Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jul 30;13(15):1856.
doi: 10.3390/healthcare13151856.

Physicians' and Residents' Well-Being in Ecological System: A Scoping Review of Positive Deviance Strategies

Hyoseon Choi  1   2 , Janghee Park  3 , Sanghee Yeo  4 , Seung-Joo Na  5 , Hyojin Kwon  3
Affiliations
Review

Physicians' and Residents' Well-Being in Ecological System: A Scoping Review of Positive Deviance Strategies

Hyoseon Choi et al. Healthcare (Basel). .

Abstract

Background/Objectives: It is essential to explore and disseminate positive deviance strategies that promote resilience, mindfulness, and well-being beyond stress and burnout reduction strategies for residents and physicians who experience high levels of occupational stress. This scoping review maps studies that investigate positive deviance strategies to enhance the well-being of residents and physicians. Methods: A scoping review was conducted by PRISMA guidelines to identify English-language studies on strategies for physician well-being. PubMed, MEDLINE, Embase, and ERIC were searched using terms related to well-being, coping, and medical education. Results: Among the 38 studies included, 17 (44.7%) targeted physicians in graduate medical education (GME), while 19 (50%) focused on continuing medical education (CME). Positive deviance strategies were identified in 26 studies and were most frequently implemented at the microsystem level, such as small group interventions (e.g., coaching, mentoring, and workshops). These strategies addressed individual and organisational factors that contribute to physician well-being and were associated with improvements in life satisfaction, resilience, professional identity, and psychological safety. The review found that positive deviance strategies were often proactive, values-driven, and disseminated organically over time, emphasising the importance of longitudinal engagement and sustained institutional support. Conclusions: This scoping review highlights the growing use of positive deviance strategies, especially at the microsystem level, to promote physician well-being. These approaches emphasise sustainable, values-driven practices and may offer effective, context-sensitive solutions within healthcare systems.

Keywords: coping strategies; doctor; macrosystem; mesosystem; microsystem; negative deviance; positive deviance; positive deviance approach; residency; well-being.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for scoping reviews which included searches of databases and registers.
Figure 2
Figure 2
Ecological system of positive deviance strategies for physicians’ and residents’ well-being.
See this image and copyright information in PMC

References

    1. Søvold L.E., Naslund J.A., Kousoulis A.A., Saxena S., Qoronfleh M.W., Grobler C., Münter L. Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front. Public. Health. 2021;9:679397. doi: 10.3389/fpubh.2021.679397. - DOI - PMC - PubMed
    1. Vizheh M., Qorbani M., Arzaghi S.M., Muhidin S., Javanmard Z., Esmaeili M. The mental health of healthcare workers in the COVID 19 pandemic: A systematic review. J. Diabet. Metab. Disord. 2020;19:1967–1978. doi: 10.1007/s40200-020-00643-9. - DOI - PMC - PubMed
    1. Alahmari A.A., Alsultan I.J., Almousaedi I.H., Sliuman A.A., Alabdullah M.A., Alabdullah H.A., Alantar A.M., Alshamrani A.A., Alsuwaidani M.A.A., Ojaym A.A., et al. Impact of healthcare provider burnout on patient care. J. Popul. Ther. Clin. Pharmacol. 2022;29:2521–2528. doi: 10.53555/jptcp.v29i04.5450. - DOI
    1. Ortega M.V., Hidrue M.K., Lehrhoff S.R., Ellis D.B., Sisodia R.C., Curry W.T., delCarmen M.G., Wasfy J.H. Patterns in physician burnout in a stable-linked cohort. JAMA Netw. Open. 2023;6:e2336745. doi: 10.1001/jamanetworkopen.2023.36745. - DOI - PMC - PubMed
    1. Marques-Pinto A., Moreira S., Costa-Lopes R., Zózimo N., Vala J. Predictors of burnout among physicians: Evidence from a national study in Portugal. Front. Psychol. 2021;12:699974. doi: 10.3389/fpsyg.2021.699974. - DOI - PMC - PubMed

LinkOut - more resources