Lower life satisfaction in physicians compared with a general population sample : a 10-year longitudinal, nationwide study of course and predictors

Challenges and solutions of medical residency: the example of Iran

BACKGROUND

Medical residency constitutes a highly demanding and taxing phase in the professional journey of physicians. Factors such as low income, excessive workloads, and uncertainty regarding their career trajectory can contribute to diminished job satisfaction among residents. Neglecting this issue can have enduring negative effects on the quality and quantity of healthcare services provided. This research aims to explore the challenges encountered during medical residency and propose viable solutions.

METHODS

In this qualitative study conducted in 2023, interviews were employed to identify challenges, facilitators, barriers, and potential solutions associated with transitioning from residency to a job. In the qualitative section, a purposive selection process led to the inclusion of 26 interviewees, and for the Delphi method, 17 experts were purposefully chosen at three hierarchical levels: macro (Ministry of Health), intermediate (university), and executive (hospital). Qualitative data underwent analysis using a conceptual framework, while Delphi data were subjected to quantitative analysis.

RESULTS

The qualitative analysis revealed five general themes with 13 main categories and 70 sub-categories as challenges, two general themes as facilitators, and barriers to the transition from residency to a job. Additionally, eight main categories with 52 interventions were identified as solutions to overcome these barriers. In the Delphi stage, the number of proposed solutions was streamlined to 44 interventions. The most significant challenges identified in this study included high workload during residency, low income, career-related uncertainties, issues related to welfare services, and challenges in education and communication.

CONCLUSION

The decline in residents' willingness, coupled with the substantial work and financial pressures they face, poses a serious threat to the healthcare system, necessitating significant reforms. Transitioning from residency to a full-fledged job emerges as a potential avenue to address a substantial portion of the expressed needs. Implementing these reforms demands resolute determination and collaboration with sectors beyond the healthcare system, integrated into a comprehensive national healthcare plan that considers the country's capabilities.

Core stories of physicians on a Swiss internal medicine ward during the first COVID-19 wave: a qualitative exploration

INTRODUCTION

The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1.

METHODS

Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to as foci, in the texts.

RESULTS

Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians' narratives, danger designated a variety of rather negative feelings and emotions, whereas threats were experienced as being dangerous for others, but also for oneself. The acquisition of knowledge and practices focus referred to the different types of acquisition that took place during W1. The narratives that focused on adaptation reflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a natural commitment (or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly, sense of belonging referred to the team and its reconfiguration during W1.

CONCLUSIONS

Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician's profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.

Does Self-Efficacy for Affect Regulation Predict Lower Neuroticism?

In social cognitive theory, belief in the ability to manage emotions renders these emotions less aversive. Reduced emotional reactions to stress and greater self-regulation have been linked to lower neuroticism. The purpose of this study was to ascertain whether self-efficacy for regulation of distress/despondency (SEDes) and anger (SEAng) and self-efficacy for experiencing and expressing positive emotions (SEPos) predicted lower subsequent neuroticism. A second purpose was to determine whether these forms of self-efficacy buffered the relationship between perceived stress and subsequent neuroticism. Among 251 university students in the United States, perceived stress predicted 8% of the variance, and SEAng negatively predicted 2% of the variance, in time 2 neuroticism over 3-4 weeks. Contrary to hypotheses, high SEDes and SEPos did not protect against higher time 2 neuroticism when stress was high, but low levels of these forms of self-efficacy were risk factors for modestly higher time 2 neuroticism when stress was low.

Life satisfaction and peace of mind among dentists: a cross-sectional study

OBJECTIVES

This study sought to identify the factors associated with the life satisfaction and peace of mind (PoM) of dentists not in full-time clinical training.

MATERIALS AND METHODS

Cross-sectional questionnaires were distributed to dentists in Taiwan to collect their life satisfaction, PoM, sociodemographic data, and dental career-related characteristics. Life satisfaction was measured using a 5-item Satisfaction with Life Scale. PoM was measured using a 7-item Peace of Mind Scale. Descriptive statistics and multiple linear regression models were estimated to explore potential associations between the two scales and the examined factors.

RESULTS

A total of 1196 dentists (45.6% female; mean age = 44.12) completed the questionnaires. The response rate of completed questionnaires from email invitations was 32.9%. On multivariable analysis, life satisfaction and PoM were associated with age (b = 0.008 in both), better perceived health (b = 0.262 and 0.308, respectively), family interaction (b = 0.264 and 0.207, respectively), and friend relationships (b = 0.076 and 0.091, respectively). Being married (b = 0.191), being specialized (b = 0.127), working in private practice, and spending 10 to 39 h per week with patients (b = 0.101 to 0.162) were associated with a higher level of life satisfaction but not PoM.

CONCLUSIONS

Specialists working in private practice without working overtime were associated with better life satisfaction. However, the dentists' health and relationships with family were more related to their subjective well-being than their professional achievements.

CLINICAL RELEVANCE

Our findings can help policymakers increase awareness of the well-being of general dentists and those in academia or hospitals to promote their mental health.

Association of Personality Traits with Life and Work of Medical Students: An Integrative Review

BACKGROUND

Personality traits are the basic components of an individual's personality. Although there are many published articles about the impact of personality traits on medical students, there is a lack of integrative reviews of existing articles. To close this gap, this review aims to summarize the impact of personality traits on medical students from two perspectives: life and work.

METHODS

The search was performed using the following databases: PubMed, Web of Science, Google Scholar, and EMBASE. All publications that assessed the impact of personality traits on life and work until February 2022 were selected.

RESULTS

Ninety-seven studies were included. The results suggest that personality traits could affect life performance, health outcomes, life satisfaction, the formation of doctor-patient relationships, mastery of knowledge, academic performance, and career planning. Different personality traits can have positive or negative impacts on these aspects.

CONCLUSIONS

The results of this review suggest that personality traits can affect medical students' lives and work. Therefore, based on the evaluation of the personality traits of medical students, it is necessary to design targeted courses and training for students to improve their personality traits, to bring about better results in their lives and work.

