data set were categorized. For the thematic analysis, we employed an inductive, line-by-line coding approach to grasp the essence and substance and to closely align with the original text. A total of 95 codes were generated by SSG, SYG, AMR, FAS, and YAM. The codes were sorted and the prospective themes, and potential connections between codes, themes, and between different levels of themes were identified. Ethical approval The study was approved by the UoS Research Ethical Committee (REC-23-04-19-02-F). Results Out of a total of 170 participants, 69 MHAs (14 professors, 20 associate professors, 35 assistant professors) and 101 HCPs (35 consultants, 41 specialists and 25 residents) were interviewed. Although a small sample size suffices qualitative analysis, our study collected and curated original data from a large cohort which enriched our data review and thematic analysis. To maintain the goodness of research, a continuous check for consistency and interpretation throughout the coding scheme was maintained. In an iterative manner, a thorough search and revision of the descriptive themes was performed which led to the rearrangement of codes into newly emerging thematic categories, resulting in the identification of five distinct themes. Engaged in researchers’ discussions involving a thorough comparison and refinement of themes, we ultimately condensed the initial five themes into three overarching themes accompanied by two sub-themes in each category. The restructuring of codes to align with the newly defined thematic categories were carried out to ensure accurate representation of contents. Another key finding which was highlighted in this study were the contrasting statements put forward by HCPs and MHAs in terms of realistic expectations, personal well-beign and work-life balance with different meanings for both groups of participants. The schema of this iterative approach is summarised in Table 1 . Stage Description of analysis process Authors involved Initial coding line-by-line inductive coding approach to grasp the essence and substance of the data. - Generated a total of 95 codes by SSG and SYG. - Organized codes into eight preliminary themes for structured representation of the data. AMR, FAS, and YAM Initial theme development - Continuous check for consistency and interpretation throughout the coding scheme. - Iterative search and review of descriptive themes. - Rearrangement of codes into newly emerging thematic categories. - Identification of five distinct themes. SSG, SYG, AMR, FAS, and YAM Theme refinement - Constant contrast and compare process. - Refined list of three themes with two sub-themes in each category. - Engaged in author discussions involving thorough comparison and refinement of themes. - Condensing the initial five themes into three overarching themes accompanied by two sub-themes in each. SSG, SYG, AMR, FAS, and YAM Code restructuring - Codes restructuring to align with newly defined thematic categories. - Ensuring accurate representation of the content through iterative refinement and alignment of codes with themes. SSG Validation - Validation of themes through peer review or other methods to ensure reliability and credibility. - Verification of thematic interpretations by cross-referencing with original data. - Addressing any discrepancies or inconsistencies through further discussion and refinement. SSG, SYG Reporting - Documentation of the final thematic structure and interpretations in the research report or publication. - Explanation of the rationale behind theme selection and development process. - Clear presentation of findings supported by illustrative examples or quotes from the data. SSG Table 1: The 6-step approach used in this study for the inductive qualitative themnatic analysis. Through a comprehensive inductive thematic analysis of responses to seven key questions, three overarching themes emerged, reflecting the intricate interplay between cognitive mastery, affective well-being, and conative efficiency ( Fig ure 1 ). Figure 1: The intricate interplay between subthemes and themes of cognitive mastery, affective well-being, and conative efficiency. The theme of ‘cognitive mastery’ underscores the significance of continuous learning, adaptation, and problem-solving skills. ‘affective well-being’ highlights the role of a positive outlook and social support in fostering emotional strength. ‘conative efficiency’ emphasizes practical strategies such as effective time management and proactive approaches. Illustrating these themes as interconnected and cyclical components provides valuable insights into the dynamic nature of resilience in the medical profession, where a harmonious integration of cognitive, affective, and conative elements plays a pivotal role in navigating the challenges posed by workplace stressors. Theme I – Cognitive mastery In the context of resilience, cognitive mastery surfaced as mental agility, continuous learning, and flexibility which HCPs and academics used to overcome challenges. Two sub-themes were identified in this theme. 1.1 Cognitive appraisal and adaptation Multiple respondents stressed the ongoing need for learning and adaptation in the medical field especially continuous professional development with an embracing attitude to evolving challenges in the medical and academic filed, especially in the context of recent COVID-19 pandemic. Most respondents identified resilience as a cognitive ability keeping the dynamic nature of the field requiring a lifelong and continuous pursuit of knowledge. "Stress in medical field comes a lot from being short staffed, extra working hours with no pay or compensation, workload, exams (residency fellowship), difficult patients and over-demanding families, difficult and abusive managers resistant to flexibility and positive change etc. All these difficulties wears a physician down and can lead to depression and burnout.” 1.2 Problem-solving abilities – role of emotional regulation A significant portion of data highlighted resilience as an ability to approach challenges with a problem-solving mindset. They identified problem-solving skills as an enabler of HCPs to navigate through complex situations, by making informed choices in a particular context. To enhance problem-solving abilities, cognitive flexibility and adaptability were the desired attributes. “Learn your limits, workout ways that work out best for you”. “ T hey fail to consider the root of their issues in order to resolve it which will only lead them to more frustration and stress”. “They build good control of their emotions and don’t overreact to every problem they face” “T hey are good at dissecting the problems they face and logically solving them without investing too many emotions in there, so that way it won’t affect them mentally as much. also, they are great at communication, this helps let their doubts out of the way ” . Theme II – Affective wellbeing Affective wellbeing comprises of emotional and psychological health. This determines the ability of an individual to manage and respond to emotions, stressors, and interpersonal relationships at the workplace. Two sub-themes were identified in this theme. 2.1 Gratification from professional efficacy To achieve professional efficacy, respondents stressed on maintaining a positive mindset by cultivating an optimistic attitude to manage stress and build resilience. Seeking gratification from the opportunity to relieve someone’s sufferings and finding self-validation after a successful complex surgery is unique to medical profession. The participants acknowledged the importance of maintaining a hopeful and constructive perspective in the face of challenges. In terms of emotional support, fair compensation, self-care, and the need for a balanced workload were the key highlights. In medical and healthcare field, the connection between financial satisfaction, quality personal time, and mental health indicates the intricate relationship between emotional support and overall well-being. “In person, reminding them about their important lifetime choice, they made to follow the Medical field, and how this is a very important contribution, to the community, society and also to themselves” "Proper distribution of workload, time management, managing employment prior to being short-staffed, and teamwork with a positive attitude and harmony can have a great impact on physician performance and mental health." "Salaries play a very distinctive role in the field of Medicine if the doctor is satisfied financially." 2.2 Social support Within the workplace and personal life, role of social support emerged as a crucial factor to build resilience. Respondents highlighted nurturing connections with family and friends while fostering relationships with colleagues and peers were crucial. This point became the highlight in the context of medical field which unlike other professions is very demanding and complex. To ensure optimal psychological wellbeing, social support plays a crucial role. “Resilient colleagues often practice self-care, use effective time management, seek support from friends and family, and engage in activities they enjoy outside of work.” "Healthcare professionals are not like any other employees. Enhance the social working environment hence develop a sense of togetherness." Theme III – Conative efficiency This theme describes the practical, goal-oriented actions and behaviours of academics and HCPs to enhance their productivity and effectiveness in the face of challenges. Two sub-themes were the highlight of this section. 