What Contributes to Clinician Wellbeing? An Evidence and Gap Map of Clinician Experiences in Primary Care

What Contributes to Clinician Wellbeing? 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An Evidence and Gap Map of Clinician Experiences in Primary Care Dorsa Salimi, Paula Louise Bush, Ashkan Baradaran, Anaïs Lacasse, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8380425/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Clinician wellbeing is important for optimal health system performance. To improve their wellbeing and resilience, the National Academy of Medicine (NAM) recommends addressing upstream drivers, detailed in their framework of both external ( learning and practice environment, organisational factors, healthcare responsibilities, society and culture, and rules and regulations ) and individual ( personal factors, skills and abilities) factors that influence clinician wellbeing. Qualitative research that reports clinician self-reported experiences can provide insight into the factors that contribute to their wellbeing. Extant qualitative literature reviews report on work-related experiences affecting the wellbeing of specific types of clinicians in specific contexts, but none captures a holistic picture of clinician experiences in providing care. Objective: Map qualitative evidence on primary care clinician self-reported experiences related to wellbeing to the NAM framework factors, and create an interactive database to support future evidence syntheses and interventions. Methods: Using an evidence and gap map approach, we searched MEDLINE, Embase, PsycINFO, and CINAHL (2013–2023) for qualitative and mixed-methods studies. We included studies from Canada, Australia, Belgium, or France that described self-reported experiences of primary care clinicians (family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, social workers). We coded the experiences in each study according to reporting clinician type and NAM factors. We generated the interactive map, with integrated bibliographic database, using EPPI-Reviewer and EPPI-Mapper. Results: From 6,133 records we included 652 publications. Most were Australian (54%) or Canadian (34%). The majority (57%) reported experiences of family physicians/general practitioners, while social workers and midwives were underrepresented (3% and 2%, respectively). Clinician-reported experiences focused mainly on learning and practice environment , organisational , and healthcare responsibilities factors. Experiences related to skills and abilities , society and culture , personal factors , and rules and regulations , were less common, with slight variations across clinician groups. Conclusions: This evidence and gap map provides a comprehensive overview of qualitative evidence of primary care clinician-reported experiences related to wellbeing. External factors were more frequently mentioned, offering insight that can inform system-level interventions. Future qualitative syntheses of the mapped evidence can inform research and policy that better support clinician wellbeing. Health personnel Wellbeing Experience Resilience Primary Health Care Evidence and gap map Qualitative research Review Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION Health and social care systems that strive to optimize health system performance should aim to improve five interdependent outcomes: patient health outcomes, patient experiences, efficiency of care, workforce wellbeing and safety, and health equity [ 1 – 4 ]. With respect to workforce wellbeing and safety, clinician wellbeing has been recognised as an urgent global public health priority [ 5 ], highlighting the need for continued attention and understanding of the factors that influence it [ 6 , 7 ]. Understanding the stressors that undermine clinician wellbeing and contribute to burnout have been described as a fiscally responsible imperative [ 8 ]. Within this context, primary care warrants particular attention as it is the cornerstone of strong healthcare systems, delivers the majority of patient care, and contributes to improved population-health and equity through its emphasis on accessible, continuous, comprehensive, and coordinated care that integrates prevention and community engagement [ 6 , 9 – 11 ]. Burnout—characterised by emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment [ 12 ]—is linked to compromised patient safety (e.g., increased medical errors); diminished patient experience (e.g., weakened clinician–patient relationships); and reduced system efficiency (e.g., clinician absenteeism, turnover, and lower productivity) [ 5 , 6 , 13 ]. Burnout reflects broader systemic and environmental pressures to a far greater extent than individual vulnerability [ 14 , 15 ]. Addressing such upstream stressors is considered more effective than focusing solely on burnout as a syndrome [ 16 , 17 ]. Indeed, understanding the factors and dynamics that shape clinician work experiences—and thus influence their wellbeing and resilience—may inform interventions to address them [ 17 , 18 ]. The National Academy of Medicine (NAM) developed a framework capturing a wide range of factors that influence clinician wellbeing and resilience. At its core, the framework recognises that clinician wellbeing, patient wellbeing, and the quality of the clinician–patient relationship are interdependent, reinforcing the principle that supporting clinicians ultimately enhances patient care. Surrounding this core are external and individual factors that contribute to clinician wellbeing. Table 1 presents the factors of the NAM framework, together with descriptions that we developed based on the NAM framework [ 19 , 20 ]. Table 1 NAM framework factors and descriptions Factors Descriptions Society and Culture Factors* Media portrayals and unrealistic societal and patient expectations increase clinician stress, while stigma around mental health discourages help-seeking. Rules and Regulations* Licensure, insurance, reimbursement, and litigation pressures create administrative and legal burdens that contribute to burnout. Organisational Factors* Leadership style, workplace culture, power dynamics, workload, compensation, staff support, inclusion, and development opportunities all shape the clinician experience and influence burnout risk. Learning and Practice Environment* The conditions in which clinicians train and work—including autonomy, mentorship, institutional culture, team dynamics, physical and digital environments, and support systems—influence wellbeing and resilience. Health Care Responsibilities* Clinical, administrative, teaching, and research duties—shaped by career stage, complexity of patient needs, and specialty—can lead to stress when misaligned with authority and support. Personal Factors** Individual influences such as work-life integration, family dynamics, financial stress, personal values, social support, and mental wellbeing affect how clinicians cope with stress and burnout. Skills and Abilities** Personal, clinical, interpersonal, and technical competencies help clinicians manage stress, adapt to change, and build resilience throughout their careers. *External factors; **Individual factors. For further information and the full list of factors within each group, see the National Academy of Medicine’s Factors Affecting Clinician Wellbeing and Resilience framework [ 20 ] Many literature reviews about clinician experience focus on specific professions or clinical contexts, such as the experiences of Aboriginal and Torres Strait Islander health workers [ 21 ], or clinicians experiences of prescribing opioids in primary care [ 22 ], providing care after stillbirth [ 23 ], working during an epidemic [ 24 ], or working in remote regions in Canada and Australia [ 25 ]. These reviews report challenges clinicians face while providing healthcare that align with the factors of the NAM framework. For example, with respect to organisational factors , two reviews identified time pressure, unclear roles, poor coordination, and limited organisational support as barriers of care provision in specific contexts that contribute to workload stress and reduced job satisfaction among clinicians [ 26 , 27 ]. Regarding learning and practice environment factors, a meta-ethnography on the interrelationships between organisational culture and primary care practice [ 28 ] and a scoping review on the use of electronic clinical decision making support tools [ 29 ] describe how workload, workflow disruptions, and reliance on electronic health tools can undermine wellbeing [ 12 , 28 , 29 ]. Filut et al [ 30 ] highlighted experiences related to society and culture factors, such as discrimination experienced by clinicians from some racial and ethnic groups through biased patient interactions, as well as organisational barriers, including limited career advancement opportunities and unsupportive workplace environments, all of which can undermine wellbeing. Finally, a meta-aggregation of qualitative evidence regarding factors influencing the retention of Canadian and Australian general practitioners working in remote areas, reports that in this context clinician burnout is driven by their experiences in relation to professional isolation, excessive workload and responsibility, difficulties maintaining boundaries between personal and professional life, and navigating cultural differences, which align with multiple NAM framework factors [ 25 ]. Indeed, Pervaz Iqbal et al. [ 31 ] suggested that more work is needed to provide a holistic picture of clinician experiences in providing care. They highlighted that exploring qualitative literature that captures clinician self-reported experiences can provide in-depth insight into the perceptions of lived realities of clinical practice and the factors that contribute to clinician wellbeing [ 31 ]. We sought to identify qualitative research that reports clinician perspectives of their work experiences related to wellbeing and to map them across the seven groups of factors of the NAM framework. We also sought to illustrate this evidence in a freely accessible, interactive database to provide a foundation for future research on the factors influencing clinician resilience and wellbeing, and to inform the development of interventions and the adaptation or creation of measurement instruments. METHODS We conducted an evidence and gap map that systematically identifies, organises, and illustrates existing research related to an area of inquiry. This approach provides a descriptive overview of the available evidence, highlighting areas where research is concentrated and where gaps remain. We followed the methodological and reporting guidance developed by the Campbell Collaboration for evidence and gap maps [ 32 – 35 ]. Through a series of team meetings and consultations with key interest holders, we explored the literature on clinician experience and iteratively defined the purpose, structure, and scope of our map, in terms of clinician types, clinical settings, and jurisdictions. Eligibility We included qualitative and mixed-methods studies that reported clinician perspectives of their experiences while working in primary care settings. Since Canadian primary care is increasingly implementing team-based models of care, we selected clinician types typically found in such teams (family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, and social workers) [ 36 ]. We included studies published from 2013 onward, given the 2014 addition of clinician wellbeing into the Quadruple Aim framework [ 4 ]. To increase the relevance of our map for Canadian policymakers and other stakeholders, we focused on literature from Canada and three other Organisation for Economic Co-operation and Development (OECD) countries—Australia, Belgium, and France—that share comparable health system structures. The OECD classifies health care systems based on shared financing, governance, and service delivery characteristics [ 37 ]. Within this typology, these four countries are grouped together as having publicly