The Association between COVID-19 Pandemic and the Quality of Life of Medical Students in Silesian Voivodeship, Poland

(1) Background: Since the COVID-19 pandemic spread rapidly in 2020, medical universities have been affected by a particular crisis. Due to the increased risk of SARS CoV-2 transmission, the authorities of medical faculties all over the world, including Poland, started to minimize direct contact between students. The objective of the paper is to identify and assess determinants of the quality of life among medical students in Poland before and during the COVID-19 pandemic. (2) Methods: We analyzed data obtained in a cross-sectional study performed among three groups of students tested in three consecutive research periods: period before the COVID-19 pandemic, the COVID-19 pandemic lockdown period and the COVID-19 pandemic period following lockdown. (3) Results: The total number of participants was 1098. We identified that the research period before the COVID-19 pandemic was the risk factor for lower quality of life in terms of the somatic and environmental domains. It was also confirmed that determinants such as poor financial situation, low frequency of physical activity and bad self-declared health status harmed the QoL scores in all domains. (4) Conclusions: The obtained results confirmed that better financial situation, higher physical activity and better self-declared health status were statistically significant factors improving the quality of life of first-year medical students in Poland. The findings of our study also showed that the declared somatic and environmental domains of QoL among medical students were better during the COVID-19 pandemic period. Our observations confirmed that the immediate implementation of e-learning could protect against the deterioration of mental health and quality of life in first-year medical students during possible future epidemic crises.

Work-Family Conflict and Suicidal Ideation Among Physicians of Pakistan: The Moderating Role of Perceived Life Satisfaction

Recent studies have shown an increased level of suicidal behavior among physicians, not only in Pakistan but all over the world. In this cross-sectional study, 622 physicians, aged 32–55 years, participated from 50 private and public hospitals located in the seven cities of the Punjab province of Pakistan. Three standardized tools were used to assess suicidal ideation, perceived life satisfaction and work-family conflict of the participants. Results showed work-family conflict as positive whereas life satisfaction was shown to be a negative predictor of suicidal ideation among the physicians. Furthermore, findings suggested that, as a moderator, percieved life satisfaction holds a significant role in decreasing the levels of work-family conflict and suicidal ideation among the physicians. Therefore, it is recommendable to incoroporate a perceived life satisfaction enhancement program into the training of physicians so that suicidal ideation may be prevented and treated effectively.

The Relationship between Emotional Stability, Psychological Well-Being and Life Satisfaction of Romanian Medical Doctors during COVID-19 Period: A Cross-Sectional Study

Due to the COVID-19 pandemic, as well as the fast progression of modern society, occupational stress has recently reached alarming levels with consequences for doctors’ psychological well-being. The aim of this study was to analyze the relationship among emotional stability, psychological well-being, and life satisfaction of medical doctors. We conducted a cross-sectional study on 280 medical doctors from Romania between February 2021 and September 2021, in the period between the third and fourth pandemic waves, who were evaluated by the DECAS, ASSET, and Satisfaction with Life scales. Our results showed that emotional stability is negatively correlated with psychological well-being (r = −0.526, p < 0.000) and positively correlated with life satisfaction (r = 0.319, p < 0.0001). Between psychological well-being and life satisfaction, we found a negative correlation (r = −0.046, p < 0.001). This study shows that there is a correlation among emotional stability, psychological well-being, and life satisfaction, which is why it can be considered that Romanian doctors have generated coping mechanisms during the COVID-19 pandemic.

The impact of a tailored mindfulness-based program for resident physicians on distress and the quality of care: A randomised controlled trial

BACKGROUND

Many resident physicians suffer from distress, which endangers their individual health and the quality of care.

OBJECTIVE

To examine the impact of a tailored mindfulness-based program (MBP) for resident physicians on distress and the quality of care.

METHODS

A single-centre, two-armed, longitudinal randomised controlled trial. The intervention group took part in an 8-week, tailored MBP that included a coursebook. The MBP was followed by a 4-month maintenance phase. The active control group received the coursebook for self-study. Assessments were at baseline (t0, 0 months), after the intervention (t1, 2 months), after the maintenance phase (t2, 6 months), and at follow-up (t3, 12 months). The primary outcome was a change in burnout at t2. Secondary outcomes included perceived stress, mental distress, perceived job strain, depression, anxiety, hair cortisol secretion, self-reported medical errors and third-party ratings by patients, supervisors and colleagues.

RESULTS

Seventy-six participants were randomised to the intervention and 71 to the control group. The intervention group showed greater improvements in the primary outcome (burnout at t2, d = 0.32, p = 0.046), in perceived stress (d = 0.31, p = 0.046) and perceived job strain (d = 0.33, p = 0.026) at t1, and in supervisor rated empathy (d = 0.71, p = 0.037) and colleague rated attentiveness (d = 0.85, p = .006) at t2. There was no difference between groups in the other outcomes.

CONCLUSION

A tailored MBP for resident physicians improved burnout and might have improved other aspects of distress and the quality of care.

Mental health among outpatient reproductive health care providers during the US COVID-19 epidemic

INTRODUCTION

Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers.

METHODS

We conducted a survey with open-ended responses among outpatient reproductive health providers across the U.S. engaged in contraceptive care to collect data on their experiences with stress, anxiety and depression during the COVID-19 epidemic. The study population included physicians, nurses, social workers, and other health professions [n = 288]. Data were collected from April 21st-June 24th 2020. We used content analysis of free text responses among providers reporting increased stress, anxiety or depression.

RESULTS

Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression related to care provision during the COVID-19 epidemic. The major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers' changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown.

CONCLUSIONS

US outpatient providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US. Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers across the US. We conducted a survey from April 21st to June 24th, 2020 among outpatient reproductive health providers, including physicians, nurses, social workers and other health professions. We asked open-ended questions to understand why providers reported increased stress, anxiety and/or depression. Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression from care provision during the COVID-19 epidemic. Major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers' changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. This study highlights that US outpatient reproductive health providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US.

A tailored mindfulness-based program for resident physicians: A qualitative study

BACKGROUND

Diminished well-being is prevalent in resident physicians. This qualitative study explored the effects of a tailored mindfulness-based program (MBP) aimed at increasing resident physicians' well-being. A second goal was to compare the MBP with an active control group.

MATERIALS AND METHODS

We conducted interviews with 35 resident physicians: 21 physicians attended an eight-week MBP (intervention group) and 14 physicians received text-based information about mindfulness for self-study (control group). The interviews were analyzed using thematic analysis.

RESULTS

Participants in the intervention group reported that the MBP helped them integrate mindfulness into their everyday life, increased their self-awareness, equanimity and well-being, and had positive effects on their self-care and interactions with patients. In the control group, the perceived effects were minor.

CONCLUSION

A tailored mindfulness-based program can help resident physicians care for their own well-being during medical residency and can have positive effects on their interactions with patients.

