RESIST: Addressing Resident Resiliency in Low-Resource Settings.

Burnout among healthcare workers in low- and middle-income countries (LMICs) is highly prevalent and driven by systemic challenges including workforce shortages, high patient volumes, and limited institutional support. These factors negatively impact trainee well-being and may compromise patient care. Despite increasing recognition of resilience as a critical competency, there is limited guidance on feasible and sustainable interventions in resource-constrained settings. We developed and implemented the RESIST strategy, a structured, low-cost approach to integrating resiliency training within residency programs at Aga Khan University Hospital, Nairobi, an ACGME-I accredited institution. The strategy targets individual, programmatic, and institutional factors through interventions focused on workload and rest optimization, emotional and peer support, skills-based training, psychological safety, and faculty engagement. Key components included duty hour monitoring, locum staffing to reduce workload, peer support groups, resiliency workshops, anonymous reporting systems, and faculty development initiatives. Implementation leveraged existing resources and emphasized contextual adaptation. Ongoing monitoring using duty hours, burnout indicators, and resident feedback informed iterative improvements. The RESIST strategy demonstrates that scalable, contextually grounded interventions can strengthen trainee well-being and support workforce sustainability in LMIC training environments.