title: Exploring resilience in rural GP registrars--implications for training.
abstract: BACKGROUND
  Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars' perceptions of their resilience and strategies they used to maintain resilience in rural general practice.
  
  
  METHODS
  In this qualitative interpretive research, semi-structured interviews were recorded, transcribed and analysed using an inductive approach. Initial coding resulted in a coding framework which was refined using constant comparison and negative case analysis. Authors developed consensus around the final conceptual model. Eighteen GP registrars from: Australian College of Rural and Remote Medicine Independent Pathway, and three GP regional training programs with rural training posts.
  
  
  RESULTS
  Six main themes emerged from the data. Firstly, rural GP registrars described four dichotomous tensions they faced: clinical caution versus clinical courage; flexibility versus persistence; reflective practice versus task-focused practice; and personal connections versus professional commitment. Further themes included: personal skills for balance which facilitated resilience including optimistic attitude, self-reflection and metacognition; and finally GP registrars recognised the role of their supervisors in supporting and stretching them to enhance their clinical resilience.
  
  
  CONCLUSIONS
  Resilience is maintained as on a wobble board by balancing professional tensions within acceptable limits. These limits are unique to each individual, and may be expanded through personal growth and professional development as part of rural general practice training.
authors.affiliation: Flinders University Rural Clinical School, PO Box 3570, Mount Gambier, SA, Australia. lucie.walters@flinders.edu.au.
authors.forename: Lucie
authors.initials: L
authors.lastname: Walters
authors.affiliation: Discipline of General Practice, The University of Adelaide, Adelaide, SA, 5005, Australia. caroline.laurence@adelaide.edu.au.
authors.forename: Caroline O
authors.initials: CO
authors.lastname: Laurence
authors.affiliation: Discipline of General Practice, The University of Adelaide, Adelaide, SA, 5005, Australia. joanne.dollard@adelaide.edu.au.
authors.forename: Joanne
authors.initials: J
authors.lastname: Dollard
authors.affiliation: Adelaide to Outback GP Training Program, 183 Melbourne Street, North Adelaide, SA, 5006, Australia. taryn.elliott@adelaide.edu.au.
authors.forename: Taryn
authors.initials: T
authors.lastname: Elliott
authors.affiliation: School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia. d.eley@uq.edu.au.
authors.forename: Diann S
authors.initials: DS
authors.lastname: Eley
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D058005:General Practitioners / Q000193:education / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D055500:Resilience, Psychological; D019035:Rural Health Services; D012424:Rural Population; D011795:Surveys and Questionnaires; D000078329:Workforce