Professional Quality of Life among Medical Doctors Working in Kathmandu: A Descriptive Cross-sectional Study

INTRODUCTION

The practice of medicine is an honorable profession besides being accompanied by a demanding environment. This study aimed to find out the professional quality of life of medical doctors working in Kathmandu valley.

METHODS

A descriptive cross-sectional study was conducted among 174 Nepalese medical doctors working in different hospitals of Kathmandu valley. Ethical approval was taken from the Ethical Review Board of the Nepal Health Research Council (Reference Number: 830). The data collection tool used in the study was WHO Professional Quality of Life Scale-5 to collect data about Compassion satisfaction, Burnout and Secondary traumatic stress among medical doctors working in Kathmandu valley. Data analysis was done in the Statistical Package for the Social Sciences version 16.0.

RESULTS

Out of 174 participants, 101 (58%), 126 (72.4%) and 135 (77.6%) were found to have moderate level of Compassion satisfaction, Burnout and Secondary Traumatic Stress respectively.

CONCLUSIONS

More than half, nearly two-third, and more than two-third participants had moderate levels of Compassion satisfaction, Burnout and Secondary Traumatic Stress respectively. The overall study findings reflected good balance between Compassion satisfaction and Compassion fatigue (burnout and secondary traumatic stress) among the Nepalese medical doctors. Further assessment of professional quality of life of doctors as well as other health care workers via Multifaceted and large-scale study is recommended.

Move It or Lose It: Summarizing Peer-reviewed Evidence for Practicing What You Preach

Physically active health care providers are more likely to provide physical activity (PA) counseling to their patients, but barriers in PA counseling exist. Common barriers include knowledge, time constraints, lack of reimbursement, as well as lack of personal habits. This article will summarize evidence-based knowledge regarding provider PA habits as a means of improving rapport, compliance, and empathy for patients when prescribing PA. Clinical pearls for successful PA counseling scenarios also will be discussed.

Recovery experiences mediate the effect of burnout on life satisfaction among Chinese physicians: a structural equation modeling analysis

PURPOSE

Recovery experiences not only make it possible for individuals to restore their energy resources and return to pre-stressor levels but also contribute to the formation of their subjective well-being. This paper investigates the effect of burnout on life satisfaction among Chinese physicians who are frequently confronted with a considerable number of work-related stressors and examines the mediating role of recovery experiences in the relationship between burnout and life satisfaction.

METHODS

A total of 642 physicians working in five public tertiary hospitals in China responded to a self-administered questionnaire including demographic information, the Satisfaction with Life Scale, the Maslach Burnout Inventory-General Scale, and the Recovery Experience Questionnaire. Hierarchical multiple regression analysis was conducted to test the incremental variance of any given set of independent variables. Structural equation modeling was employed to test the presumed relationships between variables involved. Asymptotic and resampling strategies were used to examine the mediating effects of recovery experiences in the relationship between burnout and life satisfaction.

RESULTS

Burnout and recovery experiences were important predictors of life satisfaction and the direct effect of burnout on life satisfaction was statistically significant and negative and the path coefficients of burnout with life satisfaction were significantly decreased when recovery experiences were modeled as mediators.

CONCLUSION

Findings of the study highlight the importance of promoting recovery experiences to reduce burnout and improve life satisfaction among physicians rather than focusing on the less easily modifiable work-related stressors.

Life satisfaction of Taiwanese dental graduates received residencies in the U.S.: a cross-sectional study

BACKGROUND

Each year, more than 200 international dental graduates start U.S. specialty trainings to become specialists. It is unknown if their life satisfaction is associated with any dental career-related factor before residencies (e.g. dental school class rank, research experience, or private practice experience) and after residencies (e.g. staying in the U.S., teaching status, workplace, or board certification). This cross-sectional study aimed to identify these potential factors by surveying Taiwanese dental graduates who pursued U.S. residencies.

METHODS

Life satisfaction was measured with a structured questionnaire, Satisfaction With Life Scale (SWLS), which includes five statements on a 5-point Likert scale. Online surveys were sent out to 290 Taiwanese dental graduates who were known to pursue U.S. residencies. T-test, one way analysis of variance, and multivariable adjusted generalized linear model (GLM) were used to assess the differences of mean SWLS scores from different variables.

RESULTS

Surveys were completed by 158 dentists. Mean SWLS score of 125 specialists was higher (p = 0.0007) than the score of 33 residents. For the 125 specialists, multivariable adjusted GLM demonstrated better life satisfaction was positively associated with multiple independent factors, such as having research experience, being ranked in the top 26 ~ 50% of the class in dental school, starting U.S. residency within 4 years after dental school, starting residency before year 1996, and specializing in endodontics (vs. periodontics). Life satisfaction was not associated with any factors after residency (e.g. staying in the U.S. afterwards, teaching status, or workplace), but better mean life satisfaction score was significantly associated with being American specialty board certified (p < 0.001) for the specialists in the 26 ~ 75% of their class in dental school. For the 33 residents, better mean life satisfaction score was associated with better dental school class rank in both bivariate (p = 0.020) and multivariable adjusted GLM (p = 0.004) analyses.

CONCLUSIONS

The life satisfaction of Taiwanese dental graduates pursuing U.S. residencies might be associated with some professional factors, such as research experience, dental school class rank, residency timing, specialty type, and specialty board certification. We hope our results may provide some objective information on making career decisions for international dental graduates/students who are preparing for U.S. residency.

Life satisfaction in Norwegian medical doctors: a 15-year longitudinal study of work-related predictors

BACKGROUND

Despite many recent studies on burn-out and dissatisfaction among American medical doctors, less is known about doctors in the Scandinavian public health service. The aims of this study were to analyse long-term work-related predictors of life satisfaction among established doctors in Norway and to identify predictors in a subgroup of doctors who reported a decline in life satisfaction.

METHODS

Two nationwide cohorts of doctors (n = 1052), who graduated medical school 6 years apart, were surveyed at graduation from medical school (T1, 1993/94 and 1999), and 4 (T2), 10 (T3), and 15 (T4) years later. Work-related predictors of life satisfaction (three items) obtained at T2 to T4 were analysed. Individual and lifestyle confounders were controlled for using mixed-models repeated-measures analyses, and logistic regression analyses were applied to identify predictors of the decrease in life satisfaction.