funded basic insurance complemented by private insurance for services beyond the basic coverage [ 37 ]. The eligibility criteria are detailed in Table 2 . Table 2 Eligibility criteria Inclusion Criteria Exclusion Criteria Study Design Qualitative empirical evidence (either from qualitative or mixed-methods studies) Quantitative empirical evidence, reviews, commentaries, editorials, grey literature, and other non-empirical publications Phenomenon of Interest Clinician-reported work experiences related to wellbeing Population General practitioners, family physicians, nurses, nurse practitioners, pharmacists, social workers, or midwives Other clinician types (e.g., dentists, residents, dieticians, medical students, obstetricians, occupational therapists), or studies reporting aggregated results for multiple clinician types without distinguishing their respective experiences. Setting Primary healthcare settings Secondary, tertiary, or quaternary care settings Countries Australia, Belgium, Canada, or France Other countries or studies presenting aggregated results across multiple countries. Language English and French Any other languages Lacked full-text availability Search strategy The search strategy was iteratively developed with a specialized health librarian to optimise sensitivity and specificity. To capture clinician-reported experiences related to wellbeing, concepts reflecting wellbeing and the factors of the NAM framework were incorporated as keywords. The complete search strategies for each database are provided in Additional file 1. Searches were implemented in MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCOhost). Selection All identified bibliographic records were imported into Covidence, and duplicates were removed [ 38 ]. Selection was conducted by 10 people who were trained through instructional videos. Seven screeners (PB, AB, DS, ICB, JM, CH, SG) piloted the eligibility criteria on a random 10% sample of the records, working collaboratively to refine the criteria and align their understanding (e.g., definition of primary care). Subsequently, each title and abstract was independently reviewed by two screeners, with discrepancies resolved by a third (PB or AB). Inter-rater agreement was monitored throughout, and both synchronous and asynchronous group discussions were held to ensure consistent application of the criteria. Full-text screening involved nine reviewers. They first calibrated their approach on a 10% subset of full texts; thereafter, each remaining full text was screened by a single reviewer (DS, ICB, JM, CH, AB, AN, BYD, or PB). The eligibility of every selected full text was then verified by a second reviewer (DS, CH or JM). Any remaining conflicts were adjudicated by a third (RN or PB). Coding Coding was conducted in Citavi, a reference management tool that supports structured data organisation and transparent decision tracking [ 39 ]. For coding purposes, family physicians and general practitioners were grouped, as were nurses and nurse practitioners, resulting in five clinician types: family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, and social workers. Each included study was reviewed to identify clinician-reported experiences, and code them by clinician type and NAM framework factor (e.g., Pharmacist – Organisational factors ). If a study included experiences from multiple clinician types or reflecting more than one of the seven groups of factors, it was coded multiple times. However, each unique clinician–factor pair was coded only once per study. For example, a publication including two social worker-reported experiences related to healthcare responsibilities and one pharmacist-reported experience related to society and culture was coded twice as Social worker – Healthcare responsibilities and Pharmacist – Society and culture . We also coded country and year of publication to allow map users to further filter the evidence. Subnational location was coded for Canada and Australia, where healthcare is organised provincially/territorially, but not for France or Belgium, which have more centralized nationally consistent systems. All factual data were verified by a second reviewer (clinician type, country, publication year). Regarding the experience data, random samples of 20% of included studies (across all clinician types, countries, and NAM framework factors) were verified by a second reviewer (AN and BYD) and discrepancies were resolved by a third (PB). Synthesis We generated ‘clinician-reported experiences’ data, using R (version 4.3.2) [ 40 ], and created visualizations illustrating the frequencies of clinician-reported experiences across the seven groups of NAM framework factors, five types of primary care clinicians, four countries, and 10 years of publication. To create the map and database of the literature, we imported the included studies into EPPI-Reviewer, coded them in the same way, and double-checked the coding for accuracy. Then, using EPPI-Mapper, we generated a two-dimensional matrix (the map)[ 41 , 42 ]. The horizontal axis includes the five clinician categories, each further partitioned into the seven NAM factors and the vertical axis consists of the four countries, subdivided by their respective provinces or territories. The cells visually represent the number of studies corresponding to the intersecting clinician type/factor and country/province dimensions. RESULTS Following deduplication of the 11,674 records identified, we screened 6,133 unique titles and abstracts, followed by 1580 full texts. Ultimately, 652 studies were eligible and included in the map. The flow of publications through the review is represented in the PRISMA flow diagram in Fig. 1. Figure 1. PRISMA 2020 flow diagram [ 43 ] As shown in Fig. 2, most included studies were from Australia 54% (n = 353) or Canada 34% (n = 225). There was a notable increase in the number of publications after 2020 with just over 40% (n = 269) of included studies being published since 2021. Figure 2. Number of included studies by year and country General practitioner- and family physician-reported experiences appeared in 57% of the studies, followed by self-reported experiences of nurses and nurse practitioners (23%) and pharmacists (15%). Fewer studies include experiences reported by social workers (3%) or midwives (2%). Figure 3 presents the frequencies of reported experiences across factors for each clinician type. The overall pattern is consistent across clinician types, with learning and practice environment and organisational factors being the most frequently represented factors. Learning and practice environment factors rank highest among family physicians and general practitioners, nurses and nurse practitioners, and pharmacists, whereas organisational factors take precedence for social workers and midwives. Healthcare responsibilities rank third for most clinician types. Society and culture , skills and abilities , and personal factors are moderately represented, with variation across clinician types. Experiences related to rules and regulations factors account for the smallest proportion for all clinician types. Figure 3. Frequencies of reported experiences across NAM framework factors, grouped by clinician type The frequencies of reported experiences across the factors showed relatively consistent patterns over the 10-year publication period, with a steady increase in most of them—especially between 2020 and 2022, as illustrated in Fig. 4. Figure 4. Trend of frequencies of reported experiences across NAM framework factors over 10 years Interactive online map The interactive online map is provided as Additional file 2. Users may navigate the map to view the evidence and gaps, and to retrieve bibliographic records—including abstracts and hyperlinks to full texts—for any selected subset of the literature, defined by any combination of the following attributes: NAM factor, country, province/territory, clinician type. Users may also filter by publication year. The ‘About’ section provides additional information. Screenshots of the map are presented in Fig. 5 and Fig. 6. Figure 5. Interactive evidence and gap map Figure 6. View of bibliographic filters and study-level details within the interactive map DISCUSSION This is the first review to provide a comprehensive overview of the qualitative evidence of wellbeing related clinician-reported experiences, in primary care settings. Through our novel evidence and gap map approach, we mapped this extensive evidence to NAM framework factors and present it in an accessible and interactive format. Clinician-reported experiences were most commonly related to the learning and practice environment , organisational , and healthcare responsibilities factors, which aligns with findings from a scoping review of reviews conducted by Usset et al.[ 44 ] that used the NAM framework to understand clinician stress and resilience in acute care settings. However, Usset et al. also identified personal factors among the top ones, whereas these were less prominent in our review, potentially reflecting differences in methodological approach and the care settings studied. Beyond illustrating where the evidence and gaps are, the map shows how attention to clinician wellbeing has evolved over time. While there was no increase in the number of publications per year following the move from the triple aim to the quadruple aim in 2014 (addition of clinician wellbeing) [ 4 ], there was an increase that coincides with the COVID-19 pandemic. This surge likely reflects the heightened awareness and urgency to address clinician wellbeing in the wake of the pandemic. Our review is similar to others regarding the prominence of clinician reported experiences related to external factors, compared to individual ones. Previous literature reviews have highlighted the role of external factors in shaping clinician wellbeing, such as chaotic work environments, heavy workloads, inadequate staffing, leadership style, institutional values, and workflow design [ 5 , 12 , 45 – 47 ]. This is further underscored by a systematic review, found that organisational and practice environment factors were the most frequently reported predictors of burnout among primary care providers [ 18 ]. It follows that interventions aimed at improving these factors may help improve clinician wellbeing and reduce the high rates of burnout. Indeed, it has been argued that addressing clinician wellbeing should be a responsibility that clinicians and healthcare organisations share, with structural changes viewed as more sustainable and equitable than placing responsibility solely on individuals [ 48 ]. For instance, a systematic review by Gomes-Souza et al. found that advance care planning interventions—often implemented through organisational training and system-level processes—may contribute to healthcare professionals’ wellbeing by reducing moral distress, improving role clarity, and increasing confidence in end-of-life decision-making [ 49 ]. Improving the learning and practice environment through increased professional autonomy, access to supportive mentoring, and team-based structures can enhance clinicians’ sense of control and connection, which can lead to greater engagement and lower rates of burnout [ 50 ]. Restructuring schedules to allow for adequate rest, investing in robust onboarding and continuing education, and fostering inclusive clinical cultures can enhance resilience and retention [ 51 , 52 ]. Reducing administrative tasks and improving the usability of electronic health records can lessen stress, burnout, and attrition among primary care physician [ 47 , 53 ]. Finally, providing supportive leadership fosters job satisfaction, while unclear hierarchies and poor communication contribute to disengagement [ 54 , 55 ]. Gaps A key gap identified in this evidence and gap map is the underrepresentation of social worker- and midwife-reported experiences. This is a notable limitation given the increasing shift toward team-based care and the growing emphasis on integrating healthcare and social