3.1 Proactive approaches – discipline and time management Discipline and time management are considered as an enabler of conative efficiency by reducing burnout and exhaustion. Respondents pointed out the importance of planning, commitment, and avoiding distractions to optimize productivity. Effective time management demands a crisp focus which in turn helps to achieve academic and professional success. “Create a study schedule and develop a structured study routine that includes breaks, time for self-care, and social activities." "Ensure you get enough rest to maintain focus and prevent burnout." “Set realistic expectations according to your limit and work one small goal each day until you reach the ultimate goal ahead”. “Your life is not your profession. Your profession is just a small part of your entire life and happiness. “Proper distribution of workload, time management, managing employment prior to being short-staffed and teamwork with positive attitude and harmony can have a great impact on physician performance and mental health." 3.2 Introspection and reflection This sub-theme talks about the metacognitive abilities in the form of taking initiatives to make conscious decisions to address challenges. Participants identified resilience building strategies in the form of self-delineation. Prioritizing family and health, compartmentalization, and considering alternative approaches like spirituality, could mitigate stressors. The promotion of introspection and self-awareness aligns with a proactive mindset toward personal and professional development. “To follow ‘attach and detach approach’ by keeping free time for family and recreation.” “Practice mindfulness meditation, deep breathing, or other relaxation techniques to reduce stress and anxiety.” “First, take care of yourself physically and mentally. Second, build a strong support network and finally, set realistic expectations.” “To remain dynamic and not be too fixed and practice internal reflection”. 4.0 Other key findings This study identified contrasting statements by HCPs and MHAs for realistic expectations, personal well-being and work-life balance. Each of these statement they held different meanings for both groups. 4.1 Realistic expectations for productivity and achievement. In terms of realistic expectations, productivity and achievement for the MHAs was captured in the following comment “Setting clear achievable goals and regularly reviewing progress provides a sense of direction and accomplishment which can reduce stress”. On the other hand the HCPs clarified that productivity and achievement meant; “ communication is the key and asking for help when needed, try to talk to other colleagues when facing any problems in the field because colleagues can understand and help”. 4.2 Personal well being Another striking contrast among both groups was related to personal well being. For MHAs personal well being and was viewed as; “ high-quality publication, community service and attendance at conferences… time is not sufficient to do the required work”.. Whilst in the same vein the HCPs stated; “Being a doctor is the main challenge to understand patients' physical and mental illness and bear the psychological stress of different types of patients”. 4.3 Work-life balance Interestingly work-life balance was another area which was also viewed differently by both groups. This was captured in the following statement by the MHAs; “ Multitasking multiple things at the same time could lead to setting wrong priorities including balancing work overload, high quality publications, community service and participating in conferences”. For the HCPs, work-life balance was welcomed by opportunities to; “Attend conferences and participate in workshops or other activities that hospitals provide to promote social interactions between member of staff”. Discussion In this qualitative research, the responses by the HCPs and MHAs surfaced a wealth of strategies to conceptualize, experience, and cultivate resilience and its associated coping strategies. Three overarching themes emerged; cognitive mastery, affective well-being, and conative efficiency which encapsulate how these individuals understand, appreciate, feel, and respond to workplace stressors. Cognitive mastery focuses on mental acumen, problem-solving, and adaptability in the face of challenges. Affective well-being sheds light on how emotional and social support mechanisms define a positive mindset. Lastly, conative efficiency highlights the importance of discipline and proactive measures in the dynamic and complex medical environment. These themes are not standalone; they rather share a cyclical relationship, thus highlighting their interconnected nature affecting the resilient attitudes of the respondents. Resilience, a dynamic developmental process, comprises of two core components of adversity and positive adaptation (34). Cognitive appraisal during this process of adversity moderates and mitigates the effects of adverse events (35). The model of biopsychosocial challenges and threats is rooted in cognition where the knowledge and ability to appraise the situation and available resources are measured by one’s problem-solving abilities. In a recent study, the authors have proposed how the nature of adversity guides the resilience process which can be highly subjective as per the cognitive abilities of the respondents (36). Hence, the strategies to improve the knowledge and understanding inherent in the medical field can sensitize the HCPs carving their resilience trajectories. However, a delicate balance needs to be maintained as undue appraisals of hurdles and obstacles may overwhelm the medical professionals. In our data, both aspects of cognitive appraisals of professional dynamics and the ability to problem-solve such situations indicate a positive cognitive attitude toward resilience. This attitude enhances one’s self-esteem, perceived control, and optimism leading to enhanced agency to deal with adversities. Similarly, sub-theme two of the theme I, ‘problem-solving abilities and role of emotional regulation’ is established in neuroscience research. An exhaustive list of imaging and chemical studies has established a relationship between cognitive flexibility, emotional regulation, and pain perceptions in the event of adverse events. The regions of the brain responsible for cognitive flexibility are the Amygdala, Hippocampus, and Pre-frontal cortex which also controls, executive functioning like task measurement and contextualized attention-shifting, which develop problem-solving abilities along with emotional regulation (37). Our respondents pointed towards the role of attention shifting and cognitive flexibility highlighting their resilience factor. Recent research in the field of resilience building upon attention control theory has highlighted the role of attention in modulating successful adaptive responses (38). Social sciences research looking into the concept of happiness or subjective well-being has argued that satisfaction with life fosters optimal psychological functioning (39). A similar sort of expression surfaced from respondents’ data where finding gratification in the profession enhances affective well-being and depicts a strong emotional regulation mechanism. However, personality and sociodemographic variables, like financial and relationship status play crucial roles in the affective well-being of an individual which was clear from the data (40). Financial remuneration for the medical profession has always been questionable but respondents with a positive mindset and understanding of their calling seemed to be better equipped with the coping strategies. Hence, the affective well-being theme shared an intricate relationship with the cognitive mastery theme, where problem-solving ability was strengthened in an emotionally regulated individual. Recently Cohen (41) has described an association between social support in improving one’s happiness and affective well-being. Social support acts as a multifaceted shield for affective well-being through emotional regulation, improving cognition, and influencing behaviors leading to an emotionally intelligent individual (42). Our data showed a clear understanding of where social support promotes a sense of security, self-esteem, and a feeling of control (43). Finding solace in significant others, family, and friends to pacify personal identities was compounded by the fulfillment of the professional self (44). Therefore, collegial work environment, finding support from colleagues, and fostering workplace relations splints both personal and professional self. However, recent research has shown that social support and affective well-being are highly influenced by emotional intelligence (45). In this context, development of faculty enhancement programs (46), seminars and forums for employees well-being and satisfaction (47), support services for academia and physicians by team leaders (48), and interprofessional collaboration (49) (50) are considered to be effective in alleviating work-place based stress. Resilience is the ability to buffer the effects of adversity on the physical and emotional wellbeing thus establishing a delicate relationship with one’s own self. We identified three themes that showed the commitment of our study respondents to this relationship. Cognitive mastery by bringing real meaning and understanding provides longevity to this relationship while conative efficiency (behavioral and motivational attitude) highlights the tendency to remain resilient with one’ self (51). Our respondents have highlighted this fact by showing a proactive attitude, where