Abstract
BACKGROUND: The complexity, difficulty and uncertainty inherent in the medical field pose significant challenges to physicians' ability to adapt. For interns, career resilience plays a crucial role in the transition from academia to clinical practice. This study aimed to explore the mechanism of career resilience formation during the role-transition process of medical interns. METHODS: We conducted in-depth semi-structured interviews with 16 medical interns from a regional medical university in Northwest China, recruited via purposive and snowball sampling through professional networks. Data were collected between August and September 2024; interviews lasted 35-50 min (online/offline), were audio-recorded, transcribed verbatim, and analyzed using Straussian grounded theory (open-axial-selective coding with constant comparison), guided by the Critical Incident Technique and the STAR framework. The research team performed the coding, and the process was validated through regular peer-debriefing sessions with two independent researchers. Analysis was facilitated using NVivo software (version 12) until theoretical saturation was reached. RESULTS: A Challenge-Resource-Adaptation (CRA) model was constructed to explain how medical interns develop career resilience in the face of practical challenges and role transitions during the internship. Three pillars of career resilience were identified: (1) career development challenges (knowledge updating, identity establishment, career planning); (2) facilitative resources (guidance and feedback, resources and opportunities, emotional support); and (3) proactive career adaptation (compliance/pressure management and innovative breakthrough). The CRA model depicts a recursive loop whereby each innovative breakthrough elevates demands for further knowledge updating. Illustratively, weekly mentor-guided guideline reviews and skills-lab rehearsal closed knowledge-practice gaps, enabling independent ward rounds; exposure to advanced procedures helped clarify specialty choices. CONCLUSION: Career development challenges are the trigger factor, facilitative resources are the favorable conditions, and career adaptation behavior is the external manifestation of resilience. Overall, career resilience during internship emerges as a self-reinforcing process in which targeted resources convert concrete challenges into adaptive behaviors. The CRA model identifies mentor feedback, advanced clinical opportunities, and emotional support as key leverage points for strengthening medical curricula and workplace design.