{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:19:27Z","timestamp":1787915967827,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["asmepublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Education"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Medical training is commonly imagined as a linear, uninterrupted progression, yet many trainees experience illness that necessitates a leave of absence (LOA). Illness\u2010based leaves may be especially fraught given stigma, opaque processes and training cultures that prioritise endurance. Little is known about how trainees experience illness and illness\u2010based leaves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative inquiry using Riessman's narrative analysis framework. Canadian physicians who had taken an illness\u2010based LOA during medical school or residency were recruited nationwide. Semi\u2010structured, in\u2010depth interviews were completed between December 2022 and July 2023, audio\u2010recorded, and transcribed verbatim. Analysis was inductive and iterative, examining narrative content and structure to understand participants' meaning\u2010making and shifting positioning within their stories. Rigour was supported through reflexive practice, collaborative team analysis and Criteria for Reporting Qualitative Research (COREQ)\u2010informed reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven participants shared the stories of their illness\u2010based leaves because of diverse conditions (including rheumatologic disease, malignancy, mental illness, traumatic brain injury and a movement disorder). Narratives followed common threads: (1) identity disruption, as illness fractured self\u2010concepts built on competence and grit and shifted trainee identities from clinician to patient; (2) loss of narrative control with shifting protagonists, as administrative and service demands shaped decisions and timelines, often intensifying vulnerability; (3) isolation and perceived illegitimacy, compounded by cohort separation, stigma and the need to justify both \u2018visible\u2019 and \u2018invisible\u2019 illness; (4) misalignment between individual needs and structural expectations, marked by unclear processes, limited accommodations, and reliance on informal workarounds or external advocacy; and (5) meaning\u2010making and purpose\u2014greater humanism and advocacy\u2014coexisting with residual disillusionment when systems remained unchanged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Illness\u2010based leaves in medical training are narrated as profound identity disruptions, shaped by structural rigidity and cultural expectations of uninterrupted productivity. Training programmes should develop transparent, compassionate leave and accommodation processes, normalise vulnerability within professional identity formation and incorporate trainees' voices into policy to better support learners who become ill. This will retain the perspectives they bring to patient care and teaching.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/medu.70302","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:02:17Z","timestamp":1787914937000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u2018I've been here before, but never looked at the ceiling\u2019: Narratives of medical trainees who took illness\u2010based leaves"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8296-5767","authenticated-orcid":false,"given":"Daniela","family":"Keren","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, Temerty Faculty of Medicine, Mount Sinai Hospital University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8763-7092","authenticated-orcid":false,"given":"Martina","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Cumming School of Medicine University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4150-3355","authenticated-orcid":false,"given":"Lorelei","family":"Lingard","sequence":"additional","affiliation":[{"name":"Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0930-0048","authenticated-orcid":false,"given":"Pim","family":"Teunissen","sequence":"additional","affiliation":[{"name":"School of Health Professions Education Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-5045","authenticated-orcid":false,"given":"Taryn","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology and Centre for Research and Innovation, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106920\u20107\u20106"},{"issue":"2","key":"e_1_2_11_3_1","first-page":"242","article-title":"Coping strategies, depression and anxiety among Ontario family medicine residents","volume":"51","author":"Earle L","year":"2005","journal-title":"Can Fam Physician"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102923.2011.04083.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318170520d"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326\u20105377.2002.tb04629.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)32612\u20106"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106920\u201013\u201013"},{"key":"e_1_2_11_9_1","unstructured":"American Medical Association Fact sheet on physician re\u2010entryChicago IL American Medical Association 2010 retrieved https:\/\/www.ama\u2010assn.org\/sites\/ama\u2010assn.org\/files\/corp\/media\u2010browser\/public\/med\u2010ed\u2010products\/physician\u2010reentry\u2010facts_0.pdf"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.5271\/sjweh.1009","article-title":"Systematic review of the qualitative literature on return to work after injury","volume":"32","author":"MacEachen E","year":"2006","journal-title":"Scand J Work Environ Health"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqw159"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.109\u20105709"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000002733"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742\u20106723.12851"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","DOI":"10.1370\/afm.2551","article-title":"Family leave for family medicine residents: time for a way forward","volume":"18","author":"Baxley EG","year":"2020","journal-title":"Ann Fam Med"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13684"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.15425"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102024\u2010094058"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40596\u2010018\u20100981\u20108"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6920-7-50","article-title":"\u201cIt gives you an understanding you can't get from any book.\u201d the relationship between medical students' and doctors' personal illness experiences and their performance","volume":"7","author":"Woolf K","year":"2007","journal-title":"BMC Med Educ"},{"key":"e_1_2_11_21_1","volume-title":"Narrative methods for the human sciences","author":"Riessman CK","year":"2008"},{"key":"e_1_2_11_22_1","volume-title":"Narrative inquiry: experience and story in qualitative research","author":"Clandinin DJ","year":"2000"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_11_25_1","volume-title":"The wounded storyteller: body, illness & ethics","author":"Frank AW","year":"2022"},{"issue":"3","key":"e_1_2_11_26_1","first-page":"169","article-title":"Perception of disability as a barrier for Canadian medical students","volume":"66","author":"Gault MA","year":"2020","journal-title":"Can Fam Physician"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/09687599.2022.2041403"},{"key":"e_1_2_11_28_1","unstructured":"DyrbyeLNShanafeltTDSinskyCAet alBurnout among health care professionals: a call to explore and address this underrecognized threat to safe high\u2010quality care NAM Perspect 2017"},{"key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1111\/medu.15142","article-title":"Professional identity struggle and ideology: a qualitative study of residents' experiences","volume":"57","author":"Sawatsky AP","year":"2023","journal-title":"Med Educ"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1438082"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10459\u2010024\u201010386\u20104"}],"container-title":["Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/asmepublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/medu.70302","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/asmepublications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/medu.70302","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/asmepublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/medu.70302","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:02:20Z","timestamp":1787914940000},"score":1,"resource":{"primary":{"URL":"https:\/\/asmepublications.onlinelibrary.wiley.com\/doi\/10.1111\/medu.70302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":30,"alternative-id":["10.1111\/medu.70302"],"URL":"https:\/\/doi.org\/10.1111\/medu.70302","archive":["Portico"],"relation":{},"ISSN":["0308-0110","1365-2923"],"issn-type":[{"value":"0308-0110","type":"print"},{"value":"1365-2923","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"2026-03-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"medu.70302"}}