they understand the importance of discipline, time management, and self-delineation. They highlighted the intricate relationship of the conceptual model of resilience with their well-being and professional satisfaction. Intention to remain resilient by identifying the actual role professions play in one’s life is being shaped by the continuous introspection and reflection (52). Study limitations Despite the valuable insights gained from this qualitative research, several limitations should be considered when interpreting the findings. First, the study's findings should be viewed with caution as this reflects one UAE academic university and eight hospitals. The subjective nature of resilience and coping strategies raises the possibility of bias, as individual perceptions and responses to stressors can vary substantially. Furthermore, the qualitative design of the study limits the ability to establish causal relationships or track changes in resilience over time. Furthermore, the study's potential lack of diversity in participants’ demographics may limit the exploration of resilience experiences from various perspectives. Addressing these limitations is critical for a context-relevant understanding of resilience in the medical field. Conclusion Our qualitative thematic analysis showcases a comprehensive understanding of resilience among HCPs and MHAs in UAE. This study sheds light on the valuable insights into the versatile nature of resilience in the medical profession as shown by the themes of cognitive mastery, affective well-being, and conative efficiency. These themes have a nested relationship and can help foster work-life balance and personal well-being of HCPs and MHAs to improve their resilience. The congruences and differences in work-life balance, personal productivity, and job-specific stressors among HCPs and MHAs call for well-founded resilience program for each domain in he medical field. Declarations Acknowledgements None. Author contributions SYG conceived the idea, designed the study and supervised the entire research project. AMR, FAS, MHS, SJB, MAE and AAO collected the data. SYG, AMR, FAS and YAA performed qualitative data analysis and coding for organization of thematic framework. SSG supervised the entire qualitative thematic analysis. JD, MAE, AMR, MHS, FAS and YAA prepared the initial draft and SYG revised and edited the draft. All authors reviewed and approved the final draft of the article. Funding Not applicable. Data Availability The raw dataset and other materials are available on request. The corresponding author will provide additional data if requested. Ethics approval and consent to participate The Research Ethics Committee (REC) approved the publication of this study (REC-23-04-19-02-F). Additionally, a written informed consent was obtained from all participants, and the process followed the recommended policies and guidelines of the Declaration of Helsinki. 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Outcomes in Clinicians. Workplace Wellness: From Resiliency to Suicide Prevention and Grief Management: A Practical Guide to Supporting Healthcare Professionals. Springer; 2023. pp. 13–22. Ho AHY, Tan-Ho G, Ngo TA, Ong G, Chong PH, Dignadice D, et al. A novel mindful-compassion art-based therapy for reducing burnout and promoting resilience among healthcare workers: findings from a waitlist randomized control trial. Front Psychol. 2021;12:744443. Klatt M, Westrick A, Bawa R, Gabram O, Blake A, Emerson B. Sustained resiliency building and burnout reduction for healthcare professionals via organizational sponsored mindfulness programming. Explore. 2022;18(2):179–86. Lomas T, Medina JC, Ivtzan I, Rupprecht S, Eiroa-Orosa FJ. A systematic review and meta-analysis of the impact of mindfulness-based interventions on the well-being of healthcare professionals. Mindfulness. 2019;10:1193–216. Wu AW, Connors C, Everly GS Jr. COVID-19: peer support and crisis communication strategies to promote institutional resilience. American College of Physicians; 2020. pp. 822–3. Mellins CA, Mayer LE, Glasofer DR, Devlin MJ, Albano AM, Nash SS, et al. Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response. Gen Hosp Psychiatry. 2020;67:62–9. Hurley J, Hutchinson M, Kozlowski D, Gadd M, Van Vorst S. Emotional intelligence as a mechanism to build resilience and non-technical skills in undergraduate nurses undertaking clinical placement. Int J Ment Health Nurs. 2020;29(1):47–55. Jiménez-Picón N, Romero-Martín M, Ponce-Blandón JA, Ramirez-Baena L, Palomo-Lara JC, Gómez-Salgado J. The relationship between mindfulness and emotional intelligence as a protective factor for healthcare professionals: Systematic review. Int J Environ Res Public Health. 2021;18(10):5491. Haldane V, De Foo C, Abdalla SM, Jung A-S, Tan M, Wu S, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964–80. White MA, McCallum F. Wellbeing and resilience education: COVID-19 and its impact on education. Routledge; 2021. Lyng HB, Ree E, Wibe T, Wiig S. Healthcare leaders’ use of innovative solutions to ensure resilience in healthcare during the Covid-19 pandemic: a qualitative study in Norwegian nursing homes and home care services. BMC Health Serv Res. 2021;21(1):1–11. Kuhlmann E, Dussault G, Correia T. Global health and health workforce development: what to learn from COVID-19 on health workforce preparedness and resilience. Wiley Online Library; 2021. pp. 5–8. O’Dowd E, O’Connor P, Lydon S, Mongan O, Connolly F, Diskin C, et al. Stress, coping, and psychological resilience among physicians. BMC Health Serv Res. 2018;18:1–11. Clarke V, Braun V. Thematic analysis. J Posit Psychol. 2017;12(3):297–8. Fletcher D, Sarkar M. Psychological resilience. European psychologist. 2013. Elliot AJ. Handbook of approach and avoidance motivation. Psychology; 2013. Major B, Richards C, Cooper ML, Cozzarelli C, Zubek J. Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion. J Personal Soc Psychol. 1998;74(3):735. Bonanno GA, Burton CL. Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspect Psychol Sci. 2013;8(6):591–612. Eysenck MW, Derakshan N, Santos R, Calvo MG. Anxiety and cognitive performance: attentional control theory. Emotion. 2007;7(2):336. Diener E, Lucas RE. 11 personality and subjective well-being. Well-being: Foundations of hedonic psychology. 1999:213. Lucas RE, Diener E, Suh E. Discriminant validity of well-being measures. J Personal Soc Psychol. 1996;71(3):616. Cohen S, Gottlieb B, Underwood L. Theoretical and historical perspectives. Social support measurement and intervention: A guide for health and social scientists. 2000:3–28. Bar-On R. The impact of emotional intelligence on subjective well-being. Perspect Educ. 2005;23(1):41–62. Luthar SS, Sawyer JA, Brown PJ. Conceptual issues in studies of resilience: Past, present, and future research. Ann N Y Acad Sci. 2006;1094(1):105–15. Arkar H, Sari Ö, Fidaner H, editors. Relationships Between Quality of Life, Perceived Social Support, Social Network, And Loneliness in a Turkish Sample. Yeni Symposium: psikiyatri, nöroloji ve davraniş bilimleri dergisi; 2004: Cerrahpasa Tip Fakultesi Psikiyatri Klinigi Vakfi. Gallagher EN, Vella-Brodrick DA. Social support and emotional intelligence as predictors of subjective well-being. Pers Indiv Differ. 2008;44(7):1551–61. Guraya SY, Chen S. The impact and effectiveness of faculty development program in fostering the faculty’s knowledge, skills, and professional competence: A systematic review and meta-analysis. Saudi J Biol Sci. 2019;26(4):688–97. Guraya SS, Menezes P, Lawrence IN, Guraya SY, Rashid-Doubell F. Evaluating the impact of COVID-19 pandemic on the physicians' psychological health: A systematic scoping review. Front Med. 2023;10:1071537. Khoshhal KI, Guraya SY. Leaders produce leaders and managers produce followers: A systematic review of the desired competencies and standard settings for physicians’ leadership. Saudi Med J. 2016;37(10):1061. Sulaiman N, Rishmawy Y, Hussein A, Saber-Ayad M, Alzubaidi H, Al Kawas S, et al. A mixed methods approach to determine the climate of interprofessional education among medical and health sciences students. BMC Med Educ. 2021;21:1–13. Guraya SS, Guraya SY, Doubell F-R, Mathew B, Clarke E, Ryan Á, et al. Understanding medical professionalism using express team-based learning; a qualitative case-based study. Med Educ Online. 2023;28(1):2235793. Vallerand RJ, Deshaies P, Cuerrier J-P, Pelletier LG, Mongeau C. Ajzen and Fishbein's theory of reasoned action as applied to moral behavior: A confirmatory analysis. J Personal Soc Psychol. 1992;62(1):98. Crane MF, Searle BJ, Kangas M, Nwiran Y. How resilience is strengthened by exposure to stressors: The systematic self-reflection model of resilience strengthening. Anxiety, Stress, & Coping. 