Exploring institutional factors of resilience in undergraduate medical training: a thematic inquiry into experiences of medical students

Abstract

Background

Resilience is an essential attribute for medical students to manage academic demands and sustain well-being during training. While resilience has traditionally been studied at the individual level, less attention has been given to institutional factors that shape its development.

Objective

This study explored the institutional factors contributing to resilience among undergraduate medical students.

Methods

A qualitative descriptive study was conducted with 55 participants, including 45 medical students and 10 faculty and administrative staff. Data were collected through four focus group discussions and individual interviews, transcribed verbatim, and analysed using reflexive thematic analysis.

Results

Six themes were identified: learning environment, support systems, extracurricular activities, academics, financial barriers, and faculty role. Findings indicated that supportive institutional environments enhanced resilience, while academic pressure and financial constraints undermined students’ well-being.

Conclusions

Institutional factors play a central role in shaping medical students’ resilience. Strengthening supportive learning environments and institutional support systems may enhance student well-being and academic success.

Introduction

Resilience is a vital capability for undergraduate medical learners, as it underpins their capacity to manage academic demands, sustain positive progress, and handle the pressures of their education and work life [1, 2]. Medical students constantly face stressful and challenging situations such as an extensive curriculum, heavy academic workload, frequent assessments, and clinical rotations that extend into internship, postgraduate training, and professional practice [3]. The ability to bounce back from the unfavourable association between physical demands and professional quality of life during their educational journey positively influences their well-being [4].

Evidence suggests that resilient students display lower levels of depression and anxiety, underscoring the importance of incorporating resilience-building strategies into medical education programs [1, 5]. A meta-analysis of 55 studies demonstrated a strong relationship between resilience and mental health [6]. Similarly, Tempski et al. [7] emphasized that resilience development enhances medical students’ mental health and their ability to learn effectively. Resilience skills have also been found to support medical professionals throughout their careers [8, 9].

Encouraging resilience among learners helps them adopt adaptive coping strategies in the face of challenges. A recent meta-synthesis described resilient physicians as individuals who remain determined, exercise control over their professional lives, reflect on adversity, use adaptive coping mechanisms, and view challenges as opportunities for growth [10]. Resilient students tend to perform better academically and professionally. They engage in problem-solving, time management, self-reflection, and goal setting, all of which enhance emotional well-being and promote personal and professional growth [11]. Moreover, students with higher resilience levels report a better quality of life and a more positive perception of their educational environment, while experiencing lower self-doubt and greater self-esteem [12].

Kunzler et al., [13] concluded through meta-analysis that resilience can be learned and that resilience interventions are moderately effective. Developing resilience has therefore become an important strategy to reduce emotional distress in medical training [14]. Such learners are better equipped to navigate the demands of clinical experiences and peer pressures, evolving into empathetic and compassionate physicians [15]. There is also a reciprocal relationship between resilience and education. Strong education systems enhance individual, community, and institutional resilience, and resilient populations are, in turn, better positioned to deliver safe, relevant, and high-quality education [16].

Human personality is shaped by both hereditary and environmental factors [17]. Individuals experience various social institutions such as home, school, religious settings, and neighbourhoods that shape personality and behaviour [18]. Although individual factors such as personal attributes, life experiences, and socioeconomic background are important, the role of academic institutions in fostering resilience cannot be understated [19]. Hurlington, [20] described resilience as an outcome of personal qualities interacting with protective factors within specific environments. Importantly, institutional-level interventions have been shown to produce greater effects in reducing burnout compared to individual-level approaches [21]. Institutional resilience-building strategies such as embedding resilience in the curriculum, providing soft skills training, and ensuring strong support systems play a vital role in nurturing learners’ coping strategies and preparing them to handle academic and professional challenges [1, 22]. These efforts contribute to students’ well-being, personal development, and professional readiness [22].