RESULTS

Ninety per cent (947/1052) responded at least once, and 42% (450/1052) responded at all four times. Work-related predictors of higher life satisfaction in the adjusted model were work-home stress (β = - 0.20, 95% confidence interval [CI] = - 0.25 to - 0.16, p < 0.001), perceived job demands (β = - 0.10, CI = - 0.15 to - 0.05, p < 0.001), and colleague support (β = 0.05, CI = 0.04 to 0.07, p < 0.001). The new adjusted individual predictors that we identified included female gender, reality weakness trait, and problematic drinking behaviour. Neuroticism trait and low colleague support predicted a decrease in life satisfaction.

CONCLUSIONS

Work-home stress, perceived job demands, and colleague support were the most important predictors of life satisfaction related to doctors' work. When personality traits were controlled for, female doctors were more satisfied with their life than male doctors. These findings suggest that improving work-related factors with targeted interventions, including a supportive work environment, may increase life satisfaction among doctors.

[Qualitative study on young hospital physicians: They remain satisfied…]

INTRODUCTION

Prevalence of depression, suicidal ideation and burnout are higher among physicians than in general population. Young physicians seem more concerned and the beginning of career seems to be a period of greater risks for hospital practitioners. While this may be the case, in France, few studies have specifically evaluated the quality of the working conditions of this population. The objective of this study is to identify stress factors related to the organization of work and to social relationships at work, as they are perceived by the young hospital physicians.

METHODS

A qualitative study through semi-structured interviews was conducted with hospital practitioners with less than 10 years of practice. Manual analysis of the interviews was carried out by three interviewers and supplemented by a computerized lexical analysis.

RESULTS

Eighteen physicians were interviewed. Five categories of psychosocial and organizational factors have been identified. Teamwork and communication are generally associated with positive feelings. The pace of work, professional status, organizational factors and material conditions are considered unsatisfactory. Young physicians, however, are satisfied with the content of their work, particularly because of scientific emulation and skills development.

CONCLUSION

The results of this study should help to better target prevention actions in order to improve the working conditions of young doctors. It seems a priority to reduce their workload or to regulate their working time, to offer greater stability to their work and to provide them with better material work conditions.

Change in subjective well-being over 20 years at two Norwegian medical schools and factors linked to well-being today: a survey

BACKGROUND

There is a lack of studies on factors in the curriculum, study environment and individual differences that can promote well-being among medical students as a response to the frequent reports on the negative health effects of study demands among medical students worldwide.

OBJECTIVE

This study investigates differences in well-being among today's Norwegian medical students compared with students 20 years ago, the most important predictors of well-being today, and whether there have been any changes in the levels of some of these factors since the period analysed.

METHODS

We analysed cross-sectional survey data among all medical students (63.9%, N = 1044/1635) at two medical faculties with different curriculums (traditional and integrated) in Norway in 2015 (STUDMED 2015). We used comparison data from a longitudinal survey among medical students from the same medical faculties in 1993 to 1999: the NORDOC project (T1 = 89%, T2 = 72% and T3 = 68%). Differences in subjective well-being and correlates by demographic, curriculum, and study environment factors among the present students were tested by t-tests and stepwise linear regression analysis.

RESULTS

Students today scored lower on their levels of subjective well-being than students 20 years ago. The difference was found among female and males in different study stages. The final model showed that subjective well-being today was associated with self-esteem (β = .98, p < .001) and social support from medical school friends (β = .22, p < .001), a partner (β = .08, p = .020) or other family members (β = .04, p = .041), as well as perception of medical curriculum and environment (β = -.38, p < .001), personal competence (β = -.40, p < .001), finance/accommodation (β = -.22, p < .001) and perceived exam stress (β = -.26, p < .001).

CONCLUSIONS

The results show a decrease in subjective well-being among medical students and, in particular, among female students. The faculties should pay attention to the factors identified in the study environment and curriculum associated with subjective well-being in order to promote their student's well-being and stimulate health and academic performance.

Factors influencing doctors' counselling on patients' lifestyle habits: a cohort study

Background

Lifestyle changes are important for prevention and treatment of many common diseases, and doctors have an important role in the lifestyle counselling of patients. It is important to know more about factors influencing lifestyle counselling.

Aim

To investigate the frequency of counselling about physical activity compared to that about alcohol habits; the impact of doctors' own physical activity and alcohol habits on patient counselling about these lifestyle dimensions; and whether perceived mastery of clinical work or vulnerable personality have a confounding or moderating effect on these associations.

Design & setting

In this nationwide cohort survey, a total of 978 doctors in Norway were surveyed by postal questionnaires in 1993/94 and 2014. The response rate was 562/978 (57%).

Method

The outcome variables were questions on frequency of asking about alcohol and exercise habits. Explanatory variables were questions on doctors' own exercise habits, drinking habits (using Alcohol Use Disorders Identification Test [AUDIT]), perceived mastery of clinical work, vulnerable personality, and specialty. Associations were studied by linear regression analysis.

Results

Of the 526 responders, 307 (58%) reported asking usually/often about exercise habits, while n = 140/524 (27%) usually/often asked about alcohol habits. A doctor's own physical activity level was associated with frequency of asking about physical activity (unstandardised regression coefficient [B] = 0.07; 95% confidence intervals [CI] = 0.01 to 0.13). There were no significant associations between doctors' own lifestyle habits and counselling on alcohol habits. Doctors with low levels of vulnerability asked more frequently about physical activity, regardless of their own physical activity habits (F = 2.41, P = 0.048).

Conclusion

Doctors' own lifestyles influenced their preventive counselling about physical activity, but not about alcohol. Vulnerability moderated these effects, indicating the importance of early interventions to help doctors with a vulnerable personality to handle negative criticism from patients.

Factors associated with low vs increased perceived mastery of clinical work over ten years of practice: a prospective study of Norwegian doctors

BACKGROUND

A higher sense of mastery of doctors' clinical work could benefit not only their own mental health but also their work performance and patient care. However, we know little about factors associated with perceived mastery of clinical work among physicians. Our aim was therefore to study characteristics of those with stable low levels and of those with increased levels of mastery over a period of ten years of medical practice.

METHODS

N = 631 doctors were surveyed in their final year of medical school in 1993/94 (T1) and 10 (T2), 15 (T3) and 20 (T4) years later. Low and increased perceived mastery of clinical work were measured between T2, T3 and T4. Response rates for all items measuring low and increased mastery were 238/522 (46%) and 256/522 (49%) respectively. The following explanatory variables were included: demographics, medical school factors, personality and contextual work-related and non-work-related factors.

