Flourishing by Design: Applying Self-Determination Theory and the Job Demands-Resources Model to Systems-Level Wellness in Medical Education.

Background: Physician burnout remains a defining challenge in medical education, driven by excessive demands and fragmented wellness initiatives. While calls for systemic reform grow louder, many efforts lack a unifying framework capable of addressing both distress and the cultivation of professional fulfillment. Methods: This guide applies a dual-theory lens-Self-Determination Theory (SDT) and the Job Demands-Resources (JD-R) model-to propose a systems-based approach to motivation and wellness. Drawing on empirical evidence and applied experience, it presents twelve actionable strategies across three ecological domains: the built environment, policy frameworks, and interpersonal dynamics. The first six strategies target hindrance demands that frustrate psychological needs and contribute to burnout; the next six strengthen resources that satisfy those needs and foster engagement, resilience, and well-being. Results: The strategies offer flexible, theoretically grounded entry points for reform, supporting institutions in cultivating sustainable, human-centered learning environments where wellness is embedded-not bolted on. Examples include prioritizing formative over high-stakes assessments, integrating justice and safety into institutional design, and balancing clinical responsibility with developmental support. Conclusions: Integrating SDT and JD-R provides a rigorous, coherent, and scalable foundation for systems-level wellness initiatives. It reframes well-being not as the absence of burnout but as the presence of flourishing-offering a shared language, validated metrics, and a roadmap for lasting cultural and structural transformation in medical education.