The term ‘resilience’ can be defined as the ability to recover from difficult situations, as well as the capacity to endure ongoing hardship.¹ The benefits of enhanced resilience in health care workers include better clinical outcomes for patients, a reduction in the loss of medical personnel and improved personal well-being for the individual professional.²

The Bachelor of Clinical Medical Practice (BCMP) programme trains mid-level health care workers (clinical associates) to work in district hospitals and primary health care clinics. Initial reports on the output of the BCMP programme are that the graduates make a difference where they work.³ In spite of this, a substantial number of graduates report high levels of adversity.⁴ Sources of this adversity include the understaffed and poorly resourced clinical environments they work in, long delays in finding employment, lack of a clear scope of practice and challenges in being accepted into established health care teams.⁵

While solutions are being developed, improving student resilience could help graduates cope with adversity. Previous studies have suggested that education can enhance individual resilience through interventions, such as resilience workshops,^6,7,8,9 cognitive behavioural training,^10,11 mindfulness training^12,13 and mentoring.⁸

There are currently no studies looking at resilience interventions in African medical education, and very little is known about resilience levels in health care students or professionals in an African context. This study aims to establish the resilience levels of final year BCMP students, and tries to ascertain whether brief workshop-based resilience training could change student resilience.

The study population consisted of 62 final year BCMP students.

The age range was 18–28 (mean = 22). There were 35 females (56%) and 27 males (44%).

Of the total students, 43 completed the study, 18 did not respond to the follow-up survey invitation and 1 requested to opt out of the study. No reasons were given.

The participants who dropped out (10 females and 9 males, mean age = 22) did not differ significantly in their baseline responses to the study population (mean CD-RISC non-completing participants 80.21 ± 3.58 vs. study population 77.37 ± 2.14, p = 0.20). Table 1 summarises the data for the study.

BCMP resilience scores did not change significantly after the brief workshop. When compared to results from similar studies (Table 2), it is notable that while workshops were part of all the trials (except Sood and Sharma), other studies used multiple workshops over a longer time period (48 h to 4 weeks), and the total workshop attendance time was much higher (8–16 h vs. 1.5 h).

The brief nature of the BCMP workshop may have contributed to why no significant change was observed, although the Fortney trial had multiple long workshops, and also failed to report significant improvements in resilience scores.

Confounding effects in this study were possible because of its design and may have contributed to the non-significant outcome. For example, the intervention was done at the start of the final year, students then moved to a new clinical environment prior to the follow-up measurement and this could have resulted in a change in their scores.

The relatively high baseline score of the BCMP students may have been a factor. In a Chinese study⁷, the high initial resilience group also did not show any significant changes after the resilience programme.

A comparison of the baseline CD-RISC in this study and studies on other international health care students suggests that BCMP students show high baseline resilience (Table 3).

The baseline CD-RISC scores for the study population compared with other reported South African groups are shown in Table 4. The baseline scores for BCMP students in this study are within the range of scores reported in previous South African studies.

Table 3 and Table 4 suggests that BCMP students show a good baseline resilience in comparison to other international health care students, and their scores appear to be similar to that of other reported South African groups.

BCMP student resilience scores appear to be higher than that of some groups of heath care workers in the CLCs (Table 5). Future studies could compare resilience scores between these groups and explore how resilience changes over time.

Observational studies report on changes, but can only speculate on causes. No net resilience changes were observed in this cohort. This is likely to be the result of the positive and negative resilience factors being in balance over the time period. We could speculate that the final year programme is stressful and the resilience scores may have dropped if it were not for this brief workshop; however, this study does not provide any evidence to suggest that brief workshops are associated with significant changes to BCMP student resilience.

Improving BCMP student resilience is important given the adverse working conditions that many graduates face. The literature suggests that education is a potential route to enhancing resilience. The evidence for education interventions to improve resilience is conflicting and complex. This study shows that relevant interventions must be evaluated and monitored and the outcomes must be reported. Although no statistically significant changes were observed after a brief resilience workshop, this study adds to the existing body of knowledge on resilience in an African health care training context.