Bronfenbrenner's Ecological Systems Theory provides an appropriate framework for understanding resilience as a dynamic process shaped by interactions between individuals and their surrounding environments [23]. In medical education, students' resilience may be influenced by multiple contextual factors, including faculty and peer relationships, learning environments, institutional support, academic structures, extracurricular opportunities, and socioeconomic conditions. From this perspective, supportive relationships, psychological safety, accessible support services, and adequate institutional resources may function as protective factors, whereas academic pressure, financial hardship, inadequate infrastructure, and limited support may act as environmental stressors that constrain students' adaptive capacity [24]. This ecological perspective therefore supports examining resilience beyond individual coping abilities and recognizing the role of educational institutions in creating environments that promote students' psychological well-being and capacity to adapt to challenges.

Despite the acknowledged importance of educational institutions in fostering resilience, much of the existing literature continues to focus predominantly on individual attributes. This contradicts the broader understanding that resilience arises from the interaction of both individual and organizational factors [10]. In recognition of this gap, the present study aims to identify institutional factors that foster resilience among undergraduate medical students, guided by the following research questions:

• RQ1. What is the conceptualization of resilience among undergraduate medical students?

• RQ2. What are the institutional factors that affect the resilience of medical students?

Methodology

Study design

This study adopted a qualitative descriptive design using reflexive thematic analysis to explore participants’ perceptions of institutional factors influencing medical students’ resilience and well-being [25]. The study formed part of a PhD project aimed at developing an instrument to measure institutional contributors to medical student resilience.

Ethical considerations

Ethical approval was obtained from the Institutional Review Boards of Universiti Sains Malaysia (USM/JEPeM/P UD0026/22(R)) and Dow University of Health Sciences (IRB-2968/DUHS/Approval/2023/185). The study adhered to the Declaration of Helsinki. Participants received detailed information regarding study objectives, voluntary participation, confidentiality, and their right to withdraw at any time without consequence. Verbal informed consent was obtained prior to audio recording, in accordance with ethics committee approval. Consent procedures were documented by the research team prior to each focus group and interview. Pseudonyms were used to ensure confidentiality throughout data handling and reporting [26].

Participants and sampling

Two participant groups were recruited using purposive sampling to obtain information-rich perspectives on institutional contributors to resilience [27]. The study included undergraduate medical students (Years 1–5) and faculty and administrative staff involved in teaching and student support. Participants were recruited through institutional email and student social media platforms. A total of 45 medical students and 10 faculty/administrative staff who met the inclusion criteria were invited to participate. All individuals who were approached agreed to participate, and no eligible participants declined or withdrew from the study.

Focus group discussions (FGDs) were conducted with students to capture shared and interactive perspectives, while in-depth interviews (IDIs) were conducted with faculty and administrative staff to explore individual, role-specific experiences. Although both groups addressed similar domains, data collection tools were tailored to their respective roles. Data from both groups were analysed concurrently and integrated during thematic analysis to identify convergent and divergent perspectives.

Data collection

Focus group discussions (FGDs)

Four FGDs were conducted with 45 medical students (10–12 participants per group), stratified across academic years. Discussions were held in a private setting and lasted 30–45 min. A semi-structured guide, refined after pilot testing, was used to facilitate discussion. All sessions were audio-recorded and transcribed verbatim, accompanied by field notes. The researcher acted as facilitator, while an observer ensured procedural integrity. The observer held no teaching or assessment role for participants during the study period. Measures were taken to minimize power dynamics by assuring confidentiality and clarifying that participation would not affect academic standing. Participants were also informed that comments would not be shared with faculty responsible for teaching or assessment.

In-depth interviews (IDIs)

Ten semi-structured interviews were conducted with faculty (n = 6) and administrative staff (n = 4). Interviews lasted 30–45 min and were conducted following informed consent. Data collection continued until thematic saturation was achieved, defined as the point at which no new conceptual insights emerged across consecutive interviews. Saturation was assessed separately for FGDs and IDIs through concurrent analysis and iterative team discussions [28].