RESULTS

N = 73 (31%) of the doctors reported stable low mastery from T2 to T4. The following variables were significantly associated with low mastery in the adjusted analyses: vulnerability (OR: 1.30, P < .000, CI: 1.12 to 1.50), drinking alcohol to cope with stress during medical school (OR: 2.66, P = .04, CI: 1.03 to 6.85) and social support (OR: 0.78, P = .002, CI: 0.66 to 0.91). N = 39 (15%) reported increased mastery during the ten-year period from T2 to T4. Perceived job demands (OR: 0.66, P = .02, CI: 0.45 to 0.98) and taking up a leading position (OR: 3.04, P = .01, CI: 1.31 to 7.07) were associated with increased mastery after adjustment.

CONCLUSIONS

Stable low sense of mastery over time is associated with having a vulnerable personality, a history of having used alcohol to cope with stress during medical school and lack of contemporary social support. Conversely, increased sense of mastery is associated with taking up a leading position and having the perception that job demands are decreasing over time. These findings indicate that perceived mastery of clinical work may not be a trait, but a state modifiable over time.

Six-year positive effects of a mindfulness-based intervention on mindfulness, coping and well-being in medical and psychology students; Results from a randomized controlled trial

Longitudinal research investigating the enduring impact of mindfulness training is scarce. This study investigates the six-year effects of a seven-week mindfulness-based course, by studying intervention effects in the trajectory of dispositional mindfulness and coping skills, and the association between those change trajectories and subjective well-being at six-year follow-up. 288 Norwegian medical and psychology students participated in a randomized controlled trial. 144 received a 15-hour mindfulness course over seven weeks in the second or third semester with booster sessions twice yearly, while the rest continued their normal study curricula. Outcomes were subjective well-being, and dispositional mindfulness and coping assessed using the Five Facet Mindfulness Questionnaire and the Ways of Coping Checklist. Analyses were performed for the intention-to-treat sample, using latent growth curve models. At six-year follow-up, students receiving mindfulness training reported increased well-being. Furthermore, they reported greater increases in the trajectory of dispositional mindfulness and problem-focused coping along with greater decreases in the trajectory of avoidance-focused coping. Increases in problem-focused coping predicted increases in well-being. These effects were found despite relatively low levels of adherence to formal mindfulness practice. The findings demonstrate the viability of mindfulness training in the promotion of well-being and adaptive coping, which could contribute to the quality of care given, and to the resilience and persistence of health care professionals.

TRIAL REGISTRATION

Clinicaltrials.gov NCT00892138.

A dark side of political skill? Awareness and life satisfaction in a Latin American Business

Research has typically explained the positive intrapsychic influence of political skill using Conservation of Resources (COR) theory. However, research explaining the possible negative intrapsychic consequences of high levels of political skill is lacking. Therefore, we introduce Cognitive Activation Theory (CAT) to the political skill literature to explain possible negative outcomes of political skill. In testing this theory, we used two hierarchical moderated multiple regressions to examine the relationship between affective and continuance commitment, life satisfaction, and political skill in a large, privately owned, financial services firm in Ecuador. Aligned with prior research, affective commitment positively affected life satisfaction; however, contrary to our hypothesis, continuance commitment also positively affected life satisfaction. Furthermore, consistent with both Conservation of Resources and Cognitive Activation Theory, results indicated that political skill strengthened the relationship between affective commitment and life satisfaction. However, contrary to Cognitive Activation Theory, political skill did not significantly weaken the relationship between continuance commitment and life satisfaction.

Mindfulness based stress reduction for medical students: optimising student satisfaction and engagement

BACKGROUND

Medical practitioners and students are at increased risk of a number of personal and psychological problems. Stress and anxiety due to work-load and study requirements are common and self-care methods are important in maintaining well-being. The current study examines perceptions of and satisfaction ratings with a mindfulness based stress reduction (MBSR) programme for 1(st) year (compulsory) and 2(nd) year (optional) Graduate Entry Medical School students.

METHODS

A mixed method pre and post study of Year 1 (n = 140) and Year 2 (n = 88) medical students completing a 7 week MBSR course compared student satisfaction ratings. Thematic analysis of feedback from the students on their perception of the course was also carried out.

RESULTS

Year 1 students (compulsory course) were less satisfied with content and learning outcomes than Year 2 students (optional course) (p < .0005). Thematic analysis of year 1 student feedback identified themes including great concept, poorly executed; and less discussion, more practice. Year 2 themes included session environment and satisfaction with tutors.

CONCLUSIONS

The MBSR course was associated with high levels of satisfaction and positive feedback when delivered on an optional basis. Catering for the individual needs of the participant and promoting a safe environment are core elements of a successful self-care programme.

An examination of the long-term impact of job strain on mental health and wellbeing over a 12-year period

OBJECTIVES

Job strain has been implicated in a range of employee health outcomes including psychiatric health. Much of the literature is drawn from studies that utilise cross-sectional designs, whilst the long-term follow-up of participants is limited. We examine the short and long-term risks of job strain for depression and wellbeing over a 12-year period. In particular, we utilise measures of wellbeing to emphasise the importance of discriminating between indices of subjective and psychological wellbeing that complement measures of mental health.

METHODS

Participants (n = 2530) were aged between 40 and 44 years at baseline and were drawn from the Personality and Total Health (PATH) Through Life Project. Participants were observed once every 4 years for 12 years.

RESULTS

A high strain job was associated with an increased risk of reporting sub-syndromal [RRR = 1.66 (95 % CI 1.23; 2.25), p < 0.001], minor [RRR = 1.92 (95 % CI 1.19; 3.10), p < 0.001] and major depression [RRR = 2.19 (95 % CI 1.30; 3.67), p < 0.001], but strain was not a long-term risk for depression 4 years later. In contrast, strain was a risk for both cross-sectional and longitudinal wellbeing outcomes. Moving into a high strain job was a risk for developing depression [RRR = 1.81 (95 % CI 1.26; 2.59), p < 0.001], but the cumulative exposure to a high strain job was not associated with poorer outcomes in adjusted models.

CONCLUSIONS

Overall, our results emphasise the importance of current job strain, and the risk of moving into a high strain job, on adverse mental health and wellbeing outcomes. Effects were not consistent between indices of mental health, subjective or psychological wellbeing, supporting the need to dedifferentiate between wellbeing and mental health.

