Studies included in systematic review
| First author, year | Population/country | Sample size/response rate | Study design | Definition of resilience | Aim of study | Results associated with resilience |
|---|---|---|---|---|---|---|
| Quantitative studies | ||||||
| Cooke, 20137 | GP registrars (junior doctors), hospital and GP rotations. In four regions of Australia | 148 invited: participants reported: 128 (90%) | Cross-sectional | Dynamic, evolving process of positive attitudes and effective strategies, as responses to life stressors | To measure resilience, burnout, compassion satisfaction, personal meaning in patient care, and intolerance of uncertainty | Compassion satisfaction/personal meaning in patient care; negative association with burnout/secondary traumatic stress/inhibitory anxiety/general intolerance to uncertainty/concern about bad outcomes and reluctance to disclose uncertainty to patients No relationship between burnout or resilience and reluctance to disclose uncertainty to physicians Lower resilience scores associated with higher risk of burnout |
| Eley, 201310 | Family practitioners and (10%) international medical graduates across all states in Australia | 785 invited: participants 479 (61%) | Cross-sectional | Resilience can be considered as a process of adaptation to adversity and stress. Resilient individuals tend to recover from setbacks or trauma and portray a common set of characteristics that help them cope with challenges in life | To investigate the relationship between the pattern of personality traits and measures of resilience in a sample of family practitioners | Multiple regression found significant association between resilience and high self-directedness, high persistence, and low levels of harm avoidance (full model not shown) |
| Gerber, 201412 | Healthcare workers and social insurance officers, in Sweden | 4434 invited: response rate 2705 (61%), final sample after outliers removed | Cross-sectional | Those with high stress and good mental health are defined as resilient | To examine whether employees with differing occupational stress and mental health profiles differ in their self-reported levels of physical activity | Physical activity associated with healthy and resilient profiles among the public service sector individuals, independent of social and demographic background |
| Glasberg, 200716 | Healthcare personnel including primary healthcare centres and one hospital, in rural northern Sweden | 625 invited: response rate 423 (68%) | Cross-sectional | Not given by authors Examples from Wagnild and Young (1993) and Wagnild (2009)21,22 | To determine the factors associated with burnout in healthcare personnel | Univariate analysis: higher levels of EE and DP both associated with low resilience. Multivariate analysis: EE associated with resilience (not DP) |
| Keeton, 200715 | Doctors: general obstetrician–gynaecologists, subspecialty obstetrician–gynaecologists, general internal medicine, general paediatrics, general surgery, and family medicine, in US | 2000 invited: completed surveys 935 (48%) | Cross-sectional | Not explicitly reported | To explore factors associated with physician career satisfaction, work–life balance, and burnout focusing on differences across age and specialty | Career satisfaction: females more satisfied, personal accomplishment and emotional resilience significantly associated with career satisfaction. Associations with work–life balance: some control of schedule and hours, total weekly hours, being older, fewer children. Associations with emotional resilience: control over schedule and hours, being older, fewer children. Associations with personal accomplishment: being older, some control over schedule and hours, total weekly hours, gross annual household income, and being an obstetrician–gynaecologist |
| Rossouw, 201311 | Medical doctors in community healthcare clinics and district hospitals, in South Africa | 147 invited: response rate 135 (92%), 3 excluded, total participants 132 (90%) | Cross-sectional | Resilience defined in discussion as a measure of a person’s stress coping ability and as a target for interventional measures when combating burnout | To investigate burnout and depression in medical doctors in context of work-related conditions and the role of resilience as a modifiable factor. To define magnitude of the problem to motivate the development of an action within reach of doctors working in these settings | CD-RISC score correlated negatively with emotional exhaustion, depersonalisation, and BDI score. CD-RISC score correlated positively with personal accomplishment and delivered quality of care. Participants using medication had lower CD-RISC score. No correlations with sociodemographic data |