services to provide holistic patient care [ 56 ]. For instance, because a large proportion of primary care patients present with mental health issues [ 57 ], understanding social workers’ experiences can help inform strategies for meeting the growing mental health demands on primary care teams, without compromising clinicians wellbeing. In addition, similar to other reviews [ 18 , 46 ], we found few studies with clinician-reported experiences about rules and regulations factors. Implications for Research and Policy This evidence and gap map offers a practical resource to guide both future research and policy decisions aimed at improving clinician wellbeing in primary care. From a research perspective, the structured representation facilitates systematic exploration of the evidence base, enabling researchers to select studies across professional and regional contexts for targeted scholarly inquiry. For instance, knowledge syntheses may be valuable to clarify how specific factors within the seven groups affect clinician experience, or to refine their operational definitions. A recent systematic review conducted by members of our research team [ 57 ] examined studies that used validated self-reported instruments to assess clinician wellbeing and the factors that influence it. Their review highlighted gaps such as the underrepresentation of certain NAM factors and the limited availability of tools validated for professions beyond nurses and physicians. The evidence mapped in our study could help address these gaps by informing the development of valid and context-specific Clinician Reported Experience Measures (CREMs) and tailored assessment instruments for use in primary care [ 58 ]. From a policy standpoint, care managers, administrators and policymakers can use the mapped evidence to inform the design of interventions targeting particular factors and clinicians. In particular, the map can serve as a starting point for dialogue between clinicians, decision-makers, and researchers by making visible where clinician-reported experiences cluster across NAM factors, professions, and jurisdictions, and where important gaps remain. Moreover, given the limited evidence regarding certain types of clinicians, the map highlights areas where further research may be needed to support evidence-informed inclusive policy planning and resource allocation. Together, these implications position the map as both a strategic tool for evidence synthesis and a practical guide for shaping healthier work environments in primary care. Strengths & Limitations One of the key strengths of our review is that our search strategy included all NAM framework factors thus capturing a broader range of wellbeing-related clinician experience evidence a search strategy explicitly focused on clinician wellbeing or experience. However, our scope was limited to five types of clinicians working in primary care settings in four countries. While our map organises 652 qualitative studies with clinician-reported experience evidence, according to factors of the NAM framework, it does not allow us to determine the relative influence of these factors on clinician wellbeing. This is the focus of our current work with primary care clinicians in the Canadian province of Quebec. Finally, while our literature search was completed in October 2023, we found that publication trends (Fig. 3) show that the pattern of reported-experiences across factors remained stable over the past decade, suggesting that additional studies published subsequent to our search would be unlikely to alter the overall pattern of findings. Furthermore, given the large number of studies in our map, it will support data saturation in future qualitative evidence syntheses of the self-reported experiences of a particular clinician type or relating to a particular group of NAM factors. CONCLUSION This review highlights that among the factors that influence clinician wellbeing and resilience, external ones, particularly the learning and practice environment , organisational factors , and healthcare responsibilities factors, are more commonly reported by primary care clinicians – whether they are family physicians and general practitioners, nurses and nurse practitioners, pharmacists, social workers, or midwives– working within publicly funded healthcare systems that offer universal coverage. These findings add to the evidence base that suggests high-yield areas for system-level interventions that support clinician wellbeing, supporting the development of targeted interventions and instruments tailored to primary care clinicians, and helping identify evidence clusters and gaps for policy and practice. Abbreviations CREM Clinician Reported Experience Measure NAM National Academy of Medicine Declarations Ethics approval and consent to participate Not applicable. This study did not involve human participants, human data, or human tissue. Consent for publication: Not applicable. This study did not involve human participants or individual-level data. Availability of data and materials: All materials generated and used in this study are included in this published article and its Additional files. Competing interests: The authors declare that they have no competing interests. Funding This review was supported by the Quebec Learning Health systems SUPPORT Unit (Unité de soutien au système de santé apprenant (SSA) Quebec; ssaquebec.ca) which is funded by the Canadian Institutes of Health Research as part of the Strategy for Patient Oriented Research. Acknowledgements We would like to thank Genevieve Gore for developing the search strategy, Ilhem C. Bousbiat, Bilé Yacouba Djedou, Sarah Gorguous, Caitlin Heiligmann, Jack Moncado, Raphaela Nikolopoulos, and André Nguyen for helping with article selection and coding, and Niloofar Nikgoftar for double checking the coding in EPPI-Reviewer. References Itchhaporia D. The Evolution of the Quintuple Aim. JACC. 2021 Nov 30;78(22):2262–4. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012 Apr 11;307(14):1513–6. Nundy S, Cooper LA, Mate KS. The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity. JAMA. 2022 Feb 8;327(6):521. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–6. Rehder K, Adair KC, Sexton JB. The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being. Archives of Pathology & Laboratory Medicine. 2021 Sept 1;145(9):1095–109. Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, et al. Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front Public Health. 2021 May 7;9:679397. Mehta LS, Elkind MSV, Achenbach S, Pinto FJ, Poppas A. Clinician Well-Being—addressing global needs for improvements in the health care field: a joint opinion from the American College of Cardiology, American Heart Association, European Society of Cardiology, World Heart Federation. Eur Heart J. 2021 July 13;42(33):3122–6. Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017 Dec 1;177(12):1826. Stange KC, Miller WL, Etz RS. The Role of Primary Care in Improving Population Health. Milbank Quarterly. 2023 Apr;101(S1):795–840. Glazier RH. Our role in making the Canadian health care system one of the world’s best. Can Fam Physician. 2023 Jan;69(1):11–6. Starfield B, Shi L, Macinko J. Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly. 2005;83(3):457–502. Khammissa RA, Nemutandani S, Shangase SL, Feller G, Lemmer J, Feller L. The burnout construct with reference to healthcare providers: A narrative review. SAGE Open Medicine. 2022 Jan;10:20503121221083080. Schneider J, Talamonti D, Gibson B, Forshaw M. Factors mediating the psychological well-being of healthcare workers responding to global pandemics: A systematic review. J Health Psychol. 2022 July;27(8):1875–96. De Wit K, Tran A, Clayton N, Seeburruth D, Lim RK, Archambault PM, et al. A Longitudinal Survey on Canadian Emergency Physician Burnout. Annals of Emergency Medicine. 2024 June;83(6):576–84. Tanios M, Haberman D, Bouchard J, Motherwell M, Patel J. Analyses of burn-out among medical professionals and suggested solutions—a narrative review. Journal of Hospital Management and Health Policy [Internet]. 2022 Mar [cited 2025 July 25];6(0). Available from: https://jhmhp.amegroups.org/article/view/6891 Bamforth K, Rae P, Maben J, Lloyd H, Pearce S. Perceptions of healthcare professionals’ psychological wellbeing at work and the link to patients’ experiences of care: A scoping review. International Journal of Nursing Studies Advances. 2023 Dec;5:100148. Bogue RJ, Carter KF. A Model for Advancing Nurse Well-Being: Nurse Leader. 2019 Dec;17(6):526–30. Abraham CM, Zheng K, Poghosyan L. Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review. Med Care Res Rev. 2020 Oct;77(5):387–401. Accreditations Council for Graduate Medical Education, Brigham T, Barden C, American Association of Critical Care Nurses, Legreid Dopp A, American Society of Health System Pharmacists, et al. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience. NAM Perspectives [Internet]. 2018 Jan 29 [cited 2025 Sept 11];8(1). Available from: https://nam.edu/perspectives/a-journey-to-construct-an-all-encompassing-conceptual-model-of-factors-affecting-clinician-well-being-and-resilience/ Factors Affecting Clinician Well-Being and Resilience [Internet]. Available from: https://nam.edu/wp-content/uploads/sites/3/2019/07/Factors-Affecting-Clinician-Well-Being-and-Resilience-July-2019.pdf Topp SM, Edelman A, Taylor S. “We are everything to everyone”: a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. International Journal for Equity in Health. 2018;17(1):67. Kennedy MC, Pallotti P, Dickinson R, Harley C. ‘If you can’t see a dilemma in this situation you should probably regard it as a warning’: a metasynthesis and theoretical modelling of general practitioners’ opioid prescription experiences in primary care. British Journal of Pain. 2019 Aug;13(3):159–76. Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, et al. Systematic review to understand and improve care after stillbirth: a review of parents’ and healthcare professionals’ experiences. BMC Pregnancy & Childbirth. 2016;16:16. Philip J, Cherian V. Factors Affecting the Psychological Well-being of Health Care Workers During an Epidemic: A Thematic Review. Indian J Psychol Med. 2020 July;42(4):323–33. Wieland L, Ayton J, Abernethy G. Retention of General Practitioners in remote areas of Canada and Australia: A meta-aggregation of qualitative research. Australian Journal of Rural Health. 2021;29(5):656–69. Egerton T, Diamond LE, Buchbinder R, Bennell KL, Slade SC. A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians’ barriers and enablers to the management of osteoarthritis. Osteoarthritis and Cartilage. 2017 May;25(5):625–38. Couchman E, Ejegi-Memeh S, Mitchell S, Gardiner C. Facilitators of and barriers to continuity with GPs in primary palliative cancer care: A mixed-methods systematic review. Progress in Palliative Care. 2023 Jan 2;31(1):18–36. Grant S, Guthrie B, Entwistle V, Williams B. A meta-ethnography of organisational culture in primary care medical practice. Journal of Health Organization & Management. 2014;28(1):21–40. Fletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, et al. Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review. BMC Prim Care [Internet]. 2023 Jan 20 [cited 2025 July 15];24(1). Available from: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-023-01973-2 Filut A, Alvarez M, Carnes M. Discrimination Toward Physicians of Color: A Systematic Review. Journal of the National Medical Association. 2020 Apr;112(2):117–40. Pervaz Iqbal M, Manias E, Mimmo L, Mears S, Jack B, Hay L, et al. Clinicians’ experience of providing care: a rapid review. BMC Health Serv Res. 2020 Oct 15;20:952. Khalil H, Welch V, Grainger M, Campbell F. Methodology for mapping reviews, evidence maps, and gap maps. Research Synthesis Methods. 2025 June 16;1–11. Bragge P, Clavisi O, Turner T, Tavender E, Collie A, Gruen RL. The Global Evidence Mapping Initiative: Scoping research in broad topic areas. BMC Med Res Methodol [Internet]. 