Medical and Psychology Student's Experiences in Learning Mindfulness: Benefits, Paradoxes, and Pitfalls

Mindfulness has attracted increased interest in the field of health professionals' education due to its proposed double benefit of providing self-help strategies to counter stress and burnout symptoms and cultivating attitudes central to the role of professional helpers. The current study explored the experiential aspects of learning mindfulness. Specifically, we explored how first-year medical and psychology students experienced and conceptualized mindfulness upon completion of a 7-week mindfulness-based stress reduction program. Twenty-two students participated in either two focus group interviews or ten in-depth interviews, and we performed an interpretive phenomenological analysis of the interview transcripts. All students reported increased attention and awareness of psychological and bodily phenomena. The majority also reported a shift in their attitudes towards their experiences in terms of decreased reactivity, increased curiosity, affect tolerance, patience and self-acceptance, and improved relational qualities. The experience of mindfulness was mediated by subjective intention and the interpretation of mindfulness training. The attentional elements of mindfulness were easier to grasp than the attitudinal ones, in particular with respect to the complex and inherently paradoxical elements of non-striving and radical acceptance. Some participants considered mindfulness as a means to more efficient instrumental task-oriented coping, whilst others reported increased sensitivity and tolerance towards their own state of mind. A broader range of program benefits appeared dependent upon embracing the paradoxes and integrating attitudinal elements in practising mindfulness. Ways in which culture and context may influence the experiences in learning mindfulness are discussed along with practical, conceptual, and research implications.

Workload, mental health and burnout indicators among female physicians

BACKGROUND

Female doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians.

METHODS

Two time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis.

RESULTS

No significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment.

CONCLUSIONS

In comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.

Medical Students' Perception of Their Educational Environment and Quality of Life: Is There a Positive Association?

PURPOSE

To assess perceptions of educational environment of students from 22 Brazilian medical schools and to study the association between these perceptions and quality of life (QoL) measures.

METHOD

The authors performed a multicenter study (August 2011 to August 2012), examining students' views both of (1) educational environment using the Dundee Ready Education Environment Measure (DREEM) and (2) QoL using the World Health Organization Quality of Life Assessment, abbreviated version (WHOQOL-BREF). They also examined students' self-assessment of their overall QoL and medical-school-related QoL (MSQoL). The authors classified participants' perceptions into four quartiles according to DREEM total score, overall QoL, and MSQoL.

RESULTS

Of 1,650 randomly selected students, 1,350 (81.8%) completed the study. The mean total DREEM score was 119.4 (standard deviation = 27.1). Higher total DREEM scores were associated with higher overall QoL and MSQoL scores (P < .001 for all comparisons) and younger ages (P < .001). Mean overall QoL scores were higher than MSQoL scores (mean difference, 1.35; 95% confidence interval [CI] 1.28-1.43; P < .001). Multinomial regression models showed significant dose-response patterns: Higher DREEM quartile scores were associated with better QoL. The psychological health domain of WHOQOL-BREF was most closely associated with DREEM scores (odds ratio 4.70; 95% CI = 3.80-5.81).

CONCLUSIONS

The authors observed a positive association between QoL measures and DREEM scores. This association had a dose-response effect, independent of age, sex, and year of medical training, showing that educational environment appears to be an important moderator of medical student QoL.

Exploring physiotherapists' personality traits that may influence treatment outcome in patients with chronic diseases: a cohort study

Background

During treatment of patients with Chronic Diseases (CD) the therapist-patient interaction is often intense, and the strategies used during treatment require physiotherapists to assume a coaching role. Uncovering therapist factors that explain inter-therapist variation might provide tools to improve treatment outcome and to train future therapists. The purpose of this study was to explore the so-called ‘therapist-effect’, by looking at the influence of intrinsic therapist factors, specifically personality traits, on treatment outcome in patients with CD.

Methods

A cohort study was performed using data from the NIVEL Primary Care Database (NPCD) in 2011–2012 and an additional questionnaire. Patients with CD (n = 393) treated by Dutch physiotherapists working in outpatient practices (n = 39) were included. Patient and treatment outcome variables were extracted from NPCD. The course of complaint was measured using the Numeric Rating Scale. Therapist variables were measured using a questionnaire consisting of demographics and the Big Five traits: Extraversion, Neuroticism, Agreeableness, Conscientiousness and Openness to experiences. Data were analysed using multilevel linear regression.

Results

Only Neuroticism was found to be significant (Neuroticism F = 0.71, P = 0.01; therapist gender F = 0.72, P = 0.03; life events F = −0.54, P = 0.09; patient gender F = −0.43, P = 0.10; patient age F = 0.01, P = 0.27). Subgroup analyses of 180 patients with Osteoarthritis and 30 therapists showed similar results.

Conclusions

There are indications that patients with CD who are treated by therapists who tend to be calmer, more relaxed, secure and resilient have a greater reduction in severity of complaints compared to patients treated by therapists who show less of these traits. Being a male therapist and having experienced life events influence outcome positively. However, more extensive research is needed to validate the current findings.

Quality of life of young clinical doctors in public hospitals in China's developed cities as measured by the Nottingham Health Profile (NHP)

BACKGROUND

In contemporary Chinese society, obstacles such as frequent violence against medical workers and tense doctor-patient relationships affect the health of Chinese doctors. This study attempted to explore the quality of life (QOL) of young clinical doctors in public hospitals in China's developed cities to study the psychometric properties of QOL and related risk factors of doctors' health.

METHODS

This study sampled young doctors aged 15-45 in 18 public hospitals of three cities in East China (Shanghai, Nanjing, and Hangzhou, N = 762). The Nottingham Health Profile was used to measure QOL, the dependent variable of this study. Methodologies such as reliability analysis, mean comparison, and exploratory factor analysis were used to study related psychometric properties.

RESULTS

Almost 90 % of young Chinese clinical doctors have a bachelor's degree or above. Approximately 70.4 % of the doctors have relatively low job titles. Among the sample, 76.1 % have a monthly income ranging from USD 326 to USD 1139, and 91.3 % work over eight hours daily. These respondents have poor sleeping habits and mental functions, but have relatively good physical functions. Being female, low education, low job title, low salary, and long work hours are factors associated with doctors' poor QOL. Regression analysis results emphasize the great effect of high education on the improvement of QOL.

CONCLUSIONS

Young clinical doctors in public hospitals in Chinese developed cities have poor QOL. Reforms on the current medical health system, improving the working environment of doctors and relieve their occupational stress should be required.