2019;32(1):1–17. Additional Declarations No competing interests reported. Supplementary Files SupplemetaryQuestionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 04 Feb, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 07 Oct, 2024 Reviews received at journal 04 Oct, 2024 Reviews received at journal 27 Sep, 2024 Reviewers agreed at journal 24 Sep, 2024 Reviewers agreed at journal 20 Sep, 2024 Reviewers agreed at journal 19 Sep, 2024 Reviewers agreed at journal 16 Sep, 2024 Reviewers invited by journal 16 Sep, 2024 Editor invited by journal 16 Sep, 2024 Editor assigned by journal 13 Sep, 2024 Submission checks completed at journal 13 Sep, 2024 First submitted to journal 04 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5033621","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":363151421,"identity":"f05d8f33-83a2-45c3-ad8e-451a84f95cdc","order_by":0,"name":"Salman Yousuf 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Al","lastName":"Shamsi","suffix":""},{"id":363151430,"identity":"7fb7ceaf-a0f2-498a-8b7e-340ad783c950","order_by":8,"name":"Sarah Juman Bilalaga","email":"","orcid":"","institution":"University of Sharjah","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"Juman","lastName":"Bilalaga","suffix":""},{"id":363151432,"identity":"ac1a9ebf-9088-4ed6-9c58-16a9a66db199","order_by":9,"name":"Alfred Nicholson","email":"","orcid":"","institution":"RCSI Bahrain University","correspondingAuthor":false,"prefix":"","firstName":"Alfred","middleName":"","lastName":"Nicholson","suffix":""},{"id":363151434,"identity":"ab7674cc-853c-454a-9388-8ee67993ef6d","order_by":10,"name":"Hani Malik","email":"","orcid":"","institution":"Royal Bahrain Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hani","middleName":"","lastName":"Malik","suffix":""},{"id":363151435,"identity":"ab5ccf3b-8928-4a09-a970-580fc7db8586","order_by":11,"name":"Shaista Salman Guraya","email":"","orcid":"","institution":"Mohammed Bin Rashid University of Medical and Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shaista","middleName":"Salman","lastName":"Guraya","suffix":""}],"badges":[],"createdAt":"2024-09-04 19:11:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5033621/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5033621/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06415-w","type":"published","date":"2025-02-04T15:57:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69961999,"identity":"2a9e2d2d-9ce0-499a-b9c8-d20afbe8018c","added_by":"auto","created_at":"2024-11-27 04:42:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":248385,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe intricate interplay between subthemes and themes of cognitive mastery, affective well-being, and conative efficiency.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5033621/v1/768807af9fadac5260fa39a8.png"},{"id":75930440,"identity":"9487b4e8-6c5d-46fa-8730-ff0414343c85","added_by":"auto","created_at":"2025-02-10 16:11:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1107068,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5033621/v1/6d7721e5-7f67-49e1-b43b-c554f9e757a7.pdf"},{"id":69962000,"identity":"6c56ee2f-1273-4376-9c74-5f429513f5d1","added_by":"auto","created_at":"2024-11-27 04:42:12","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18662,"visible":true,"origin":"","legend":"","description":"","filename":"SupplemetaryQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-5033621/v1/677b8767426a9463c286804d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unfolding insights about resilience and its coping strategies by medical academics and healthcare professionals at their workplaces: A thematic qualitative analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eThe medical and health sciences sector is distinguished by its unique set of challenges, complexity, and vital functions in the society (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Healthcare professionals (HCPs) and medical and health academics (MHAs) including doctors, scientists, and educators, and physicians from diverse medical disciplines play pivotal role in maintaining and enhancing human health by providing quality heathcare services and excellence in medical education (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The demanding nature of healthcare systems and medical academics leds to physiological, psychological, or even burnout in MHAs and HCPs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Considering the work-specific challenges, resilience has become a fundamental necessity not only for human well-being but also for the application of modern expertise, the sustainability of healthcare systems, and the quality of healthcare administration (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResilience is a dynamic and multifaceted entity with mental, physiological, and behavioral components. It is not only about overcoming struggles, but also about learning, growing, and thriving amidst stress-provolking environment (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The ability to tolerate and recover from the adverse effects of anxiety and nervousness can have a significant impact on the quality of patient care, research outcomes, and overall well-being in the medical and health sciences (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Moreover, stress has a significant impact on the overall ability and job satisfaction of medical professionals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Though a lack of resilience is not the only factor which can potentially lead to work-related stress. Resilience has extended its reach into a variety of professional fields, including healthcare and academics. In the context of medical and health sciences, resilience is crucial not just for professionals but also for researchers and patients. To maintain standard patient care, encourage innovation, and sustain the long-term prospects of healthcare systems, the potential to withstand the demands of the medical and health sciences is considered essential (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHCPs encounter a multitude of inventive and profound obstacles and stressors. Long working hours, emotional toll of patient care, life-or-death circumstances, and the ongoing necessity for continuing education to be abreast with the rapidly expanding medical knowledge are the main challenges which HCPs frequently face (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). MHAs balance research, teaching, and community service responsibilities while often facing the strain of securing research grants and publishing in prestigious journals (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Furthermore they are required to confront the high expectations for productivity, including obtaining grant funding, conducting experiments, and providing excellence in teaching and community services (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Additionally, MHAs and HCPs are confronted with the administrative burdens of healthcare systems and institutions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These factors adevesely affect the performance HCPs and MHAs and its imperative to understand that resilience can overcome some of these challenges and not all.\u003c/p\u003e \u003cp\u003eThe gravity of the challenges faced by HCPs and MLAs should not be underestimated. Stress, burnout, and, in some cases, mental health issues, can potentially lead to significant consequences. These concerns can affect the well-being of MHAs and HCPs which, in turn, can adversely impact patient care, research outcomes, and the quality of medical education (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, some of these these challenges can be partially or completely counterbalanced by resilience, which empowers individuals to withstand and excel in the face of hardship. Resilient professionals are more equipped to handle the pressures of their roles, adapt to new circumstances, and sustain their passion and effectiveness in their work (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Moreover, they are more likely to make positive contributions to their communities, benefiting both their colleagues and the patients they serve (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious interventions have been developed to support and enhance the well-being of HCPs and MHAs in fostering their resilience at work environment (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In this perspective, there is concrete evidence that cognitive behavioral therapy is effective in resolving negative thought patterns and equips individuals with coping techniques to deal with stress and difficulties (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Meditations, stress reduction programs and other mindfulness-based interventions have become more well-known.due to their potential to enhance consciousness and emotional stability (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Peer support programs provide a sense of community and connection by allowing HCPs to express their ideas and empower one another (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, training programs emphasizing emotional intelligence and communication skills have been shown to enhance social communication within the healthcare team as well as with patients (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Collectively, these interventions help HCPs and MHAs to become more psychologically resilient, allowing them to deal with the challenges of their professions with better adaptation, emotional stability, and a long-term dedication to their critical work (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite an established role of resilience, there is a proliferation of research which indicates a significant rise in work-place based stress and burnout in the medical field (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This might be attributed to the emergence of new stressors particularly COVID and long COVID syndrome, but also due to the changing dynamics of healthcare systems and medical academia (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). There is a gross scarcity of qualitative research on the insights of MHAs and HCPs about resilience in the recent past which could shed light on their experiences and plausablibe remedies in coping with workplace based stressors. Therefore, this study thoroughly investigated the diverse range of stressors experienced by MHAs and HCPs as they navigate their professional careers in clinical and academic settings. Our research aimed to determine an in-depth understanding of the strategies by HCPs and MHAs to comprehend, nurture, and sustain resilience when confronted with challenges and stressors at their workplaces.