2011 Dec [cited 2025 July 16];11(1). Available from: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-11-92 Saran A, White H. Evidence and gap maps: a comparison of different approaches. Campbell Systematic Reviews. 2018 Jan;14(1):1–38. White H, Albers B, Gaarder M, Kornør H, Littell J, Marshall Z, et al. Guidance for producing a Campbell evidence and gap map. Campbell Systematic Reviews [Internet]. 2020 Dec [cited 2025 July 15];16(4). Available from: https://onlinelibrary.wiley.com/doi/10.1002/cl2.1125 Gupta A, Gray CS, Landes M, Sridharan S, Bhattacharyya O. Family medicine: An evolving field around the world. Can Fam Physician. 2021 Sept;67(9):647–51. Health Care Systems: Efficiency and Institutions [Internet]. Organisation for Economic Co-Operation and Development (OECD); 2010 May [cited 2025 July 16]. (OECD Economics Department Working Papers). Available from: https://www.oecd.org/en/publications/health-care-systems_5kmfp51f5f9t-en.html Veritas Health Innovation. Covidence systematic review software [Internet]. Covidence. Available from: https://www.covidence.org Swiss Academic Software. Citavi [Internet]. Wädenswil, Switzerland: Swiss Academic Software; Available from: https://www.citavi.com R Core Team. R: A language and environment for statistical computing Author [Internet]. Available from: https://www.R-project.org EPPI-Centre. EPPI-Mapper [Internet]. London, UK: University College London; Available from: https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=3846 EPPI-Centre. EPPI-Reviewer [Internet]. London, UK: UCL Institute of Education, University College London; Available from: https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=2914 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021 Apr;88:105906. Usset TJ, Stratton RG, Knapp S, Schwartzman G, Yadav SK, Schaefer BJ, et al. Factors Associated With Healthcare Clinician Stress and Resilience: A Scoping Review. J Healthc Manag. 2024 Feb 1;69(1):12–28. Munn LT, Huffman CS, Connor CD, Swick M, Danhauer SC, Gibbs MA. A qualitative exploration of the National Academy of medicine model of well‐being and resilience among healthcare workers during COVID‐19. Journal of Advanced Nursing. 2022 Aug;78(8):2561–74. Norful AA, Brewer KC, Cahir KM, Dierkes AM. Individual and organizational factors influencing well-being and burnout amongst healthcare assistants: A systematic review. International Journal of Nursing Studies Advances. 2024 June;6:100187. Wranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, et al. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy. 2019 June;123(6):550–63. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings. 2017 Jan 1;92(1):129–46. Gomes Souza L, Bouba DA, Corôa RDC, Dofara SG, Robitaille V, Blanchette V, et al. The Impact of Advance Care Planning on Healthcare Professionals’ Well-being: A Systematic Review. Journal of Pain and Symptom Management. 2024 Feb;67(2):173–87. National Academy of Medicine. Practice environment [Internet]. Clinician Well-Being Knowledge Hub. Available from: https://nam.edu/clinicianwellbeing/causes/practice-environment/ Morris ME, Brusco NK, McAleer R, Billett S, Brophy L, Bryant R, et al. Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education. Hum Resour Health. 2023 Dec 13;21(1):95. Uhde A, Schlicker N, Wallach DP, Hassenzahl M. Fairness and Decision-making in Collaborative Shift Scheduling Systems. 2020 [cited 2025 Aug 4]; Available from: https://arxiv.org/abs/2001.09755 Erickson SM, Rockwern B, Koltov M, McLean RM, for the Medical Practice and Quality Committee of the American College of Physicians*. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Ann Intern Med. 2017 May 2;166(9):659–61. Zhao J, Liu T, Liu Y. Leadership support and satisfaction of healthcare professionals in China’s leading hospitals: a cross-sectional study. BMC Health Serv Res. 2024 Sept 2;24(1):1016. Sfantou D, Laliotis A, Patelarou A, Sifaki- Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare. 2017 Oct 14;5(4):73. Van Hoorn ES, Ye L, Van Leeuwen N, Raat H, Lingsma HF. Value-Based Integrated Care: A Systematic Literature Review. Int J Health Policy Manag. 2024 Feb 19;13:8038. Caspi A, Houts RM, Moffitt TE, Richmond-Rakerd LS, Hanna MR, Sunde HF, et al. A nationwide analysis of 350 million patient encounters reveals a high volume of mental-health conditions in primary care. Nat Mental Health. 2024 Oct;2(10):1208–16. Audet C, Bernier A, Godbout-Parent M, Nguena Nguefack HL, Ferland L, Bush PL, et al. Assessment of clinician well-being and the factors that influence it using validated questionnaires: a systematic review. Commun Med. 2025 Aug 8;5(1):343. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1SearchStrategy.docx Additional file 1. Search strategies (DOCX) Title: Full search strategies for all databases Description: This file contains the complete search strategies AdditionalFile2IInteractiveevidenceandgapmap.html Additional file 2. Interactive evidence and gap map (HTML) Title: Interactive evidence and gap map Description: An EPPI-Mapper interactive evidence and gap map enabling users to navigate studies by NAM factor, clinician type, country/province, and publication year, with access to abstracts and links to full texts. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Feb, 2026 Reviews received at journal 05 Feb, 2026 Reviews received at journal 29 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers invited by journal 30 Dec, 2025 Editor invited by journal 26 Dec, 2025 Editor assigned by journal 22 Dec, 2025 Submission checks completed at journal 22 Dec, 2025 First submitted to journal 16 Dec, 2025 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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06:24:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1185974,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequencies of reported experiences across NAM framework factors, grouped by clinician type\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure.3.png","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/68947f17ed7cbf2441b4566b.png"},{"id":98485706,"identity":"0a8d7818-9fb5-41b2-b695-c648fe258f9b","added_by":"auto","created_at":"2025-12-18 06:24:46","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":262262,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrend of frequencies of reported experiences across NAM framework factors over 10 years\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure.4.png","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/42282de2bc25ba156e9dbe9a.png"},{"id":98485681,"identity":"af23dd4d-a223-4d49-b53a-3569b1446099","added_by":"auto","created_at":"2025-12-18 06:24:42","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":482197,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInteractive evidence and gap map\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure.5.png","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/e3ddb1fb1dda0ab214db3c72.png"},{"id":98485702,"identity":"610e232e-05d3-470d-b5b9-51ffe75a1372","added_by":"auto","created_at":"2025-12-18 06:24:45","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1011834,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eView of bibliographic filters and study-level details within the interactive map\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure.6.png","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/40b95d3c38511f9da72ed937.png"},{"id":98775631,"identity":"bbae174b-4c4d-40e8-8b3a-baef02342d8e","added_by":"auto","created_at":"2025-12-22 12:20:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5128073,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/7ae8d6eb-f3ed-4cec-b5d8-ffae13d0219e.pdf"},{"id":98624283,"identity":"59ade9b5-e87b-4d8e-9bb2-c37cbd9e8658","added_by":"auto","created_at":"2025-12-19 17:08:15","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":56138,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 1.\u003c/strong\u003e Search strategies (DOCX)\u003c/p\u003e\n\u003cp\u003eTitle: Full search strategies for all databases\u003c/p\u003e\n\u003cp\u003eDescription: This file contains the complete search strategies\u003c/p\u003e","description":"","filename":"AdditionalFile1SearchStrategy.docx","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/094e2078e8f1d15d986f1eeb.docx"},{"id":98485686,"identity":"8122da61-6a85-4e87-8cbc-676ecf700fa3","added_by":"auto","created_at":"2025-12-18 06:24:43","extension":"html","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":3059753,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 2.\u003c/strong\u003e Interactive evidence and gap map (HTML)\u003c/p\u003e\n\u003cp\u003eTitle: Interactive evidence and gap map\u003c/p\u003e\n\u003cp\u003eDescription: An EPPI-Mapper interactive evidence and gap map enabling users to navigate studies by NAM factor, clinician type, country/province, and publication year, with access to abstracts and links to full texts.\u003c/p\u003e","description":"","filename":"AdditionalFile2IInteractiveevidenceandgapmap.html","url":"https://assets-eu.researchsquare.com/files/rs-8380425/v1/d1f848ebb4114ae083f45599.html"}],"financialInterests":"No competing interests reported.","formattedTitle":"What Contributes to Clinician Wellbeing? An Evidence and Gap Map of Clinician Experiences in Primary Care","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHealth and social care systems that strive to optimize health system performance should aim to improve five interdependent outcomes: patient health outcomes, patient experiences, efficiency of care, workforce wellbeing and safety, and health equity [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With respect to workforce wellbeing and safety, clinician wellbeing has been recognised as an urgent global public health priority [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], highlighting the need for continued attention and understanding of the factors that influence it [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Understanding the stressors that undermine clinician wellbeing and contribute to burnout have been described as a fiscally responsible imperative [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Within this context, primary care warrants particular attention as it is the cornerstone of strong healthcare systems, delivers the majority of patient care, and contributes to improved population-health and equity through its emphasis on accessible, continuous, comprehensive, and coordinated care that integrates prevention and community engagement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBurnout\u0026mdash;characterised by emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u0026mdash;is linked to compromised patient safety (e.g., increased medical errors); diminished patient experience (e.g., weakened clinician\u0026ndash;patient relationships); and reduced system efficiency (e.g., clinician absenteeism, turnover, and lower productivity) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Burnout reflects broader systemic and environmental pressures to a far greater extent than individual vulnerability [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Addressing such upstream stressors is considered more effective than focusing solely on burnout as a syndrome [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Indeed, understanding the factors and dynamics that shape clinician work experiences\u0026mdash;and thus influence their wellbeing and resilience\u0026mdash;may inform interventions to address them [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe National Academy of Medicine (NAM) developed a framework capturing a wide range of factors that influence clinician wellbeing and resilience. At its core, the framework recognises that clinician wellbeing, patient wellbeing, and the quality of the clinician\u0026ndash;patient relationship are interdependent, reinforcing the principle that supporting clinicians ultimately enhances patient care. Surrounding this core are external and individual factors that contribute to clinician wellbeing. