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

## TL;DR

This review explores strategies to improve the well-being of physicians and residents by focusing on positive deviance approaches that promote resilience and mindfulness.

## Contribution

The study maps positive deviance strategies for physician well-being, emphasizing microsystem-level interventions and their long-term impact.

## Key findings

- Positive deviance strategies were most often implemented at the microsystem level, such as through coaching and workshops.
- These strategies improved life satisfaction, resilience, and psychological safety among physicians.
- Long-term engagement and institutional support are crucial for the success of these strategies.

## 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.