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and settings\u003c/h2\u003e \u003cp\u003eDriven by the overarching objectives, this inductive qualitative study delved into the insights of HCPs of eight hospitals in the Northern Emirates and Dubai at the United Arab Emirates (UAE) and MHAs of the University of Sharjah (UoS). The research aimed to acquire an in-depth comprehension of how HCPs and MHAs approach, cultivate, and sustain resilience when confronted with challenges and stressors at their workplaces. The study sought to address three questions: 1) how do HCPs and MHA define resilience?; 2) what are the challenges posed by workplace stressors and the coping strategies to deal with them?; and 3) to compare and contrast the strategies through which HCPs and MHAs develop and sustain resilience when facing challenges and stressors in their respective workplaces.\u003c/p\u003e \u003cp\u003eThe UoS has four colleges in the medical cluster; College of Medicine (CoM), College of Dental Medicine (CDM), College of Health Sciences (CHS), and College of Pharmacy (CoP). All medical and health colleges run several programs with the primary goal of graduating students with professional competence and skills essential for each discipline. In practice there are no dedicated faculty development, training or educational courses that can target and enhance resilience or help them to develop their stress coping strategies. This study was conducted on MHAs of the four medical and health clleges of UoS (professors, associate professors, and assistant professors) and HCPs of egitht hospitals in the Northern Emirates and Dubai states of UAE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy questionnaire\u003c/h2\u003e \u003cp\u003eFor our study, we adopted the questionnaire developed by O\u0026rsquo;Dowd et al (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) (\u003cb\u003eSupplementary 1\u003c/b\u003e). The questionnaire contains eight open-ended questions about the definition of resilience, major challenges that can affect physical health and job satisfaction, staratgeies which can keep physicians and academics healthy, coping strategies to be resilient in stressful workplace, and a free-text answer for other areas which were not covered in the questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eRecruitment of the participants and data collection\u003c/h2\u003e \u003cp\u003eFor this qualitative study, we invited HCPs of the selected hospitals and UoS MHAs through emails via a blurb about the research and registration link. This selection of cohort from the clinical disciplines and medical academia offered a distinct opportunity to compare the stressors and coping strategies of the partipants from context-specific areas of the same primary field of medicine. Participants' information leaflets were sent to the registered participants. The researchers then arranged on-site meetings with the participants depending on their convenience and availability. An interview guide was administered to all registered participants before the structured interviews. Finally, structured face-to-face interviews were conducted as the primary method of data collection. Each interview lasted up to approximately 15 minutes. The research design was characterized by open-ended interview questions that encouraged participants to share their perceptions. An informed consent was obtained from all participants before the distribution of the questionnaire during the semi-structured interviews.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThis study adopted an inductive analytical approach to unravel the multifaceted experiences of the MHAs and HCPs in navigating workplace stressors and cultivating their resilience. The interview responses were categorized and analysed on excel sheets using the Braun and Clarke six-stage thematic analysis framework (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This process included familiarization of the data, initial codes generation, searching for themes, reviewing the themes followed by defining and naming the themes to the production of the final report. Initially, an iterative process of reading, re-reading, and transcribing the data noting down the main points was utilized. Later, coding and the organization of key points across the data set were categorized. For the thematic analysis, we employed an inductive, line-by-line coding approach to grasp the essence and substance and to closely align with the original text. A total of 95 codes were generated by SSG, SYG, AMR, FAS, and YAM. The codes were sorted and the prospective themes, and potential connections between codes, themes, and between different levels of themes were identified.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the UoS Research Ethical Committee (REC-23-04-19-02-F).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of a total of 170 participants, 69 MHAs (14 professors, 20 associate professors, 35 assistant professors) and 101 HCPs (35 consultants, 41 specialists and 25 residents) were interviewed. Although a small sample size suffices qualitative analysis, our study collected and curated original data from a large cohort which enriched our data review and thematic analysis. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo maintain the goodness of research, a continuous check for consistency and interpretation throughout the coding scheme was maintained. In an iterative manner, \u0026nbsp;a thorough search and revision of the descriptive themes was performed which led to the rearrangement of codes into newly emerging thematic categories, resulting in the identification of five distinct themes. Engaged in researchers\u0026rsquo; discussions involving a thorough comparison and refinement of themes, we ultimately condensed the initial five themes into three overarching themes accompanied by two sub-themes in each category. The restructuring of codes to align with the newly defined thematic categories were carried out to ensure accurate representation of contents. Another \u0026nbsp;key finding which was highlighted in this study were \u0026nbsp;the contrasting statements put forward by HCPs and MHAs in terms of realistic expectations, personal well-beign and work-life balance with different meanings \u0026nbsp;for both \u0026nbsp; groups of participants. The schema of this iterative approach is summarised in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription of analysis process\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors involved\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003eInitial coding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003eline-by-line inductive coding approach to grasp the essence and substance of the data.\u003c/p\u003e\n \u003cp\u003e- Generated a total of 95 codes by SSG and SYG.\u003c/p\u003e\n \u003cp\u003e- Organized codes into eight preliminary themes for structured representation of the data.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003eAMR, FAS, and YAM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003eInitial theme development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003e- Continuous check for consistency and interpretation throughout the coding scheme.\u003c/p\u003e\n \u003cp\u003e- Iterative search and review of descriptive themes.\u003c/p\u003e\n \u003cp\u003e- Rearrangement of codes into newly emerging thematic categories.\u003c/p\u003e\n \u003cp\u003e- Identification of five distinct themes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003eSSG, SYG, AMR, FAS, and YAM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003eTheme refinement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003e- Constant contrast and compare process.\u003c/p\u003e\n \u003cp\u003e- Refined list of three themes with two sub-themes in each category.\u003c/p\u003e\n \u003cp\u003e- Engaged in author discussions involving thorough comparison and refinement of themes.\u003c/p\u003e\n \u003cp\u003e- Condensing the initial five themes into three overarching themes accompanied by two sub-themes in each.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003eSSG, SYG, AMR, FAS, and YAM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003eCode restructuring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003e- Codes restructuring to align with newly defined thematic categories.\u003c/p\u003e\n \u003cp\u003e- Ensuring accurate representation of the content through iterative refinement and alignment of codes with themes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003eSSG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003eValidation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003e- Validation of themes through peer review or other methods to ensure reliability and credibility.\u003c/p\u003e\n \u003cp\u003e- Verification of thematic interpretations by cross-referencing with original data.\u003c/p\u003e\n \u003cp\u003e- Addressing any discrepancies or inconsistencies through further discussion and refinement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003eSSG, SYG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3301%;\"\u003e\n \u003cp\u003eReporting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53.3981%;\"\u003e\n \u003cp\u003e- Documentation of the final thematic structure and interpretations in the research report or publication.