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the factors of the NAM framework, together with descriptions that we developed based on the NAM framework [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNAM framework factors and descriptions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescriptions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociety and Culture Factors*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedia portrayals and unrealistic societal and patient expectations increase clinician stress, while stigma around mental health discourages help-seeking.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRules and Regulations*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLicensure, insurance, reimbursement, and litigation pressures create administrative and legal burdens that contribute to burnout.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganisational Factors*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership style, workplace culture, power dynamics, workload, compensation, staff support, inclusion, and development opportunities all shape the clinician experience and influence burnout risk.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning and Practice Environment*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe conditions in which clinicians train and work\u0026mdash;including autonomy, mentorship, institutional culture, team dynamics, physical and digital environments, and support systems\u0026mdash;influence wellbeing and resilience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Care Responsibilities*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical, administrative, teaching, and research duties\u0026mdash;shaped by career stage, complexity of patient needs, and specialty\u0026mdash;can lead to stress when misaligned with authority and support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal Factors**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual influences such as work-life integration, family dynamics, financial stress, personal values, social support, and mental wellbeing affect how clinicians cope with stress and burnout.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkills and Abilities**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal, clinical, interpersonal, and technical competencies help clinicians manage stress, adapt to change, and build resilience throughout their careers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003e*External factors; **Individual factors. For further information and the full list of factors within each group, see the National Academy of Medicine\u0026rsquo;s Factors Affecting Clinician Wellbeing and Resilience framework\u003c/em\u003e [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMany literature reviews about clinician experience focus on specific professions or clinical contexts, such as the experiences of Aboriginal and Torres Strait Islander health workers [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], or clinicians experiences of prescribing opioids in primary care [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], providing care after stillbirth [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], working during an epidemic [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], or working in remote regions in Canada and Australia [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These reviews report challenges clinicians face while providing healthcare that align with the factors of the NAM framework. For example, with respect to \u003cem\u003eorganisational factors\u003c/em\u003e, two reviews identified time pressure, unclear roles, poor coordination, and limited organisational support as barriers of care provision in specific contexts that contribute to workload stress and reduced job satisfaction among clinicians [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Regarding \u003cem\u003elearning and practice environment\u003c/em\u003e factors, a meta-ethnography on the interrelationships between organisational culture and primary care practice [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and a scoping review on the use of electronic clinical decision making support tools [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] describe how workload, workflow disruptions, and reliance on electronic health tools can undermine wellbeing [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Filut et al [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] highlighted experiences related to \u003cem\u003esociety and culture\u003c/em\u003e factors, such as discrimination experienced by clinicians from some racial and ethnic groups through biased patient interactions, as well as organisational barriers, including limited career advancement opportunities and unsupportive workplace environments, all of which can undermine wellbeing. Finally, a meta-aggregation of qualitative evidence regarding factors influencing the retention of Canadian and Australian general practitioners working in remote areas, reports that in this context clinician burnout is driven by their experiences in relation to professional isolation, excessive workload and responsibility, difficulties maintaining boundaries between personal and professional life, and navigating cultural differences, which align with multiple NAM framework factors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Indeed, Pervaz Iqbal et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] suggested that more work is needed to provide a holistic picture of clinician experiences in providing care. They highlighted that exploring qualitative literature that captures clinician self-reported experiences can provide in-depth insight into the perceptions of lived realities of clinical practice and the factors that contribute to clinician wellbeing [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe sought to identify qualitative research that reports clinician perspectives of their work experiences related to wellbeing and to map them across the seven groups of factors of the NAM framework. We also sought to illustrate this evidence in a freely accessible, interactive database to provide a foundation for future research on the factors influencing clinician resilience and wellbeing, and to inform the development of interventions and the adaptation or creation of measurement instruments.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eWe conducted an evidence and gap map that systematically identifies, organises, and illustrates existing research related to an area of inquiry. This approach provides a descriptive overview of the available evidence, highlighting areas where research is concentrated and where gaps remain. We followed the methodological and reporting guidance developed by the Campbell Collaboration for evidence and gap maps [\u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Through a series of team meetings and consultations with key interest holders, we explored the literature on clinician experience and iteratively defined the purpose, structure, and scope of our map, in terms of clinician types, clinical settings, and jurisdictions.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility\u003c/h2\u003e \u003cp\u003eWe included qualitative and mixed-methods studies that reported clinician perspectives of their experiences while working in primary care settings. Since Canadian primary care is increasingly implementing team-based models of care, we selected clinician types typically found in such teams (family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, and social workers) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. We included studies published from 2013 onward, given the 2014 addition of clinician wellbeing into the Quadruple Aim framework [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. To increase the relevance of our map for Canadian policymakers and other stakeholders, we focused on literature from Canada and three other Organisation for Economic Co-operation and Development (OECD) countries\u0026mdash;Australia, Belgium, and France\u0026mdash;that share comparable health system structures. The OECD classifies health care systems based on shared financing, governance, and service delivery characteristics [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Within this typology, these four countries are grouped together as having publicly funded basic insurance complemented by private insurance for services beyond the basic coverage [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The eligibility criteria are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEligibility criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative empirical evidence (either from qualitative or mixed-methods studies)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuantitative empirical evidence, reviews, commentaries, editorials, grey literature, and other non-empirical publications\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhenomenon of Interest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinician-reported work experiences related to wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral practitioners, family physicians, nurses, nurse practitioners, pharmacists, social workers, or midwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther clinician types (e.g., dentists, residents, dieticians, medical students, obstetricians, occupational therapists), or studies reporting aggregated results for multiple clinician types without distinguishing their respective experiences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary healthcare settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSecondary, tertiary, or quaternary care settings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia, Belgium, Canada, or France\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther countries or studies presenting aggregated results across multiple countries.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnglish and French\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny other languages\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLacked full-text availability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eThe search strategy was iteratively developed with a specialized health librarian to optimise sensitivity and specificity. To capture clinician-reported experiences related to wellbeing, concepts reflecting wellbeing and the factors of the NAM framework were incorporated as keywords. The complete search strategies for each database are provided in Additional file 1. Searches were implemented in MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCOhost).\u003c/p\u003e\n\u003ch3\u003eSelection\u003c/h3\u003e\n\u003cp\u003eAll identified bibliographic records were imported into Covidence, and duplicates were removed [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Selection was conducted by 10 people who were trained through instructional videos. Seven screeners (PB, AB, DS, ICB, JM, CH, SG) piloted the eligibility criteria on a random 10% sample of the records, working collaboratively to refine the criteria and align their understanding (e.g., definition of primary care). Subsequently, each title and abstract was independently reviewed by two screeners, with discrepancies resolved by a third (PB or AB). Inter-rater agreement was monitored throughout, and both synchronous and asynchronous group discussions were held to ensure consistent application of the criteria. Full-text screening involved nine reviewers. They first calibrated their approach on a 10% subset of full texts; thereafter, each remaining full text was screened by a single reviewer (DS, ICB, JM, CH, AB, AN, BYD, or PB). The eligibility of every selected full text was then verified by a second reviewer (DS, CH or JM). Any remaining conflicts were adjudicated by a third (RN or PB).