To ensure confidentiality and facilitate analysis, participants were assigned codes:

• Focus group participants: XFGY (e.g., 2FG3 = Participant 3 in Focus Group 2)

• Faculty: IDIF1–F6

• Administrative staff: IDIA1–A4

Data analysis

Data were analysed using reflexive thematic analysis following Braun & Clarke [25]. Transcripts were read repeatedly to ensure familiarisation. Initial codes were generated inductively using in vivo and descriptive coding. Coding was conducted manually using Microsoft Word and Excel to support data organization.

Codes were then collated into potential themes through iterative team discussions. Themes were reviewed for internal coherence and external distinction and refined through ongoing analysis. Final themes were defined, named, and supported with illustrative quotations. Discrepancies in coding and interpretation were resolved through consensus among researchers.

Trustworthiness and Rigor

Trustworthiness was ensured using Guba’s four criteria [29]. Credibility was enhanced through prolonged engagement, triangulation, and member checking. Transferability was supported through thick description of context and participants. Dependability was ensured through a code–recode process. Researcher reflexivity was maintained through reflective notes and regular discussions among the research team regarding potential assumptions and interpretations throughout the analytical process. Confirmability was maintained through an audit trail documenting all analytical decisions.

Results

Participants’ demographics

Demographic characteristics of participants are presented in Tables 1 and 2.

Table 1.

Focus Groups – Medical Students (N = 45)

Characteristic	Frequency (n)	Percentage (%)
Gender
Male	20	44.4
Female	25	55.6
Year of Study
Year 1	10	22.2
Year 2	12	26.7
Year 3	8	17.8
Year 4	10	22.2
Year 5	5	11.1

Table 2.

Individual Interviews with Faculty and Administrative Staff (N = 10)

Characteristic	Frequency (n)	Percentage (%)
Gender
Male	6	60
Female	4	40
Designation
Faculty Member	6	60
Administrative Staff	4	40
Years of Experience
1–5 years	2	20
6–10 years	4	40
> 10 years	4	40

Data from focus group discussions (FGDs) with medical students and individual interviews (IDIs) with faculty and administrative staff provided insights into institutional factors shaping medical students’ resilience. Thematic analysis yielded six key themes as shown in Fig. 1.

Fig. 1.

Institutional factors that affect students’ resilience

1. Learning Environment

2. Support systems

3. Extracurricular Activities

4. Financial barriers

5. Academics

6. Faculty Role

Conceptualization of Resilience (RQ1)

Participants broadly viewed resilience as the ability to cope under stress and recover from challenges. Many extended this understanding beyond mere recovery to include growth, adaptation, and emotional regulation.

“For me, resilience is being able to survive the stresses exams, clinical rotations and still show up the next day, ready to keep going.” (2FG3).

Students described resilience as developing emotional maturity through repeated exposure to challenges:

“You can’t be emotional and soft all the time in medicine. You have to control your emotions and mature emotionally, otherwise you’ll burn out before graduation.” (4FG2).

Faculty and administrative participants echoed similar views, associating resilience with professional identity formation and ethical functioning under pressure:

“Resilience is the ability to function professionally and empathetically, even when you’re overwhelmed and working under pressure.” (IDIF1).

“Students are navigating academic stress, family expectations, and intense clinical exposure. They need resilience to recalibrate and keep going.” (IDIA2).

Participants’ conceptualizations of resilience as emotional regulation, adaptability, perseverance, and recovery from stress informed how institutional factors were perceived throughout the study. Institutional environments that promoted psychological safety, accessible support, constructive faculty relationships, and balanced academic demands were viewed as strengthening these dimensions of resilience, whereas unsupportive environments and financial stress were perceived to undermine students’ adaptive capacity and emotional well-being.

Institutional factors contributing to resilience (RQ2)

Learning environment

Participants consistently emphasized that a supportive and inclusive learning environment fosters student well-being, motivation, and engagement. Both students and faculty highlighted that feeling valued, respected, and heard enhanced psychological safety and academic focus.

“A learning environment where students feel valued and heard is crucial for their academic success and well-being.” (IDIF3).

“When we feel safe and comfortable in our learning environment, we can focus better and actually enjoy our studies.” (1FG8).