\u003c/p\u003e\n \u003cp\u003e- Explanation of the rationale behind theme selection and development process.\u003c/p\u003e\n \u003cp\u003e- Clear presentation of findings supported by illustrative examples or quotes from the data.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2718%;\"\u003e\n \u003cp\u003eSSG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: The 6-step approach used in this study for the inductive qualitative themnatic analysis. \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThrough a comprehensive inductive thematic analysis of responses to seven key questions, three overarching themes emerged, reflecting the intricate interplay between cognitive mastery, affective well-being, and conative efficiency\u0026nbsp;(\u003cstrong\u003eFig\u003c/strong\u003e\u003cstrong\u003eure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;1\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1: The intricate interplay between subthemes and themes of cognitive mastery, affective well-being, and conative efficiency.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe theme of \u0026lsquo;cognitive mastery\u0026rsquo; underscores the significance of continuous learning, adaptation, and problem-solving skills. \u0026lsquo;affective well-being\u0026rsquo; highlights the role of a positive outlook and social support in fostering emotional strength. \u0026lsquo;conative efficiency\u0026rsquo; emphasizes practical strategies such as effective time management and proactive approaches. Illustrating these themes as interconnected and cyclical components provides valuable insights into the dynamic nature of resilience in the medical profession, where a harmonious integration of cognitive, affective, and conative elements plays a pivotal role in navigating the challenges posed by workplace stressors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTheme I \u0026ndash; Cognitive mastery\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the context of resilience, cognitive mastery surfaced as mental agility, continuous learning, and flexibility which HCPs and academics used to overcome challenges.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwo sub-themes were identified in this theme.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1.1 Cognitive appraisal and adaptation\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMultiple respondents stressed the ongoing need for learning and adaptation in the medical field especially continuous professional development with an embracing attitude to evolving challenges in the medical and academic filed, especially in the context of recent COVID-19 pandemic. Most respondents identified resilience as a cognitive ability keeping the dynamic nature of the field requiring a lifelong and continuous pursuit of knowledge.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Stress in medical field comes a lot from being short staffed, extra working hours with no pay or compensation, workload, exams (residency fellowship), difficult patients and over-demanding families, difficult and abusive managers resistant to flexibility and positive change etc. All these difficulties wears a physician down and can lead to depression and burnout.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1.2\u0026nbsp;Problem-solving abilities \u0026ndash; role of emotional regulation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA significant portion of data highlighted resilience as an ability to approach challenges with a problem-solving mindset. They identified problem-solving skills as an enabler of HCPs to navigate through complex situations, by making informed choices in a particular context. To enhance problem-solving abilities, cognitive flexibility and adaptability were the desired attributes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Learn your limits, workout ways that work out best for you\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eT\u003c/em\u003e\u003cem\u003ehey fail to consider the root of their issues in order to resolve it which will only lead them to more frustration and stress\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They build good control of their emotions and don\u0026rsquo;t overreact to every problem they face\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;T\u003c/em\u003e\u003cem\u003ehey are good at dissecting the problems they face and logically solving them without investing too many emotions in there, so that way it won\u0026rsquo;t affect them mentally as much. also, they are great at communication, this helps let their doubts out of the way\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTheme II \u0026ndash; Affective wellbeing\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAffective wellbeing comprises of emotional and psychological health. This determines the ability of an individual to manage and respond to emotions, stressors, and interpersonal relationships at the workplace. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwo sub-themes were identified in this theme.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.1 Gratification from professional efficacy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo achieve professional efficacy, respondents stressed on maintaining a positive mindset by cultivating an optimistic attitude to manage stress and build resilience. Seeking gratification from the opportunity to relieve someone\u0026rsquo;s sufferings and finding self-validation after a successful complex surgery is unique to medical profession. The participants acknowledged the importance of maintaining a hopeful and constructive perspective in the face of challenges. In terms of emotional support, fair compensation, self-care, and the need for a balanced workload were the key highlights. In medical and healthcare field, the connection between financial satisfaction, quality personal time, and mental health indicates the intricate relationship between emotional support and overall well-being.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In person, reminding them about their important lifetime choice, they made to follow the Medical field, and how this is a very important contribution, to the community, society and also to themselves\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Proper distribution of workload, time management, managing employment prior to being short-staffed, and teamwork with a positive attitude and harmony can have a great impact on physician performance and mental health.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Salaries play a very distinctive role in the field of Medicine if the doctor is satisfied financially.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2\u003c/em\u003e\u003cem\u003e\u0026nbsp;Social support\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWithin the workplace and personal life, role of social support emerged as a crucial factor to build resilience. Respondents highlighted nurturing connections with family and friends while fostering relationships with colleagues and peers were crucial. This point became the highlight in the context of medical field which unlike other professions is very demanding and complex. To ensure optimal psychological wellbeing, social support plays a crucial role.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Resilient colleagues often practice self-care, use effective time management, seek support from friends and family, and engage in activities they enjoy outside of work.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Healthcare professionals are not like any other employees. Enhance the social working environment hence develop a sense of togetherness.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTheme III \u0026ndash; Conative efficiency\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme describes the practical, goal-oriented actions and behaviours of academics and HCPs to enhance their productivity and effectiveness in the face of challenges. Two sub-themes were the highlight of this section.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.1 Proactive approaches \u0026ndash; discipline and time management \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDiscipline and time management are considered as an enabler of conative efficiency by reducing burnout and exhaustion. Respondents pointed out the importance of planning, commitment, and avoiding distractions to optimize productivity. Effective time management demands a crisp focus which in turn helps to achieve academic and professional success.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Create a study schedule and develop a structured study routine that includes breaks, time for self-care, and social activities.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Ensure you get enough rest to maintain focus and prevent burnout.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Set realistic expectations according to your limit and work one small goal each day until you reach the ultimate goal ahead\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Your life is not your profession. Your profession is just a small part of your entire life and happiness.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Proper distribution of workload, time management, managing employment prior to being short-staffed and teamwork with positive attitude and harmony can have a great impact on physician performance and mental health.