Exploring the lived experiences of presenteeism among postgraduate residents with chronic illness

Presenteeism, a common phenomenon among postgraduate residents (PGRs), has received negligible attention in graduate medical education policies. This phenomenological study, framed by the Conservation of Resources (COR) Theory and Self-Determination Theory (SDT), explores the complicated interaction between motivational stress and resource-related pressures that explain the PGRs’ decision to perform their duties while ill. Employing a qualitative phenomenological design, semi-structured interviews were conducted with twelve PGRs from different specialities in the hospitals of Khyber Pakhtunkhwa, Pakistan. Data were analysed following Braun and Clark’s reflexive thematic analysis. The resultant themes were explained through the complementary lenses of the COR theory and the SDT. Five themes were developed during data analysis. Theme 1: The Essence of Duty: described an internalised professional identity whereby physical presence at the workplace characterized the notion of being a good doctor. Theme 2: The Reality of Precarity: encompassed financial precariousness and anxiety about career and economic victimisation due to a dearth of resources. Theme 3: The Moral Burden: explained moral conflict between self-care and patient responsibility. Theme 4: The Erosion of Self: emphasised how the current levels of presenteeism and exhaustion adversely affect well-being and learning. Theme 5: The Yearning for Support: reflected the desire for empathetic systems, financial stability, and psychological safety. Personal motivation, institutional culture, and systemic constraints drive presenteeism among PGRs. Sustainable graduate medical education involves a balance between the service needs and organizational support, promoting autonomy, financial and psychosocial support, and equitable leave policies. Safeguarding PGRs’ health is at the centre of professional development, patient safety, workforce stability, and the integrity of medical education.