Objective:

To describe the development and implementation of RESIST, a structured, feasible, and cost-conscious approach to embedding resilience training in residency programs in low- and middle-income countries.

Approach:

• Framework: RESIST organizes resilience efforts around six areas: rest and manageable workloads; emotional and collegial support; resident skills development; psychological safety and institutional culture; faculty mentorship and role modeling; and ongoing measurement and…
• Workload and rest: The program tracked duty hours and workload and supported rest, nutrition, exercise, and supervision. Four part-time locum junior providers covered additional shifts, academic half-days, and weekends.
• Support and skills: Initiatives included peer support, mentorship, community mental health partnerships, critical-event debriefing, education on sleep and fatigue, burnout recognition and substance use, and confidential referral pathways.
• Culture and evaluation: Quarterly town halls, small-group debriefs, monthly wellness check-ins, anonymous reporting, and resident-selected faculty mentors were used to support open communication and psychological safety.

Key Findings:

• The article cites burnout in 95.4% of healthcare workers at Kenya’s largest government referral hospital and high burnout risk in 47.3% of residents at a Kenyan tertiary teaching center.
• After workload measures were implemented, monitored metrics showed reduced resident attrition and lower self-reported burnout.
• Residents and faculty gave favorable informal feedback on skills training, but formal outcome data for these measures were unavailable.
• Preliminary surveys and structured discussions indicated stronger faculty–resident engagement; a formal longitudinal evaluation was being developed.

Interpretation:

The authors present RESIST as a locally implemented framework informed by international literature, shared lived experience, and observations at Aga Khan University Hospital, Nairobi. After workload measures were implemented, monitored metrics showed reduced resident attrition and lower self-reported burnout; formal outcome data for some skills interventions were unavailable.

Limitations:

• Formal outcome data were unavailable for some resident skills interventions.
• The reported findings are preliminary; a formal longitudinal evaluation of faculty–resident engagement was still being developed.