Residents' perceptions of impaired wellness in China: Accepting the inevitable, questioning the preventable

Introduction Impaired wellness among residents has become a global concern, with burnout, stress and fatigue linked to negative outcomes for both residents and patients. To date, most of the existing research has come from Western contexts, where cultural norms and training structures may significantly differ from those in other regions. However, there remains limited understanding of how residents in non-Western settings experience and interpret impaired wellness. This study aims to explore the perceptions and experiences of residents' impaired wellness within the context of residency training in China.Methods We conducted a constructivist qualitative study. Participants were recruited through purposive and snowball sampling from a teaching hospital in Shanghai. Semi-structured interviews were conducted in Chinese between March 2024 and February 2025, guided by a six-dimensional wellness framework developed from existing literature. We used reflexive thematic analysis to analyse the data both deductively and inductively.Results Chinese residents perceived some degree of wellness impairment across physical, psychological and social dimension as acceptable, often framing such impairments as contributing to professional and personal growth, reflecting cultural values emphasising acceptance of and growth through hardship. In contrast, impairments in the intellectual and financial dimensions, exacerbated by unfair compensation, limited supervision and research pressure, were seen as unreasonable yet preventable. Residents' recognition of these challenges as rooted in systemic and structural conditions of residency training, largely beyond their control, often led to resignation, passive endurance, and in some cases, consideration of leaving the profession. Harmonious work relationships were described as central to navigating impaired wellness, serving as vital buffers when present but vulnerabilities when absent, largely echoing cultural ideals of harmony.Discussion This study sheds light on how the inherently demanding nature of clinical practice, cultural values and local systemic and structural conditions of residency training intersect to shape residents' perceptions and experiences of impaired wellness.