\u003c/p\u003e\n\u003ch3\u003eCoding\u003c/h3\u003e\n\u003cp\u003eCoding was conducted in Citavi, a reference management tool that supports structured data organisation and transparent decision tracking [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. For coding purposes, family physicians and general practitioners were grouped, as were nurses and nurse practitioners, resulting in five clinician types: family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, and social workers.\u003c/p\u003e \u003cp\u003eEach included study was reviewed to identify clinician-reported experiences, and code them by clinician type and NAM framework factor (e.g., \u003cem\u003ePharmacist \u0026ndash; Organisational factors\u003c/em\u003e). If a study included experiences from multiple clinician types or reflecting more than one of the seven groups of factors, it was coded multiple times. However, each unique clinician\u0026ndash;factor pair was coded only once per study. For example, a publication including two social worker-reported experiences related to \u003cem\u003ehealthcare responsibilities\u003c/em\u003e and one pharmacist-reported experience related to \u003cem\u003esociety and culture\u003c/em\u003e was coded twice as \u003cem\u003eSocial worker \u0026ndash; Healthcare responsibilities\u003c/em\u003e and \u003cem\u003ePharmacist \u0026ndash; Society and culture\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eWe also coded country and year of publication to allow map users to further filter the evidence. Subnational location was coded for Canada and Australia, where healthcare is organised provincially/territorially, but not for France or Belgium, which have more centralized nationally consistent systems. All factual data were verified by a second reviewer (clinician type, country, publication year). Regarding the experience data, random samples of 20% of included studies (across all clinician types, countries, and NAM framework factors) were verified by a second reviewer (AN and BYD) and discrepancies were resolved by a third (PB).\u003c/p\u003e\n\u003ch3\u003eSynthesis\u003c/h3\u003e\n\u003cp\u003eWe generated \u0026lsquo;clinician-reported experiences\u0026rsquo; data, using R (version 4.3.2) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], and created visualizations illustrating the frequencies of clinician-reported experiences across the seven groups of NAM framework factors, five types of primary care clinicians, four countries, and 10 years of publication. To create the map and database of the literature, we imported the included studies into EPPI-Reviewer, coded them in the same way, and double-checked the coding for accuracy. Then, using EPPI-Mapper, we generated a two-dimensional matrix (the map)[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The horizontal axis includes the five clinician categories, each further partitioned into the seven NAM factors and the vertical axis consists of the four countries, subdivided by their respective provinces or territories. The cells visually represent the number of studies corresponding to the intersecting clinician type/factor and country/province dimensions.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFollowing deduplication of the 11,674 records identified, we screened 6,133 unique titles and abstracts, followed by 1580 full texts. Ultimately, 652 studies were eligible and included in the map. The flow of publications through the review is represented in the PRISMA flow diagram in Fig.\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1. PRISMA 2020 flow diagram\u003c/b\u003e [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;2, most included studies were from Australia 54% (n\u0026thinsp;=\u0026thinsp;353) or Canada 34% (n\u0026thinsp;=\u0026thinsp;225). There was a notable increase in the number of publications after 2020 with just over 40% (n\u0026thinsp;=\u0026thinsp;269) of included studies being published since 2021.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 2. Number of included studies by year and country\u003c/b\u003e \u003c/p\u003e \u003cp\u003eGeneral practitioner- and family physician-reported experiences appeared in 57% of the studies, followed by self-reported experiences of nurses and nurse practitioners (23%) and pharmacists (15%). Fewer studies include experiences reported by social workers (3%) or midwives (2%).\u003c/p\u003e \u003cp\u003eFigure 3 presents the frequencies of reported experiences across factors for each clinician type. The overall pattern is consistent across clinician types, with \u003cem\u003elearning and practice environment\u003c/em\u003e and \u003cem\u003eorganisational factors\u003c/em\u003e being the most frequently represented factors. \u003cem\u003eLearning and practice environment\u003c/em\u003e factors rank highest among family physicians and general practitioners, nurses and nurse practitioners, and pharmacists, whereas \u003cem\u003eorganisational factors\u003c/em\u003e take precedence for social workers and midwives. \u003cem\u003eHealthcare responsibilities\u003c/em\u003e rank third for most clinician types. \u003cem\u003eSociety and culture\u003c/em\u003e, \u003cem\u003eskills and abilities\u003c/em\u003e, and \u003cem\u003epersonal factors\u003c/em\u003e are moderately represented, with variation across clinician types. Experiences related to \u003cem\u003erules and regulations\u003c/em\u003e factors account for the smallest proportion for all clinician types.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 3. Frequencies of reported experiences across NAM framework factors, grouped by clinician type\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe frequencies of reported experiences across the factors showed relatively consistent patterns over the 10-year publication period, with a steady increase in most of them\u0026mdash;especially between 2020 and 2022, as illustrated in Fig.\u0026nbsp;4.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 4. Trend of frequencies of reported experiences across NAM framework factors over 10 years\u003c/b\u003e \u003c/p\u003e\n\u003ch3\u003eInteractive online map\u003c/h3\u003e\n\u003cp\u003eThe interactive online map is provided as Additional file 2. Users may navigate the map to view the evidence and gaps, and to retrieve bibliographic records\u0026mdash;including abstracts and hyperlinks to full texts\u0026mdash;for any selected subset of the literature, defined by any combination of the following attributes: NAM factor, country, province/territory, clinician type. Users may also filter by publication year. The \u0026lsquo;About\u0026rsquo; section provides additional information. Screenshots of the map are presented in Fig.\u0026nbsp;5 and Fig.\u0026nbsp;6.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 5. Interactive evidence and gap map\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 6. View of bibliographic filters and study-level details within the interactive map\u003c/b\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis is the first review to provide a comprehensive overview of the qualitative evidence of wellbeing related clinician-reported experiences, in primary care settings. Through our novel evidence and gap map approach, we mapped this extensive evidence to NAM framework factors and present it in an accessible and interactive format. Clinician-reported experiences were most commonly related to the \u003cem\u003elearning and practice environment\u003c/em\u003e, \u003cem\u003eorganisational\u003c/em\u003e, and \u003cem\u003ehealthcare responsibilities\u003c/em\u003e factors, which aligns with findings from a scoping review of reviews conducted by Usset et al.[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] that used the NAM framework to understand clinician stress and resilience in acute care settings. However, Usset et al. also identified \u003cem\u003epersonal factors\u003c/em\u003e among the top ones, whereas these were less prominent in our review, potentially reflecting differences in methodological approach and the care settings studied. Beyond illustrating where the evidence and gaps are, the map shows how attention to clinician wellbeing has evolved over time. While there was no increase in the number of publications per year following the move from the triple aim to the quadruple aim in 2014 (addition of clinician wellbeing) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], there was an increase that coincides with the COVID-19 pandemic. This surge likely reflects the heightened awareness and urgency to address clinician wellbeing in the wake of the pandemic.\u003c/p\u003e \u003cp\u003eOur review is similar to others regarding the prominence of clinician reported experiences related to external factors, compared to individual ones. Previous literature reviews have highlighted the role of external factors in shaping clinician wellbeing, such as chaotic work environments, heavy workloads, inadequate staffing, leadership style, institutional values, and workflow design [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. This is further underscored by a systematic review, found that organisational and practice environment factors were the most frequently reported predictors of burnout among primary care providers [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It follows that interventions aimed at improving these factors may help improve clinician wellbeing and reduce the high rates of burnout. Indeed, it has been argued that addressing clinician wellbeing should be a responsibility that clinicians and healthcare organisations share, with structural changes viewed as more sustainable and equitable than placing responsibility solely on individuals [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. For instance, a systematic review by Gomes-Souza et al. found that advance care planning interventions\u0026mdash;often implemented through organisational training and system-level processes\u0026mdash;may contribute to healthcare professionals\u0026rsquo; wellbeing by reducing moral distress, improving role clarity, and increasing confidence in end-of-life decision-making [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Improving the learning and practice environment through increased professional autonomy, access to supportive mentoring, and team-based structures can enhance clinicians\u0026rsquo; sense of control and connection, which can lead to greater engagement and lower rates of burnout [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Restructuring schedules to allow for adequate rest, investing in robust onboarding and continuing education, and fostering inclusive clinical cultures can enhance resilience and retention [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Reducing administrative tasks and improving the usability of electronic health records can lessen stress, burnout, and attrition among primary care physician [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Finally, providing supportive leadership fosters job satisfaction, while unclear hierarchies and poor communication contribute to disengagement [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGaps\u003c/h2\u003e \u003cp\u003eA key gap identified in this evidence and gap map is the underrepresentation of social worker- and midwife-reported experiences. This is a notable limitation given the increasing shift toward team-based care and the growing emphasis on integrating healthcare and social services to provide holistic patient care [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. For instance, because a large proportion of primary care patients present with mental health issues [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], understanding social workers\u0026rsquo; experiences can help inform strategies for meeting the growing mental health demands on primary care teams, without compromising clinicians wellbeing. In addition, similar to other reviews [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], we found few studies with clinician-reported experiences about \u003cem\u003erules and