Access to basic infrastructure and amenities such as libraries, study spaces, common rooms, and sports facilities was seen as essential for reducing stress. Limited infrastructure, however, created frustration and hindered concentration:

“We often can’t find space in the library, and sometimes there’s not even clean drinking water available it affects our ability to concentrate.” (1FG4).

Faculty acknowledged these challenges, attributing them to resource constraints but recognized the importance of addressing them:

“We understand that students need better infrastructure, but funding and space limitations make it difficult.” (IDIF4).

Overall, participants identified the learning environment as a cornerstone of resilience. Students consistently linked the quality of the learning environment with their emotional well-being, confidence, and willingness to engage in learning activities, suggesting that resilience is influenced by both psychological and organizational aspects of the educational environment rather than by individual characteristics alone.

Support systems

The availability and accessibility of institutional support systems emerged as a critical determinant of resilience. While students valued mentorship and counselling, many described existing systems as informal, inconsistent, or poorly publicized.

“A good mentor can make all the difference it’s not just about academics but about having someone to guide you through the pressures of medical school.” (3FG2).

“We need a more structured mentorship system so every student can access academic and emotional support.” (IDIF4).

Although counselling services were available, students reported stigma and lack of awareness as barriers to accessing counselling services.

“We have counselling services, but most students don’t know how to book appointments, and many feel hesitant to go.” (2FG3).

“Students hesitate to talk about mental health because they fear it might be seen as weakness.” (IDIF6). Faculty and administrators acknowledged these barriers and advocated for policy-level changes to normalize mental health support:

“Mental health support should be a core part of student services, not something optional.” (IDIA1).

Participants emphasized that institutional support systems were most effective when they were highly visible, easily accessible, and embedded within routine educational practices rather than being perceived as services available only during crises.

Extracurricular activities

Extracurricular engagement including sports, student clubs, and social events was perceived as essential in promoting well-being, balance, and social connectedness. Students noted that participation in such activities helped them manage stress and maintain motivation:

“Having sports and social activities helps us take a mental break and reset. Otherwise, it’s just nonstop studying and stress.” (3FG5).

However, time constraints and restricted access to facilities limited participation:

“Even if I want to play sports or join an activity, my schedule is too packed.” (2FG7).

“The gym is available, but it’s closed when we actually have time to use it.” (4FG1).

Faculty recognized these issues and supported integrating structured wellness initiatives within the academic schedule:

“We are working on incorporating more structured wellness breaks into the curriculum.” (IDIF4).

Extracurricular activities also contributed to leadership development and peer bonding, particularly in diverse student groups. Overall, participants emphasized that such opportunities should be institutionally supported rather than optional.

Financial barriers

Financial concerns were identified as a major source of stress and inequity among students, affecting both academic focus and well-being.

“Sometimes I feel like I spend more time worrying about money than actually studying.” (2FG2).

Limited scholarships, high tuition fees, and lack of transparency in financial aid programs heightened anxiety and reduced engagement.

“Some of us struggle to buy textbooks or pay for extra materials. It feels like a disadvantage compared to those who can afford everything easily.” (2FG3).

Faculty acknowledged the impact of financial stress and emphasized the need for institutional mechanisms such as grants and need-based aid.

“Financial concerns significantly affect academic performance, and we’re working to expand scholarship options.” (IDIF3).

Participants described financial stress as influencing not only their academic performance but also their emotional well-being, participation in extracurricular activities, and ability to access educational resources, illustrating the broad institutional impact of financial circumstances on resilience.

Academics

Participants highlighted that clinically relevant and interactive learning enhanced engagement and preparedness for professional practice. Students preferred small-group sessions, orientation programs, and hands-on clinical exposure, which fostered deeper understanding and confidence.

“When we get hands-on clinical exposure, learning becomes more meaningful and memorable.” (2FG1).

“Small-group discussions help us understand complex topics better than long lectures.” (4FG2).

High-stakes assessments were perceived as stress-inducing, prompting calls for formative assessments emphasizing feedback and reflection.

“It would help if we had more formative assessments instead of just big exams.” (1FG10). Faculty expressed efforts toward curricular reform that emphasizes problem-solving, deep learning, and clinical application.