This thing called life

Academic pursuits are inseparable from the medium within which they take place - life. The lives of medical trainees can present many challenges that are independent of academic demands. Poor psychological health has been found to develop in medical trainees. Can medical educators minimize this decline in well-being? Positive education - learning skills for traditional academia and to foster happiness - has been shown to improve students' well-being. This piece considers the application of 'positive education' to medical training. By using this approach, we may optimize the lives of our trainees, potentially enhance learning and improve their academic and personal outcomes.

Empathy among medical students: is there a relation with quality of life and burnout?

Background

We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout.

Method

A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students.

Results

Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d≥0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = −0.18) and perspective taking (β = −0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = −0.26; p<0.001) scores.

Conclusions

Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.

Personality traits predict job stress, depression and anxiety among junior physicians

BACKGROUND

High levels of stress and deteriorating mental health among medical students are commonly reported. In Bergen, Norway, we explored the impact of personality traits measured early in their curriculum on stress reactions and levels of depression and anxiety symptoms as junior physicians following graduation.

METHODS

Medical students (n = 201) from two classes participated in a study on personality traits and mental health early in the curriculum. A questionnaire measuring personality traits (Basic Character Inventory (BCI)) was used during their third undergraduate year. BCI assesses four personality traits: neuroticism, extroversion, conscientiousness and reality weakness. Questionnaires measuring mental health (Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 25 (SCL-25)), and stress (Perceived Medical School Stress (PMSS)) were used during their third and sixth undergraduate year. During postgraduate internship, Cooper's Job Stress Questionnaire (CJSQ) was used to measure perceived job stress, while mental health and stress reactions were reassessed using HADS and SCL-25.

RESULTS

Extroversion had the highest mean value (5.11) among the total group of participants, while reality weakness had the lowest (1.51). Neuroticism and reality weakness were related to high levels of perceived job stress (neuroticism r = .19, reality weakness r = .17) as well as higher levels of anxiety symptoms (neuroticism r = .23, reality weakness r = .33) and symptoms of depression (neuroticism r = .21, reality weakness r = .36) during internship. Neuroticism indirectly predicted stress reactions and levels of depression and anxiety symptoms. These relations were mediated by perceived job stress, while reality weakness predicted these mental health measures directly. Extroversion, on the other hand, protected against symptoms of depression (r = -.20). Furthermore, females reported higher levels of job stress than males (difference = 7.52).

CONCLUSIONS

Certain personality traits measured early in the course of medical school relates to mental health status as junior physicians during postgraduate internship training. This relation is mediated by high levels of perceived job stress.

Mindfulness training for stress management: a randomised controlled study of medical and psychology students

BACKGROUND

Distress and burnout among medical and psychology professionals are commonly reported and have implications for the quality of patient care delivered. Already in the course of university studies, medicine and psychology students report mental distress and low life satisfaction. There is a need for interventions that promote better coping skills in students in order to prevent distress and future burnout. This study examines the effect of a seven-week Mindfulness-Based Stress Reduction (MBSR) programme on mental distress, study stress, burnout, subjective well-being, and mindfulness of medical and psychology students.

METHODS

A total of 288 students (mean age = 23 years, 76% female) from the University of Oslo and the University of Tromsø were randomly allocated to an intervention or control group. The control group continued with their standard university courses and received no intervention. Participants were evaluated using self-reported measures both before and after the intervention. These were: the 'General Health Questionnaire, Maslach Burnout Inventory Student version, Perceived Medical School Stress, Subjective Well-being, and Five Facet Mindfulness Questionnaire' and additional indices of compliance.

RESULTS

Following the intervention, a moderate effect on mental distress (Hedges'g 0.65, CI = .41, .88), and a small effect on both subjective well-being (Hedges'g 0.40, CI = .27, .63) and the mindfulness facet 'non-reacting' (Hedges'g 0.33, CI = .10, .56) were found in the intervention group compared with the control group. A higher level of programme attendance and reported mindfulness exercises predicted these changes. Significant effects were only found for female students who additionally reported reduced study stress and an increase in the mindfulness facet 'non-judging'. Gender specific effects of participation in the MBSR programme have not previously been reported, and gender differences in the present study are discussed.

CONCLUSION

Female medical and psychology students experienced significant positive improvements in mental distress, study stress, subjective well-being and mindfulness after participating in the MBSR programme.

TRIAL REGISTRATION

NCT00892138.

Prevalence and persistence of depression among undergraduate medical students: a longitudinal study at one UK medical school

OBJECTIVES

To determine the prevalence of depression among male and female medical students, its change over time and whether depression persists for affected students.

DESIGN

Longitudinal study comprising annual questionnaire surveys which included the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D).

PARTICIPANTS

Between 2007 and 2010 all 1112 students entering the Core Science component (Year 1) and all 542 students entering the Clinical component (Year 4) of the Cambridge (UK) medical course were followed-up annually.

METHODS

We analysed, separately for men and women, mean HADS-D scores, the proportions whose scores indicated depression at different time-points and for students maintaining participation, the number of occasions on which their HADS-D scores indicated depression.

RESULTS

725 Core Science and 364 Clinical students participated. Mean HADS-D scores ranged between 3.34 and 3.49 among all Core Science students and between 2.16 and 2.91 among all Clinical students. There was no difference between men and women in median HADS-D scores. Prevalence of depression ranged between 5.7% and 10.6% among all Core Science students and between 2.7% and 8.2% among all Clinical students. Over time Core Science students displayed no increase in mean HADS-D score. Among Clinical students only men displayed a small increase (time coefficient 0.33 (95% CI 0.11 to 0.55)). Prevalence did not increase over time. 220 Core Science and 150 Clinical students participated throughout the study. Of these, 18.2% and 10.6%, respectively, recorded HADS-D scores indicating depression on at least one occasion. Of 56 students recording depression at some point, 37 did so only once.

CONCLUSIONS

Prevalence of depression among participants was similar to that reported for comparable groups. Among men approaching the end of clinical studies depression scores increased. In all years a minority of students displayed depression; for some this persisted. Mechanisms are needed to identify and support students suffering from depression, particularly when persistent.