regulations\u003c/em\u003e factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Research and Policy\u003c/h2\u003e \u003cp\u003eThis evidence and gap map offers a practical resource to guide both future research and policy decisions aimed at improving clinician wellbeing in primary care. From a research perspective, the structured representation facilitates systematic exploration of the evidence base, enabling researchers to select studies across professional and regional contexts for targeted scholarly inquiry. For instance, knowledge syntheses may be valuable to clarify how specific factors within the seven groups affect clinician experience, or to refine their operational definitions. A recent systematic review conducted by members of our research team [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] examined studies that used validated self-reported instruments to assess clinician wellbeing and the factors that influence it. Their review highlighted gaps such as the underrepresentation of certain NAM factors and the limited availability of tools validated for professions beyond nurses and physicians. The evidence mapped in our study could help address these gaps by informing the development of valid and context-specific Clinician Reported Experience Measures (CREMs) and tailored assessment instruments for use in primary care [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom a policy standpoint, care managers, administrators and policymakers can use the mapped evidence to inform the design of interventions targeting particular factors and clinicians. In particular, the map can serve as a starting point for dialogue between clinicians, decision-makers, and researchers by making visible where clinician-reported experiences cluster across NAM factors, professions, and jurisdictions, and where important gaps remain. Moreover, given the limited evidence regarding certain types of clinicians, the map highlights areas where further research may be needed to support evidence-informed inclusive policy planning and resource allocation. Together, these implications position the map as both a strategic tool for evidence synthesis and a practical guide for shaping healthier work environments in primary care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths \u0026amp; Limitations\u003c/h2\u003e \u003cp\u003eOne of the key strengths of our review is that our search strategy included all NAM framework factors thus capturing a broader range of wellbeing-related clinician experience evidence a search strategy explicitly focused on clinician wellbeing or experience. However, our scope was limited to five types of clinicians working in primary care settings in four countries. While our map organises 652 qualitative studies with clinician-reported experience evidence, according to factors of the NAM framework, it does not allow us to determine the relative influence of these factors on clinician wellbeing. This is the focus of our current work with primary care clinicians in the Canadian province of Quebec. Finally, while our literature search was completed in October 2023, we found that publication trends (Fig.\u0026nbsp;3) show that the pattern of reported-experiences across factors remained stable over the past decade, suggesting that additional studies published subsequent to our search would be unlikely to alter the overall pattern of findings. Furthermore, given the large number of studies in our map, it will support data saturation in future qualitative evidence syntheses of the self-reported experiences of a particular clinician type or relating to a particular group of NAM factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis review highlights that among the factors that influence clinician wellbeing and resilience, external ones, particularly the \u003cem\u003elearning and practice environment\u003c/em\u003e, \u003cem\u003eorganisational factors\u003c/em\u003e, and healthcare responsibilities factors, are more commonly reported by primary care clinicians \u0026ndash; whether they are family physicians and general practitioners, nurses and nurse practitioners, pharmacists, social workers, or midwives\u0026ndash; working within publicly funded healthcare systems that offer universal coverage. These findings add to the evidence base that suggests high-yield areas for system-level interventions that support clinician wellbeing, supporting the development of targeted interventions and instruments tailored to primary care clinicians, and helping identify evidence clusters and gaps for policy and practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCREM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinician Reported Experience Measure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNAM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Academy of Medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study did not involve human participants, human data, or human tissue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003cbr\u003e\u003c/strong\u003eNot applicable. This study did not involve human participants or individual-level data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;All materials generated and used in this study are included in this published article and its Additional files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review was supported by the Quebec Learning Health systems SUPPORT Unit (Unité de soutien au système de santé apprenant (SSA) Quebec; ssaquebec.ca) which is funded by the Canadian Institutes of Health Research as part of the Strategy for Patient Oriented Research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Genevieve Gore for developing the search strategy, Ilhem C. Bousbiat, Bilé Yacouba Djedou, Sarah Gorguous, Caitlin Heiligmann, Jack Moncado, Raphaela Nikolopoulos, and André Nguyen for helping with article selection and coding, and Niloofar Nikgoftar for double checking the coding in EPPI-Reviewer.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eItchhaporia D. The Evolution of the Quintuple Aim. JACC. 2021 Nov 30;78(22):2262\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eBerwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012 Apr 11;307(14):1513\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eNundy S, Cooper LA, Mate KS. The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity. JAMA. 2022 Feb 8;327(6):521. \u003c/li\u003e\n\u003cli\u003eBodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eRehder K, Adair KC, Sexton JB. The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being. Archives of Pathology \u0026amp; Laboratory Medicine. 2021 Sept 1;145(9):1095\u0026ndash;109. \u003c/li\u003e\n\u003cli\u003eS\u0026oslash;vold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, et al. Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front Public Health. 2021 May 7;9:679397. \u003c/li\u003e\n\u003cli\u003eMehta LS, Elkind MSV, Achenbach S, Pinto FJ, Poppas A. Clinician Well-Being\u0026mdash;addressing global needs for improvements in the health care field: a joint opinion from the American College of Cardiology, American Heart Association, European Society of Cardiology, World Heart Federation. Eur Heart J. 2021 July 13;42(33):3122\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eShanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017 Dec 1;177(12):1826. \u003c/li\u003e\n\u003cli\u003eStange KC, Miller WL, Etz RS. The Role of Primary Care in Improving Population Health. Milbank Quarterly. 2023 Apr;101(S1):795\u0026ndash;840. \u003c/li\u003e\n\u003cli\u003eGlazier RH. Our role in making the Canadian health care system one of the world\u0026rsquo;s best. Can Fam Physician. 2023 Jan;69(1):11\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eStarfield B, Shi L, Macinko J. Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly. 2005;83(3):457\u0026ndash;502. \u003c/li\u003e\n\u003cli\u003eKhammissa RA, Nemutandani S, Shangase SL, Feller G, Lemmer J, Feller L. The burnout construct with reference to healthcare providers: A narrative review. SAGE Open Medicine. 2022 Jan;10:20503121221083080. \u003c/li\u003e\n\u003cli\u003eSchneider J, Talamonti D, Gibson B, Forshaw M. Factors mediating the psychological well-being of healthcare workers responding to global pandemics: A systematic review. J Health Psychol. 2022 July;27(8):1875\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eDe Wit K, Tran A, Clayton N, Seeburruth D, Lim RK, Archambault PM, et al. A Longitudinal Survey on Canadian Emergency Physician Burnout. Annals of Emergency Medicine. 2024 June;83(6):576\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eTanios M, Haberman D, Bouchard J, Motherwell M, Patel J. Analyses of burn-out among medical professionals and suggested solutions\u0026mdash;a narrative review. Journal of Hospital Management and Health Policy [Internet]. 2022 Mar [cited 2025 July 25];6(0). Available from: https://jhmhp.amegroups.org/article/view/6891\u003c/li\u003e\n\u003cli\u003eBamforth K, Rae P, Maben J, Lloyd H, Pearce S. Perceptions of healthcare professionals\u0026rsquo; psychological wellbeing at work and the link to patients\u0026rsquo; experiences of care: A scoping review. International Journal of Nursing Studies Advances. 2023 Dec;5:100148. \u003c/li\u003e\n\u003cli\u003eBogue RJ, Carter KF. A Model for Advancing Nurse Well-Being: Nurse Leader. 2019 Dec;17(6):526\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eAbraham CM, Zheng K, Poghosyan L. Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review. Med Care Res Rev. 2020 Oct;77(5):387\u0026ndash;401. \u003c/li\u003e\n\u003cli\u003eAccreditations Council for Graduate Medical Education, Brigham T, Barden C, American Association of Critical Care Nurses, Legreid Dopp A, American Society of Health System Pharmacists, et al. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience. NAM Perspectives [Internet]. 2018 Jan 29 [cited 2025 Sept 11];8(1). Available from: https://nam.edu/perspectives/a-journey-to-construct-an-all-encompassing-conceptual-model-of-factors-affecting-clinician-well-being-and-resilience/\u003c/li\u003e\n\u003cli\u003eFactors Affecting Clinician Well-Being and Resilience [Internet]. Available from: https://nam.edu/wp-content/uploads/sites/3/2019/07/Factors-Affecting-Clinician-Well-Being-and-Resilience-July-2019.pdf\u003c/li\u003e\n\u003cli\u003eTopp SM, Edelman A, Taylor S. \u0026ldquo;We are everything to everyone\u0026rdquo;: a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. International Journal for Equity in Health. 2018;17(1):67. \u003c/li\u003e\n\u003cli\u003eKennedy MC, Pallotti P, Dickinson R, Harley C. \u0026lsquo;If you can\u0026rsquo;t see a dilemma in this situation you should probably regard it as a warning\u0026rsquo;: a metasynthesis and theoretical modelling of general practitioners\u0026rsquo; opioid prescription experiences in primary care. British Journal of Pain. 2019 Aug;13(3):159\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eEllis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, et al. Systematic review to understand and improve care after stillbirth: a review of parents\u0026rsquo; and healthcare professionals\u0026rsquo; experiences. BMC Pregnancy \u0026amp; Childbirth. 2016;16:16. \u003c/li\u003e\n\u003cli\u003ePhilip J, Cherian V. Factors Affecting the Psychological Well-being of Health Care Workers During an Epidemic: A Thematic Review. Indian J Psychol Med. 2020 July;42(4):323\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eWieland L, Ayton J, Abernethy G. Retention of General Practitioners in remote areas of Canada and Australia: A meta-aggregation of qualitative research. Australian Journal of Rural Health. 2021;29(5):656\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eEgerton T, Diamond LE, Buchbinder R, Bennell KL, Slade SC. A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians\u0026rsquo; barriers and enablers to the management of osteoarthritis. Osteoarthritis and Cartilage. 