| Taku, 201313 | Doctors: mixture of internal medicine; family medicine, radiology, and other. Mixture of residents, attending, and fellows, in US | 839 invited: total participants 290 (34.5%) | Cross-sectional | Resilience is a personality attribute that moderates the negative effects of stress and promotes the ability to ‘bounce back’ after adversity.20 Resilience moderates the negative effects of stress and promotes the ability to ‘bounce back’ following adversity (Wagnild & Young 1993)21 | To examine the relationships between perceived growth as a physician and burnout after controlling for the effects of perceived family support, dispositional resilience, age, and marital status | PTG significantly associated with burnout in all three burnout domains. EE: higher PTG associated with lower levels of EE-resilience and family support not significant in final model. DP: PTG/family support associated with DP, interaction between PTG and family support, that is, high DP had low levels of PTG family support. Personal accomplishment: resilience and PTG associated, interaction between resilience and PTG, effect of PTG stronger for physicians with lower resilience |
| Unrath, 201217 | GPs in outpatient sector (primary care) in Rhineland-Palatinate, Germany | 2092 invited: response rate 808 (39%) | Cross-sectional | Resilience relates to the capacity to remain healthy in the face of strain and is therefore a sort of hardiness | To identify possible risk factors for AUDs among GPs working in the outpatient sector | Resilience negatively associated with AUD. Results suggest certain resilience level is protective against AUD; does not alter much with increased resilience |
| Qualitative studies | ||||||
| Bowden, 201414 | Frontline mental health professionals (locally known as ‘linkworkers’) working mainly in general practice settings, in UK | 10 invited: 9 (90%) involved in individual interviews and focus groups | Qualitative | Not defined but referred to in guidance papers as ‘linked with adaptability to change’ 23,24 | To investigate frontline mental health professionals’ perceptions of work stress and the rewards and demands associated with their work | Factors related to caring role: stressors control and responsibility for care, demands/managing boundaries/ownership. Creativity related to developing service. Range of coping seen in individual and team strategies. Linkworkers: aspects of work positive but in excess could become sources of stress |
| Jensen, 200818 | Family physicians (GPs) in Hamilton, Ontario, Canada | 20 invited to attend focus groups: participants 17 (85%) | Qualitative | No working definition — in guidance papers ‘A dynamic evolving process of positive attitudes and effective strategies’ | To explore the dimensions of family physician resilience | Four main aspects of physician resilience were: 1) attitudes and perspectives, includes valuing physician role, maintaining interest, developing self-awareness, accepting personal limitations; 2) balance and prioritisation, includes setting limits, taking effective approaches to continuing professional development, honouring the self; 3) practice management style, includes sound business management, good staff, using effective practice arrangements; 4) supportive relations, includes positive personal relationships, effective professional relationships, and good communication |
| Stevenson, 201119 | Primary healthcare physicians working in Aboriginal health, prisons, drug and alcohol medicine, or youth and refugee health, in Australia | 15 (100%) | Qualitative | No explicit definition of resilience given | To explore job satisfaction and resilience among primary care doctors who have worked for sustained periods in medically underserved populations in Australia | Emergent theory: reflectiveness, respectful engagement with job, and clear sense of boundaries and limits important in mitigating impact of work volume and intensity that organisations often struggled to contain. Also linked to and argued as predictors of resilience: job satisfaction, respect for patients, sense of control, and intellectual interest. Referred from existing literature, construct of ‘prosociality’ links to ‘vicarious resilience’ |
| Zwack, 20139 | Psychiatrists, surgeons, GPs, and other physicians, across Germany | Recruiting followed pyramid approach; 200 interviews conducted | Qualitative | Not defined | To identify health-promoting strategies employed by experienced physicians in order to define prototypical resilience processes and key aspects of resilience-fostering preventive actions | 30 subcodes/three dimensions: 1) job-related gratifications derived from treatment interactions; 2) practices: leisure-time activities, self-demarcation, limitation of working hours, continuous professional development; 3) attitudes: acceptance of professional and personal boundaries, focus on positive aspects of work, personal reflexivity Conclusion: ‘In relation to Conservation of Resources Theory, physician resilience emerged as the ability to invest personal resources in a way that initiates positive resource spirals in spite of stressful working conditions.’ |
| Intervention | ||||||
| Fortney, 20138 | Primary care clinicians Wisconsin-Madison, US | Number invited unknown: 30 recruited | Intervention | The ability to recover from adversity | To investigate whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians | Reductions in job burnout, depression, anxiety, and stress associated with participation in mindfulness training courses adapted for primary care physicians. Resilience score not significantly changed at any follow-up (1 day, 8 weeks, or 9 months) |
AUD = alcohol use disorder. BDI = Beck Depression Inventory. CD-RISC = Connor Davidson Resilience Scale. DP = depersonalisation. EE = emotional exhaustion. PTG = post-traumatic growth.