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.2 Introspection and reflection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis sub-theme talks about the metacognitive abilities in the form of taking initiatives to make conscious decisions to address challenges. Participants identified resilience building strategies in the form of self-delineation. Prioritizing family and health, compartmentalization, and considering alternative approaches like spirituality, could mitigate stressors. The promotion of introspection and self-awareness aligns with a proactive mindset toward personal and professional development.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;To follow \u0026lsquo;attach and detach approach\u0026rsquo; by keeping free time for family and recreation.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Practice mindfulness meditation, deep breathing, or other relaxation techniques to reduce stress and anxiety.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;First, take care of yourself physically and mentally. Second, build a strong support network and finally, set realistic expectations.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;To remain dynamic and not be too fixed and practice internal reflection\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.0 \u0026nbsp;Other key findings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study identified contrasting statements by HCPs and MHAs for \u0026nbsp;realistic expectations, personal well-being and work-life balance. Each of these statement they held different meanings for both groups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.1 Realistic expectations for productivity and achievement.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn terms of realistic \u0026nbsp; expectations, productivity and \u0026nbsp; achievement for \u0026nbsp;the MHAs \u0026nbsp; was captured in the following comment\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Setting clear achievable goals and regularly reviewing progress provides \u0026nbsp;a sense of \u0026nbsp;direction and accomplishment which can reduce stress\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOn the other hand the HCPs \u0026nbsp;clarified that productivity and achievement meant;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo; communication is the key and asking for help when needed, try to talk to other colleagues when facing any problems in the field because colleagues can understand and help\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.2 Personal well being\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother striking contrast among both groups was related to \u0026nbsp;personal well being. For \u0026nbsp;MHAs \u0026nbsp;personal well being and was viewed \u0026nbsp;as;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo; high-quality publication, community service and attendance at conferences\u0026hellip; time is not sufficient to do the required work\u0026rdquo;..\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhilst in the same vein the \u0026nbsp;HCPs stated;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Being a doctor is the main challenge to understand patients\u0026apos; physical and mental illness and bear the psychological stress of different types of patients\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.3 Work-life balance\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInterestingly work-life balance \u0026nbsp;was \u0026nbsp;another area which was also viewed differently by both groups. This was captured in the following statement by the MHAs;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo; Multitasking multiple things at the same time could lead to setting wrong priorities including balancing \u0026nbsp;work overload, high quality publications, community service and participating in conferences\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor the HCPs, work-life balance \u0026nbsp;was \u0026nbsp;welcomed by opportunities to;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Attend \u0026nbsp;conferences and \u0026nbsp;participate in workshops or other activities that hospitals provide to promote social interactions between member of staff\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this qualitative research, the responses by the HCPs and MHAs\u0026nbsp;surfaced a wealth of strategies\u0026nbsp;to\u0026nbsp;conceptualize, experience, and cultivate\u0026nbsp;resilience and its associated coping strategies.\u0026nbsp;Three overarching themes\u0026nbsp;emerged;\u0026nbsp;cognitive mastery, affective well-being, and conative efficiency\u0026nbsp;which\u0026nbsp;encapsulate how these individuals understand, appreciate, feel, and respond to workplace stressors. Cognitive mastery focuses on mental acumen, problem-solving, and adaptability in the face of challenges. Affective well-being sheds light on how emotional and social support mechanisms define a positive mindset.\u0026nbsp;Lastly, conative efficiency highlights the importance of discipline and proactive measures in the dynamic and complex medical environment. These themes are not standalone; they rather share a cyclical relationship, thus\u0026nbsp;highlighting\u0026nbsp;their\u0026nbsp;interconnected nature affecting the resilient attitudes of the respondents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience,\u0026nbsp;a dynamic developmental process,\u0026nbsp;comprises of two core components\u0026nbsp;of\u0026nbsp;adversity and positive adaptation\u0026nbsp;(34). Cognitive appraisal during this process of adversity moderates and mitigates the effects of adverse events\u0026nbsp;(35). \u0026nbsp;The model of biopsychosocial challenges and threats is rooted in cognition where the knowledge and ability to appraise the situation and available resources are measured by one\u0026rsquo;s problem-solving abilities. In a recent study, the authors have proposed how the nature of adversity guides the resilience process which can be highly subjective as per the cognitive abilities of the respondents\u0026nbsp;(36). Hence, the strategies to improve the knowledge and understanding inherent in the medical field can sensitize the HCPs carving their resilience trajectories. However, a delicate balance needs to be maintained as undue appraisals of hurdles and obstacles may overwhelm the medical professionals. In our data, both aspects of cognitive appraisals of professional dynamics and the ability to problem-solve such situations indicate a positive cognitive attitude toward resilience. This attitude enhances one\u0026rsquo;s self-esteem, perceived control, and optimism leading to enhanced agency to deal with adversities.\u003c/p\u003e\n\u003cp\u003eSimilarly, sub-theme two of the theme I, \u0026lsquo;problem-solving abilities and role of emotional regulation\u0026rsquo; is established in neuroscience research.\u0026nbsp;An\u0026nbsp;exhaustive list of imaging and chemical studies has established a relationship between cognitive flexibility, emotional regulation, and pain perceptions in the event of adverse events. The regions of the brain responsible for cognitive flexibility are the Amygdala, Hippocampus, and Pre-frontal cortex which also controls, executive functioning like task measurement and contextualized attention-shifting, which develop problem-solving abilities along with emotional regulation\u0026nbsp;(37). Our respondents pointed towards the role of attention shifting and cognitive flexibility highlighting their resilience factor. Recent research in the field of resilience building upon attention control theory has highlighted the role of attention in modulating successful adaptive responses\u0026nbsp;(38).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSocial sciences research looking into the concept of happiness or subjective well-being has argued that satisfaction with life fosters optimal psychological functioning\u0026nbsp;(39). A similar sort of expression surfaced from respondents\u0026rsquo; data where finding gratification in the profession enhances affective well-being and depicts a strong emotional regulation mechanism. However, personality and sociodemographic variables, like financial and relationship status play crucial roles in the affective well-being of an individual which was clear from the data\u0026nbsp;(40). Financial remuneration for the medical profession has always been questionable but respondents with a positive mindset and understanding of their calling seemed to be better equipped with the coping strategies. Hence, the affective well-being theme shared an intricate relationship with the cognitive mastery theme, where problem-solving ability was strengthened in an emotionally regulated individual.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecently Cohen\u0026nbsp;(41)\u0026nbsp;has described an association between social support in improving one\u0026rsquo;s happiness and affective well-being. Social support acts as a multifaceted shield for affective well-being through emotional regulation, improving cognition, and influencing behaviors leading to an emotionally intelligent individual\u0026nbsp;(42). Our data showed a clear understanding of where social support promotes a sense of security, self-esteem, and a feeling of control\u0026nbsp;(43). Finding solace in significant others, family, and friends to pacify personal identities was compounded by the fulfillment of the professional self\u0026nbsp;(44). Therefore, collegial work environment, finding support from colleagues, and fostering workplace relations splints both personal and professional self. However, recent research has shown that social support and affective well-being are highly influenced by emotional intelligence\u0026nbsp;(45). In this context, development of faculty enhancement programs\u0026nbsp;(46), seminars and forums for employees well-being and satisfaction\u0026nbsp;(47), support services for academia and physicians by team leaders\u0026nbsp;(48), and interprofessional collaboration\u0026nbsp;(49)\u0026nbsp;(50)\u0026nbsp;are considered to be effective in alleviating work-place based stress.