“We are working toward a curriculum that prioritizes problem-solving and clinical exposure rather than memorization.” (IDIF5).

Faculty role

Faculty members were recognized as key influencers in students’ resilience. Supportive, empathetic mentors were described as instrumental in motivating students and normalizing struggle.

“When faculty members share their experiences and struggles, it helps us see that challenges are part of the learning process.” (3FG12).

Conversely, lack of faculty accessibility hindered help-seeking:

“Some faculty members are unapproachable, which makes it hard to ask for guidance when we need it most.” (2FG10).

Faculty acknowledged these concerns and expressed commitment to improving mentorship and communication.

“We are trying to create an environment where students feel comfortable reaching out for support.” (IDIF6).

Across themes, participants described resilience as being shaped not by isolated institutional factors, but by the interaction between academic structures, psychological support, faculty relationships, financial stability, and opportunities for recovery through extracurricular engagement. Financial stress, for example, frequently influenced students’ ability to access academic resources and participate in wellness activities, while supportive faculty relationships enhanced students’ willingness to seek help and navigate academic pressures. These findings suggest that resilience within medical education is embedded within a broader institutional ecology rather than residing solely within individual students.

Table 3 summarizes the codes, subthemes, and themes identified from the FGDs and IDIs regarding institutional factors that contribute to resilience development in undergraduate medical education.

Table 3.

Codes, subthemes and themes of qualitative study

Codes	Sub-Themes	Themes
Lack of structured mentorship; stigma toward mental health; limited access to counselling; underutilized wellness services	Mentoring and counselling; visibility and accessibility of support services	Support systems
Positive, inclusive learning spaces; respect and empowerment; access to basic amenities; safe study environment	Psychological safety; infrastructure; institutional gaps	Learning Environment
Sports and social events; recreation; time management challenges	Physical health; social bonding; work–life balance	Extracurricular Activities
Clinical relevance; small-group learning; formative assessment	Teaching methods; curriculum; assessment reform	Academics
Faculty as mentors; communication and approachability; role modelling	Faculty–student interaction; mentorship culture	Faculty Role
Financial stress; limited aid; inequity in access to resources	Financial insecurity; need for proactive financial policies	Financial barriers

Discussion

This qualitative study explored the conceptualization of resilience and the factors influencing its development in undergraduate medical education. Resilience is widely perceived as the ability to adapt, recover, and grow stronger in response to challenges. This aligns with the concept of dynamic resilience the ability of an individual or system to adapt and recover from stressors in a complex environment [30]. This ability is especially essential for health professionals who must work under pressure in healthcare settings facing resource constraints. Participants consistently described resilience as dependent not only on personal coping abilities but also on the availability of supportive relationships, accessible institutional resources, equitable policies, and psychologically safe learning spaces. This shifts the focus from individual adaptation alone toward institutional responsibility in fostering sustainable student well-being [10].

These findings can be understood through Bronfenbrenner's Ecological Systems Theory, which views development as shaped by interactions between individuals and their surrounding environments [23]. From this perspective, institutional factors may function as protective resources or stressors that influence students' capacity to adapt to challenges. This supports an ecological understanding of resilience in which responsibility extends beyond individual coping to include the educational environment [24]. The discussion below elaborates on each theme, highlighting the interaction between positive and negative influences.

Learning environment

Participants highlighted that the learning environment of the institution has a significant impact on their mental health and resilience. A supportive, inclusive, and conducive learning environment enables students to cope effectively with challenges. A positive environment where students feel content and mentally relaxed fosters resilience and reduces burnout [31]. Dyrbye et al., [32] also reported that medical students who experienced mistreatment or perceived their learning environment unfavourably were more likely to develop exhaustion, disengagement, lower empathy, and career regret. Conversely, an unsupportive environment lacking adequate support systems can exacerbate stress and contribute to burnout [33].