Self-compassion and relationship maintenance: the moderating roles of conscientiousness and gender

Should intimates respond to their interpersonal mistakes with self-criticism or with self-compassion? Although it is reasonable to expect self-compassion to benefit relationships by promoting self-esteem, it is also reasonable to expect self-compassion to hurt relationships by removing intimates' motivation to correct their interpersonal mistakes. Two correlational studies, 1 experiment, and 1 longitudinal study demonstrated that whether self-compassion helps or hurts relationships depends on the presence versus absence of dispositional sources of the motivation to correct interpersonal mistakes. Among men, the implications of self-compassion were moderated by conscientiousness. Among men high in conscientiousness, self-compassion was associated with greater motivation to correct interpersonal mistakes (Studies 1 and 3), observations of more constructive problem-solving behaviors (Study 2), reports of more accommodation (Study 3), and fewer declines in marital satisfaction that were mediated by decreases in interpersonal problem severity (Study 4); among men low in conscientiousness, self-compassion was associated with these outcomes in the opposite direction. Among women, in contrast, likely because women are inherently more motivated than men to preserve their relationships for cultural and/or biological reasons, self-compassion was never harmful to the relationship. Instead, women's self-compassion was positively associated with the motivation to correct their interpersonal mistakes (Study 1) and changes in relationship satisfaction (Study 4), regardless of conscientiousness. Accordingly, theoretical descriptions of the implications of self-promoting thoughts for relationships may be most complete to the extent that they consider the presence versus absence of other sources of the motivation to correct interpersonal mistakes.

Sources of distress during medical training and clinical practice: Suggestions for reducing their impact

BACKGROUND

Medical students and doctors experience several types of professional distress. Their causes ("stressors") are commonly classified as exogenous (adapting to medical school or clinical practice) and endogenous (due to personality traits). Attempts to reduce distress have consisted of providing students with support and counseling, and improving doctors' management of work time and workload.

AIM

To review the common professional stressors, suggest additional ones, and propose ways to reduce their impact.

METHOD

Narrative review of the literature.

RESULTS AND CONCLUSION

We suggest adding two professional stressors to those already described in the literature. First, the incongruity between students' expectations and the realities of medical training and practice. Second, the inconsistencies between some aspects of medical education (e.g., its biomedical orientation) and clinical practice (e.g., high proportion of patients with psychosocial problems). The impact of these stressors may be reduced by two modifications in undergraduate medical programs. First, by identifying training-practice discrepancies, with a view of correcting them. Second, by informing medical students, both upon admission and throughout the curriculum, about the types and frequency of professional distress, with a view of creating realistic expectations, teaching students how to deal with stressors, and encouraging them to seek counseling when needed.

Self-Control and Self-Efficacy for Affect Regulation as Moderators of the Negative Affect–Life Satisfaction Relationship

Trait negative affect has a unique inverse relationship with life satisfaction across the life span. Because lower life satisfaction predicts mortality and higher suicidality, ascertaining malleable psychological factors that attenuate the effects of negative affect on life satisfaction is particularly important. The authors tested the hypothesis that self-efficacy for ability to regulate one’s negative emotions, and general self-control, would moderate the relationship between trait negative affect and life satisfaction. Among 191 college students, self-efficacy for ability to regulate anger moderated, but self-control did not moderate, the relationship between negative affect and life satisfaction. At high levels of self-efficacy, the relationship between negative affect and life satisfaction was nonsignificant. At mean and low levels of self-efficacy, negative affect was strongly and inversely related to life satisfaction. Implications for theory and practice are discussed.

Life satisfaction of Swedish pediatric oncologists: The role of personality, work-related aspects, and emotional distress

BACKGROUND

The first nationwide, population-based study of Swedish pediatric oncologists was conducted in 2006 and it revealed that various aspects of their life satisfaction obviously influenced their stress-resilience. This second part of the study, with a response rate of 89% in the target group, therefore, focused on their life satisfaction and the role of personality, work-related aspects, and emotional distress related to type of medical center and gender.

PROCEDURE

This descriptive study was based on a cross-sectional mail survey with questionnaires involving 90 pediatric oncologists. Using hierarchical regression models, their total, present, past, and future life satisfaction was analyzed.

RESULTS

The vast majority (76.7%) stated that working in this medical field was very stimulating for their personal development. Male pediatricians were more satisfied with their present lives and physicians working at academic medical centers were more confident about the future. Some oncologists (13.4%), in particular females at non-academic medical centers, needed professional help dealing with work-related psychological problems. Personality trait (Hedonic Capacity) and low levels of depression contributed to every aspect of overall life satisfaction. Work-related aspects influenced present and future life satisfaction. The models explained between 5% and 43% of the variance in life satisfaction in the whole group.

CONCLUSIONS

Pediatric oncologists face life-threatening conditions and psychosocial issues factors that may negatively influence their life satisfaction. This study group, a single population of physicians, is characterized by an optimistic attitude and stable emotional status pointing to a high level of satisfaction, which is probably a main basic condition when meeting seriously ill children.

Physician wellness: a missing quality indicator

When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

Job satisfaction among hospital doctors in Norway and Germany. A comparative study on national samples

Aims: To compare German and Norwegian hospital doctors on 10 different aspects of job satisfaction and general life satisfaction. Methods: The study population consisted of a representative sample of 1,448 German and 484 Norwegian hospital doctors aged 33—65 years (n = 1,932), selected from nationwide postal surveys in 2006. The questionnaires contained items on subjective life satisfaction and the validated 10-item Job Satisfaction Scale. Each item was scored on a seven-point Likert scale from 1 (very dissatisfied) to 7 (very satisfied). A mean sum score was calculated, ranging from 1 to 7. Regression analyses and generalized-linear-model-estimated means controlled for age and gender with 95% confidence intervals were used for comparison. Results: Norwegian hospital doctors had significantly higher life satisfaction (mean 5.31 vs. 5.15) and job satisfaction (mean 5.09 vs. 4.55) than their German colleagues. Item by item, doctors in Norway were significantly more content with seven aspects of their work: ``Freedom to choose your own methods of working'' (mean 5.00 vs. 4.72), ``opportunities to use your skills'' (mean 5.49 vs. 5.01), ``physical working conditions'' (mean 4.62 vs. 4.08), ``recognition you get for good achievements'' (mean 4.83 vs. 4.26), ``overall job situation'' (mean 5.57 vs. 4.64), ``work hours'' (mean 4.39 vs. 3.39), ``rate of pay'' (mean 4.70 vs. 3.70). General life satisfaction and age, but not gender, were positively associated with job satisfaction in both countries. Conclusions: Norwegian hospital doctors enjoy a higher level of life and job satisfaction than German hospital doctors. The most likely reasons for this are more acceptable work hours, salary and control over clinical work in Norway.