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience is the ability to buffer the effects of adversity on the physical and emotional wellbeing thus establishing a delicate relationship with one\u0026rsquo;s own self. We identified three themes that showed the commitment of our study respondents to this relationship. Cognitive mastery by bringing real meaning and understanding provides longevity to this relationship while conative efficiency (behavioral and motivational attitude) highlights the tendency to remain resilient with one\u0026rsquo; self\u0026nbsp;(51). Our respondents have highlighted this fact by showing a proactive attitude, where they understand the importance of discipline, time management, and self-delineation. They highlighted the intricate relationship of the conceptual model of resilience with their well-being and professional satisfaction. Intention to remain resilient by identifying the actual role professions play in one\u0026rsquo;s life is being shaped by the continuous introspection and reflection\u0026nbsp;(52).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the valuable insights gained from this qualitative research, several limitations should be considered when interpreting the findings. First, the study\u0026apos;s findings should be viewed with caution as this reflects one UAE academic university and eight hospitals. The subjective nature of resilience and coping strategies raises the possibility of bias, as individual perceptions and responses to stressors can vary substantially. Furthermore, \u0026nbsp;the qualitative design of the study limits the ability to establish causal relationships or track changes in resilience over time. Furthermore, the study\u0026apos;s potential lack of diversity in participants\u0026rsquo; demographics may limit the exploration of resilience experiences from various perspectives. Addressing these limitations is critical for a context-relevant understanding of resilience in the medical field.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur qualitative thematic analysis showcases a comprehensive understanding of resilience \u0026nbsp;among HCPs and MHAs in UAE. This study sheds light on the valuable insights into the versatile nature of resilience in the medical profession as shown by the themes of cognitive mastery, affective well-being, and conative efficiency. These themes have a nested relationship and can help foster work-life balance and personal well-being of HCPs and MHAs to improve their resilience. The congruences and differences in work-life balance, personal productivity, and job-specific stressors among HCPs and MHAs call for well-founded resilience program for each domain in he medical field.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSYG conceived the idea, designed the study and supervised the entire research project. AMR, FAS, MHS, SJB, MAE and AAO collected the data. SYG, AMR, FAS and YAA performed qualitative data analysis and coding for organization of thematic framework. SSG supervised the entire qualitative thematic analysis. JD, MAE, AMR, MHS, FAS and YAA prepared the initial draft and SYG revised and edited the draft. All authors reviewed and approved the final draft of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw dataset and other materials are available on request. The corresponding author will provide additional data if requested.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee (REC) approved the publication of this study (REC-23-04-19-02-F). Additionally, a written informed consent was obtained from all participants, and the process followed the recommended policies and guidelines of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProf. Salman Y. Guraya is a senior editorial board member of BMC Medical Education. \u0026nbsp;JD is an editorial board members of BMC Medical Education. Other authors don\u0026rsquo;t have any conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMahdi S, Marzieh L, Habib R, Elahe P, Sanaz D. 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Anxiety, Stress, \u0026amp; Coping. 2019;32(1):1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stressors, resilience, health care professionals, medical and health academics, resilience, work-life balance","lastPublishedDoi":"10.21203/rs.3.rs-5033621/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5033621/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth care professionals (HCPs) and medical and health academics (MHAs) strive to maintain and promote population health through evidence-based medical education and practice. At their workplaces, due to the demanding nature of work, HCPs and MHAs face substantial degree of physiological, psychological, and physical stress including burnout. Resilience has therefore become a fundamental necessity in the medical field. Our research aimed to acquire an in-depth comprehension of how HCPs and MHAs understand, cultivate, and sustain resilience when confronted with challenges and stressors at their workplaces.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe reviewed the existing corpus of literature on resilience, stressors, and coping strategies and followed an iterative process of deliberations for the development of a questionnaire. It was validated by content experts and was piloted on a small group of MHAs of the University of Sharjah (UoS) and HCPs from different hospitals of the United Arab Emirates to test its relevance, clarity of items, internal consistency, and inter-observer validity. The validated questionnaire was then used for in-depth interviews on HCPs and MHAs. Lastly, we adopted the Braun and Clarke 6-stage thematic model for qualitative data analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur study recorded insights of 170 participants; 69 MHAs and 101 HCPs. Through an inductive thematic analysis of responses, three overarching themes with sub-themes emerged; cognitive mastery (cognitive appraisal and problem-solving abilities), affective well-being (gratification from professional efficacy and social support), and conative efficiency (proactive approaches and introspection and reflection). Other main findings highlighted stress-related factors, realistic expectations, personal well-being and work-life balance. MHAs were concerned about academic output and research, while HCPs were stressed about patient care, delivery of services, and workload. These constructs showcase an intricate interplay between cognitive mastery, affective well-being, and conative efficiency.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings of our study bestow valuable insights into the dynamic nature of resilience in the medical profession. The synergies and dissimilarities in work-life balance, personal productivity, and job-specific stressors among HCPs and MHAs demand a well-structured resilience program. The themes of cognitive mastery, affective well-being, and conative efficiency are interconnected and can help foster work-life balance and personal well-being of HCPs and MHAs to improve their resilience.\u003c/p\u003e","manuscriptTitle":"Unfolding insights about resilience and its coping strategies by medical academics and healthcare professionals at their workplaces: A thematic qualitative analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 04:42:07","doi":"10.21203/rs.3.rs-5033621/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-07T12:51:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-05T00:07:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-27T19:22:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269809576782382068077872700867134660493","date":"2024-09-24T16:32:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33489916222415998332180333079445803583","date":"2024-09-21T00:46:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215642177479219437715708567303427292877","date":"2024-09-19T13:47:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320245395621185563561540377331310914573","date":"2024-09-17T01:32:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-16T21:06:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-16T10:56:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-13T11:33:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-13T11:30:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-09-04T19:09:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4387a97-11d0-4896-851b-469af1dced53","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T16:02:49+00:00","versionOfRecord":{"articleIdentity":"rs-5033621","link":"https://doi.org/10.1186/s12909-024-06415-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-02-04 15:57:42","publishedOnDateReadable":"February 4th, 2025"},"versionCreatedAt":"2024-11-27 04:42:07","video":"","vorDoi":"10.1186/s12909-024-06415-w","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06415-w","workflowStages":[]},"version":"v1","identity":"rs-5033621","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5033621","identity":"rs-5033621","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}