Participants also noted that the availability of basic amenities and resources such as common rooms, libraries, and sports facilities enhances mental well-being. Access to these resources is essential for academic success and emotional balance [33]. A lack of infrastructure, on the other hand, increases stress and decreases resilience. Dunn et al., [34] similarly concluded that the physical and psychological components of the learning environment influence students’ well-being and resilience, suggesting that a well-equipped and positive setting reduces stress and promotes optimal learning.

These findings are consistent with an ecological perspective in which the learning environment represents an immediate context that can either provide protective conditions, such as psychological safety and adequate resources, or create stressors that undermine students' adaptive capacity [35].

Support systems

Another important theme that emerged was the institutional support systems. Mentoring, counselling, wellness services, and financial aid play crucial roles in alleviating stress and promoting resilience. Institutional support is often more effective in reducing strain than individual-level interventions [21]. When these systems are accessible and stigma-free, they significantly enhance students’ ability to cope with academic and emotional pressures [36].

Participants emphasized that although wellness services exist, their accessibility and perceived stigma remain barriers. Many students reported not seeking help despite stress due to fear of judgment. This finding reinforces the observation that early reporting of distress is essential, as unaddressed stress can escalate, affecting careers, patient care, and the health system as a whole [37]. From an ecological perspective, accessible and stigma-free support systems provide protective resources that can strengthen help-seeking, perceived social support, and students' capacity to cope with academic and emotional stress [22].

Financial barriers

Financial barriers were also identified as a major determinant of resilience. Financial challenges can hinder access to resources and exacerbate anxiety, while financial assistance such as scholarships and grants can mitigate these effects [38]. Clear communication regarding available financial and academic support enhances students’ confidence and academic focus [39]. Similarly, transparent institutional policies on attendance, grievances, and academic procedures help students navigate challenges effectively, fostering trust and resilience [22]. Financial stress may therefore operate as an environmental stressor that extends beyond economic difficulty to affect access to educational resources, psychological well-being, and students' capacity to cope with academic demands, illustrating the interaction between broader socioeconomic conditions and the educational environment [40].

Extracurricular activities

Engagement in extracurricular activities including social events, sports, and recreational opportunities was found to promote a balanced lifestyle and enhance resilience. Participation in such activities provides relaxation and facilitates work-life balance, protecting students from burnout [41]. Conversely, lack of engagement in extracurricular activities can lead to mood disturbances [37]. In the present study, students have reported insufficient time for sleep and social activities, resulting in fatigue and reduced quality of life. These findings suggest that the demanding nature of medical education limits opportunities for recovery and recreation, which in turn affects mental well-being [37]. Within an ecological framework, extracurricular engagement provides opportunities for social connection, recovery, and belonging that may buffer academic stress and support adaptive functioning [22].

Faculty role

Faculty members were identified as pivotal contributors to resilience development among medical students through role modelling, communication, and collaboration. Supportive and empathetic faculty behaviour fosters a psychologically safe environment, allowing students to express concerns and seek feedback without fear of criticism. Approachable and accessible faculty strengthen students’ coping abilities and sense of belonging [42, 43].

Role modelling was emphasized as a key component. Faculty members who demonstrate empathy, ethical conduct, professionalism, and resilience provide students with real-life examples of how to manage challenges effectively. Such positive modelling encourages the adoption of resilient behaviours [44]. Faculty communication characterized by openness and constructive feedback enhances students’ motivation and confidence, reducing stress and promoting resilience.

Faculty relationships therefore represent an important interpersonal context within students' educational environment, with supportive and approachable faculty potentially strengthening psychological safety, help-seeking, and confidence in managing challenges [23].

Academics

Academics emerged as a central factor influencing resilience. The structure of teaching, assessments, and curriculum design shapes how students experience and manage challenges. Orientation programs help students acclimate to the academic culture and expectations, fostering belonging and preparedness. Active learning approaches such as problem-based learning and case discussions cultivate adaptability and problem-solving core elements of resilience [45].

Assessments, when transparent and fair, contribute positively by encouraging reflection and growth [46]. Constructive feedback is another crucial academic element. Feedback that is specific, supportive, and improvement-focused helps students perceive setbacks as opportunities for learning, fostering a growth mindset. Creating an environment where mistakes are viewed as learning experiences rather than failures enables students to bounce back from challenges more effectively [47].