2017 May;25(5):625\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eCouchman E, Ejegi-Memeh S, Mitchell S, Gardiner C. Facilitators of and barriers to continuity with GPs in primary palliative cancer care: A mixed-methods systematic review. Progress in Palliative Care. 2023 Jan 2;31(1):18\u0026ndash;36. \u003c/li\u003e\n\u003cli\u003eGrant S, Guthrie B, Entwistle V, Williams B. A meta-ethnography of organisational culture in primary care medical practice. Journal of Health Organization \u0026amp; Management. 2014;28(1):21\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eFletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, et al. Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review. BMC Prim Care [Internet]. 2023 Jan 20 [cited 2025 July 15];24(1). Available from: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-023-01973-2\u003c/li\u003e\n\u003cli\u003eFilut A, Alvarez M, Carnes M. Discrimination Toward Physicians of Color: A Systematic Review. Journal of the National Medical Association. 2020 Apr;112(2):117\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003ePervaz Iqbal M, Manias E, Mimmo L, Mears S, Jack B, Hay L, et al. Clinicians\u0026rsquo; experience of providing care: a rapid review. BMC Health Serv Res. 2020 Oct 15;20:952. \u003c/li\u003e\n\u003cli\u003eKhalil H, Welch V, Grainger M, Campbell F. Methodology for mapping reviews, evidence maps, and gap maps. Research Synthesis Methods. 2025 June 16;1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eBragge P, Clavisi O, Turner T, Tavender E, Collie A, Gruen RL. The Global Evidence Mapping Initiative: Scoping research in broad topic areas. BMC Med Res Methodol [Internet]. 2011 Dec [cited 2025 July 16];11(1). Available from: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-11-92\u003c/li\u003e\n\u003cli\u003eSaran A, White H. Evidence and gap maps: a comparison of different approaches. Campbell Systematic Reviews. 2018 Jan;14(1):1\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eWhite H, Albers B, Gaarder M, Korn\u0026oslash;r H, Littell J, Marshall Z, et al. Guidance for producing a Campbell evidence and gap map. Campbell Systematic Reviews [Internet]. 2020 Dec [cited 2025 July 15];16(4). Available from: https://onlinelibrary.wiley.com/doi/10.1002/cl2.1125\u003c/li\u003e\n\u003cli\u003eGupta A, Gray CS, Landes M, Sridharan S, Bhattacharyya O. Family medicine: An evolving field around the world. Can Fam Physician. 2021 Sept;67(9):647\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eHealth Care Systems: Efficiency and Institutions [Internet]. Organisation for Economic Co-Operation and Development (OECD); 2010 May [cited 2025 July 16]. (OECD Economics Department Working Papers). Available from: https://www.oecd.org/en/publications/health-care-systems_5kmfp51f5f9t-en.html\u003c/li\u003e\n\u003cli\u003eVeritas Health Innovation. Covidence systematic review software [Internet]. Covidence. Available from: https://www.covidence.org\u003c/li\u003e\n\u003cli\u003eSwiss Academic Software. Citavi [Internet]. W\u0026auml;denswil, Switzerland: Swiss Academic Software; Available from: https://www.citavi.com\u003c/li\u003e\n\u003cli\u003eR Core Team. R: A language and environment for statistical computing Author [Internet]. Available from: https://www.R-project.org\u003c/li\u003e\n\u003cli\u003eEPPI-Centre. EPPI-Mapper [Internet]. London, UK: University College London; Available from: https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=3846\u003c/li\u003e\n\u003cli\u003eEPPI-Centre. EPPI-Reviewer [Internet]. London, UK: UCL Institute of Education, University College London; Available from: https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=2914\u003c/li\u003e\n\u003cli\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021 Apr;88:105906. \u003c/li\u003e\n\u003cli\u003eUsset TJ, Stratton RG, Knapp S, Schwartzman G, Yadav SK, Schaefer BJ, et al. Factors Associated With Healthcare Clinician Stress and Resilience: A Scoping Review. J Healthc Manag. 2024 Feb 1;69(1):12\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eMunn LT, Huffman CS, Connor CD, Swick M, Danhauer SC, Gibbs MA. A qualitative exploration of the National Academy of medicine model of well‐being and resilience among healthcare workers during COVID‐19. Journal of Advanced Nursing. 2022 Aug;78(8):2561\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eNorful AA, Brewer KC, Cahir KM, Dierkes AM. Individual and organizational factors influencing well-being and burnout amongst healthcare assistants: A systematic review. International Journal of Nursing Studies Advances. 2024 June;6:100187. \u003c/li\u003e\n\u003cli\u003eWranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, et al. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy. 2019 June;123(6):550\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eShanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings. 2017 Jan 1;92(1):129\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eGomes Souza L, Bouba DA, Cor\u0026ocirc;a RDC, Dofara SG, Robitaille V, Blanchette V, et al. The Impact of Advance Care Planning on Healthcare Professionals\u0026rsquo; Well-being: A Systematic Review. Journal of Pain and Symptom Management. 2024 Feb;67(2):173\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eNational Academy of Medicine. Practice environment [Internet]. Clinician Well-Being Knowledge Hub. Available from: https://nam.edu/clinicianwellbeing/causes/practice-environment/\u003c/li\u003e\n\u003cli\u003eMorris ME, Brusco NK, McAleer R, Billett S, Brophy L, Bryant R, et al. Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education. Hum Resour Health. 2023 Dec 13;21(1):95. \u003c/li\u003e\n\u003cli\u003eUhde A, Schlicker N, Wallach DP, Hassenzahl M. Fairness and Decision-making in Collaborative Shift Scheduling Systems. 2020 [cited 2025 Aug 4]; Available from: https://arxiv.org/abs/2001.09755\u003c/li\u003e\n\u003cli\u003eErickson SM, Rockwern B, Koltov M, McLean RM, for the Medical Practice and Quality Committee of the American College of Physicians*. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Ann Intern Med. 2017 May 2;166(9):659\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eZhao J, Liu T, Liu Y. Leadership support and satisfaction of healthcare professionals in China\u0026rsquo;s leading hospitals: a cross-sectional study. BMC Health Serv Res. 2024 Sept 2;24(1):1016. \u003c/li\u003e\n\u003cli\u003eSfantou D, Laliotis A, Patelarou A, Sifaki- Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare. 2017 Oct 14;5(4):73. \u003c/li\u003e\n\u003cli\u003eVan Hoorn ES, Ye L, Van Leeuwen N, Raat H, Lingsma HF. Value-Based Integrated Care: A Systematic Literature Review. Int J Health Policy Manag. 2024 Feb 19;13:8038. \u003c/li\u003e\n\u003cli\u003eCaspi A, Houts RM, Moffitt TE, Richmond-Rakerd LS, Hanna MR, Sunde HF, et al. A nationwide analysis of 350 million patient encounters reveals a high volume of mental-health conditions in primary care. Nat Mental Health. 2024 Oct;2(10):1208\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eAudet C, Bernier A, Godbout-Parent M, Nguena Nguefack HL, Ferland L, Bush PL, et al. Assessment of clinician well-being and the factors that influence it using validated questionnaires: a systematic review. Commun Med. 2025 Aug 8;5(1):343. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health personnel, Wellbeing, Experience, Resilience, Primary Health Care, Evidence and gap map, Qualitative research, Review","lastPublishedDoi":"10.21203/rs.3.rs-8380425/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8380425/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Clinician wellbeing is important for optimal health system performance. To improve their wellbeing and resilience, the National Academy of Medicine (NAM) recommends addressing upstream drivers, detailed in their framework of both external (\u003cem\u003elearning and practice environment, organisational factors, healthcare responsibilities, society and culture, \u003c/em\u003eand\u003cem\u003e rules and regulations\u003c/em\u003e) and individual (\u003cem\u003epersonal factors, skills and abilities)\u003c/em\u003e factors that influence clinician wellbeing. Qualitative research that reports clinician self-reported experiences can provide insight into the factors that contribute to their wellbeing. Extant qualitative literature reviews report on work-related experiences affecting the wellbeing of specific types of clinicians in specific contexts, but none captures a holistic picture of clinician experiences in providing care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Map qualitative evidence on primary care clinician self-reported experiences related to wellbeing to the NAM framework factors, and create an interactive database to support future evidence syntheses and interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Using an evidence and gap map approach, we searched MEDLINE, Embase, PsycINFO, and CINAHL (2013–2023) for qualitative and mixed-methods studies. We included studies from Canada, Australia, Belgium, or France that described self-reported experiences of primary care clinicians (family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, social workers). We coded the \u003cstrong\u003eexperiences in each study according to reporting clinician type and NAM factors.\u003c/strong\u003e We generated the interactive map, with integrated bibliographic database, using EPPI-Reviewer and EPPI-Mapper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e From 6,133 records we included 652 publications. Most were Australian (54%) or Canadian (34%). The majority (57%) reported experiences of family physicians/general practitioners, while social workers and midwives were underrepresented (3% and 2%, respectively). Clinician-reported experiences focused mainly on \u003cem\u003elearning and practice environment\u003c/em\u003e, \u003cem\u003eorganisational\u003c/em\u003e, and \u003cem\u003ehealthcare responsibilities\u003c/em\u003e factors. Experiences related to \u003cem\u003eskills and abilities\u003c/em\u003e, \u003cem\u003esociety and culture\u003c/em\u003e, \u003cem\u003epersonal factors\u003c/em\u003e, and \u003cem\u003erules and regulations\u003c/em\u003e, were less common, with slight variations across clinician groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This evidence and gap map provides a comprehensive overview of qualitative evidence of primary care clinician-reported experiences related to wellbeing. External factors were more frequently mentioned, offering insight that can inform system-level interventions. Future qualitative syntheses of the mapped evidence can inform research and policy that better support clinician wellbeing.\u003c/p\u003e","manuscriptTitle":"What Contributes to Clinician Wellbeing? An Evidence and Gap Map of Clinician Experiences in Primary Care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 06:24:19","doi":"10.21203/rs.3.rs-8380425/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-11T08:36:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-05T21:48:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-29T07:39:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164497428471981103018701314207161780618","date":"2026-01-24T00:31:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4786217582073307098863218228296371462","date":"2026-01-23T18:23:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-30T18:08:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-26T08:37:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-22T20:28:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-22T20:28:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-12-17T01:16:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8886b7fb-52c2-4168-b6a7-00993e625c23","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T11:53:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 06:24:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8380425","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8380425","identity":"rs-8380425","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}