The six themes demonstrate that resilience is shaped by the interaction between students and their educational environment. Consistent with Bronfenbrenner's ecological perspective, supportive learning environments, accessible support, positive faculty relationships, balanced academic structures, extracurricular opportunities, and financial resources may provide protective conditions, whereas institutional gaps and socioeconomic stressors may constrain adaptation [23]. These findings therefore support a shift from solely individual-focused resilience interventions toward institution-wide strategies that strengthen the conditions in which students learn, develop, and cope with adversity.

Limitations

This study has several limitations. The small, non-random sample from a single institution restricts generalizability and introduces potential selection bias. Self-reported data through focus groups and interviews, may be subject to social desirability bias, particularly when discussing sensitive issues such as mental health and perceptions of faculty approachability, which may have influenced participants’ responses. Additionally, the subjective nature of thematic analysis may affect interpretation. Cultural and institutional specificity further limits the transferability of the findings. Although measures were taken to minimize power dynamics, including ensuring that the observer had no teaching or assessment role, participants’ awareness of the institutional context may still have influenced their responses. Researcher reflexivity was also considered important, as the study was conducted within an institutional setting where participants may have perceived potential hierarchies or sensitivities when discussing institutional challenges.

Conclusion

Resilience among medical undergraduates is shaped by multiple interrelated institutional factors. A supportive and inclusive learning environment, accessible support systems, reduced financial barriers, work-life balance through extracurricular engagement, effective faculty mentorship, and fair academic structures collectively nurture students’ ability to adapt and thrive. Institutions must prioritize these aspects to foster resilience and ensure both academic success and well-being.

Recommendations

Based on the identified themes of learning environment, support systems, academics, faculty role, extracurricular activities, and financial barriers, the following recommendations are proposed:

• Establish structured support systems including mentorship, counselling, and wellness programs that are easily accessible and stigma-free.

• Improve infrastructure such as libraries, learning spaces, and student amenities to reduce stress.

• Expand financial aid and scholarships to alleviate economic pressures.

• Encourage work-life balance by integrating extracurricular and recreational activities into the curriculum.

• Implement faculty development programs focusing on communication, empathy, and role modeling.

• Maintain clear, transparent, and accessible policies related to academics and student welfare.

• Integrate clinically relevant and real-world experiences into the curriculum to prepare students for professional challenges.

By adopting these measures, educational institutions can create nurturing environments that empower medical students to build resilience, manage stress effectively, and thrive academically and professionally.

Authors’ contributions

Syeda Rubaba Azim Contributed substantially to the conception and design of the study. Led data acquisition, coordinated data collection, and managed the overall research process. Drafted the manuscript and conducted substantive revisions. Approved the final submitted version and agrees to be accountable for all aspects of the work. Nurhanis Syazni Roslan Provided major input in the conception and design of the study. Critically reviewed and revised the manuscript for intellectual content. Supervised the overall research and guided throughout all stages. Approved the final submitted version and agrees to be accountable for accuracy and integrity. Muhamad Saiful Bahri Yusoff Contributed to the design and methodological guidance of the study. Assisted in interpreting the findings and provided critical revisions to the manuscript. Approved the final version and agrees to be accountable for the work. Syed Muhammad Azfar Contributed to the conceptualization of the study and supported data analysis and interpretation. Provided input during manuscript drafting and revision. Approved the final submitted version and agrees to be accountable for their contributions. Munizha Nisar Assisted with the acquisition of data, the coordination of study procedures, and the management of research logistics. Reviewed the manuscript and provided important feedback on interpretation. Approved the final version and agrees to be accountable for their contributions. Nooreen Adnan Supported data collection and contributed to organizing and validating research materials. Reviewed and provided feedback on the manuscript. Approved the final version and agrees to be accountable for the work.

Funding

No funding was received for this study.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to institutional restrictions and participant confidentiality. However, the data can be made available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.