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Fujikawa H, Aoki T, Ando T, Haruta J. Associations of clinical context-specific ambiguity tolerance with burnout and work engagement among Japanese physicians: a nationwide cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:660. [PMID: 38877544 PMCID: PMC11179221 DOI: 10.1186/s12909-024-05644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Ambiguity tolerance specific to the clinical context - in contrast to ambiguity tolerance as a personality trait - may vary with experience and has received considerable attention. Although this tolerance appears to be related to burnout and work engagement, few studies have examined this association among physicians. Thus, we aimed to examine the relationships between clinical context-specific ambiguity tolerance, burnout, and work engagement among physicians in Japan. METHODS We conducted a nationwide cross-sectional study in Japan. We invited family physicians from 14 family medicine residency programs and physicians with specialties other than family medicine from monitors of an Internet survey company to participate in the study. We measured ambiguity tolerance in the clinical context using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors (J-TAMSAD) scale, burnout using the Japanese version of the Burnout Assessment Scale (BAT-J), and work engagement using the Utrecht Work Engagement Scale (UWES). We performed a multivariable linear regression analysis to determine whether the J-TAMSAD scale score was associated with the BAT-J and UWES scores. RESULTS 383 respondents were included in the analysis. After adjustment for possible confounders, clinical context-specific ambiguity tolerance showed a dose-dependent negative association with burnout (adjusted mean difference -0.39, 95% confidence interval (CI) -0.56 to -0.22 for the highest J-TAMSAD score quartile compared with the lowest). Ambiguity tolerance in the clinical context also showed a dose-dependent positive association with work engagement (adjusted mean difference 0.83, 95% CI 0.49 to 1.16 for the highest J-TAMSAD score quartile compared with the lowest). CONCLUSIONS Our study showed that tolerance for ambiguity in the clinical context was negatively associated with burnout, and positively associated with work engagement. These findings will be useful in developing interventions aimed at preventing burnout and promoting work engagement among physicians.
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Affiliation(s)
- Hirohisa Fujikawa
- Center for General Medicine Education, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Takuya Aoki
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Takayuki Ando
- Center for General Medicine Education, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junji Haruta
- Center for General Medicine Education, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Medical Education Center, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
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Pope BA, Carney PA, Brooks MC, Rice DR, Albright AA, Halvorson SAC. Resident Assessment of Clinician Educators According to Core ACGME Competencies. J Gen Intern Med 2024; 39:377-384. [PMID: 38052735 PMCID: PMC10897103 DOI: 10.1007/s11606-023-08496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/16/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) requires faculty to pursue annual development to enhance their teaching skills. Few studies exist on how to identify and improve the quality of teaching provided by faculty educators. Understanding the correlation between numeric scores assigned to faculty educators and their tangible, practical teaching skills would be beneficial. OBJECTIVE This study aimed to identify and describe qualities that differentiate numerically highly rated and low-rated physician educators. DESIGN This observational mixed-methods study evaluated attending physician educators between July 1, 2015, and June 30, 2021. Quantitative analysis involved descriptive statistics, normalization of scores, and stratification of faculty into tertiles based on a summary score. We compared the highest and lowest tertiles during qualitative analyses of residents' comments. PARTICIPANTS Twenty-five attending physicians and 111 residents in an internal medicine residency program. MAIN MEASURES Resident evaluations of faculty educators, including 724 individual assessments of faculty educators on 15 variables related to the ACGME core competencies. KEY RESULTS Quantitative analyses revealed variation in attending physician educators' performance across the ACGME core competencies. The highest-rated teaching qualities were interpersonal and communication skills, medical knowledge, and professionalism, while the lowest-rated teaching quality was systems-based practice. Qualitative analyses identified themes distinguishing high-quality from low-quality attending physician educators, such as balancing autonomy and supervision, role modeling, engagement, availability, compassion, and excellent teaching. CONCLUSIONS This study provides insights into areas where attending physicians' educational strategies can be improved, emphasizing the importance of role modeling and effective communication. Ongoing efforts are needed to enhance the quality of faculty educators and resident education in internal medicine residency programs.
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Affiliation(s)
- Bailey A Pope
- Division of Hospital Medicine, Oregon Health & Science University, School of Medicine, Portland, OR, USA.
- Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Patricia A Carney
- Department of Family Medicine, School of Medicine, Portland, OR, USA
| | - Mary C Brooks
- Division of Hospital Medicine, Oregon Health & Science University, School of Medicine, Portland, OR, USA
| | - Doug R Rice
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ashly A Albright
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Stephanie A C Halvorson
- Division of Hospital Medicine, Oregon Health & Science University, School of Medicine, Portland, OR, USA
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Begin AS, Hidrue M, Lehrhoff S, Del Carmen MG, Armstrong K, Wasfy JH. Factors Associated with Physician Tolerance of Uncertainty: an Observational Study. J Gen Intern Med 2022; 37:1415-1421. [PMID: 33904030 PMCID: PMC8074695 DOI: 10.1007/s11606-021-06776-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Physicians need to learn and work amidst a plethora of uncertainties, which may drive burnout. Understanding differences in tolerance of uncertainty is an important research area. OBJECTIVE To examine factors associated with tolerance of uncertainty, including well-being metrics such as burnout. DESIGN Online confidential survey. SETTING The Massachusetts General Physicians Organization (MGPO). PARTICIPANTS All 2172 clinically active faculty in the MGPO. MAIN MEASURES We examined associations for tolerance of uncertainty with demographic information, personal and professional characteristics, and physician well-being metrics. KEY RESULTS Two thousand twenty (93%) physicians responded. Multivariable analyses identified significant associations of lower tolerance of uncertainty with female gender (OR, 1.23; 95% CI, 1.03-1.48); primary care practice (OR, 1.56; 95% CI, 1.22-2.00); years since training (OR, 0.99; 95% CI, 0.98-0.995); and lacking a trusted advisor (OR, 1.25; 95% CI, 1.03-1.53). Adjusting for demographic and professional characteristics, physicians with low tolerance of uncertainty had higher likelihood of being burned-out (OR, 3.06; 95% CI, 2.41-3.88), were less likely to be satisfied with career (OR, 0.37; 95% CI, 0.26-0.52), and less likely to be engaged at work (RR, 0.87; 95% CI, 0.84-0.90). CONCLUSION At a time when concern about physician well-being is high, with much speculation about causes of burnout, we found a strong relationship between tolerance of uncertainty and physician well-being, across specialties. Particular attention likely needs to be paid to those with less experience, those in specialties with high rates of undifferentiated illness and uncertainty, such as primary care, and ensuring all physicians have access to a trusted advisor. These results generate the potential hypothesis that efforts focused in understanding and embracing uncertainty could be potentially effective for reducing burnout. This concept should be tested in prospective trials.
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Affiliation(s)
- Arabella Simpkin Begin
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Pharmacology, University of Oxford, Oxford, UK.
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Michael Hidrue
- Massachusetts General Physicians Organization, Boston, USA
| | - Sara Lehrhoff
- Massachusetts General Physicians Organization, Boston, USA
| | - Marcela G Del Carmen
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Physicians Organization, Boston, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jason H Wasfy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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McKinley T. Toward Useful Interventions for Burnout in Academic Medical Faculty: The Case for Unit-Specific Approaches. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:e69-e74. [PMID: 34609350 DOI: 10.1097/ceh.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Despite a plethora of research on the topic of physician burnout, drivers and interventions are poorly understood. This study aimed to create a holistic picture of burnout drivers in academic medical faculty within a single department of a large, research university to better inform organization-sponsored interventions. METHODS The author used interpretive phenomenological analysis and the Job Demands-Resources model in this qualitative study. Full-time academic medical faculty completed two semistructured interviews approximately 6 months apart. Transcripts were coded using deductive and inductive coding. RESULTS Twenty-two faculty members participated in both interviews. Factors affecting burnout depended on individual and unit-level context, but interpersonal factors such as relationships with colleagues and interaction with learners created meaning for faculty or drove intention to leave the university. All participants reported personal coping mechanisms, and none participated in organization-sponsored, individual-level interventions. DISCUSSION In striving for meaningful burnout interventions, organizations should promote interpersonal factors (relationships with colleagues and meaningful interaction with learners) and provide protected time for faculty for their own personal coping. Research has suggested moving toward a universal burnout driver and intervention plan, but these data point toward the need for unit-specific study and interventions.
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Affiliation(s)
- Tara McKinley
- Dr. McKinley: LEAD, College of Education and Human Development, Louisville, KY
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The influence of job crafting on the quality of care provided by nursing home employees: The moderating effect of organizational identification. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractOur goal was to analyze the positive effect of job crafting activities involving nursing home employees on their perceived quality of care, and the moderating effect of organizational identification. A two-wave non-experimental design (with an interval of 12 months) was used. The Job Crafting Questionnaire, the Identification-Commitment Inventory, and the Quality of Care Questionnaire (QoC) were administered to 226 nursing home employees in two waves. The results of the hierarchical regression analyses found significant association between job crafting subdimensions and quality of care twelve months later. Organizational identification was shown to play a moderating role in these relationships when analyzing the effect of cognitive crafting. In this sense, the effect of cognitive crafting on quality of care is only found with high levels of identification. The findings highlight the importance of the job crafting dimensions (task, relational and cognitive) when it comes to enhancing quality of care in residential homes for the elderly. This is especially relevant for cognitive crafting among employees with high levels of organizational identification. This research provides managers with guidance when allocating job crafting opportunities aimed at making improvements in quality of care. In this respect, organizations must offer job crafting training to stimulate and support their employees and, on the other hand, managers should encourage employees to craft their jobs, gearing their needs, abilities, and goals to corporate values and competencies.
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Roussel D, Gordon PR, Wagner JM, Bardack M, Sardesai MG, Colbert-Getz JM. The learning community faculty experience: how longitudinal relationships with learners enhance work meaning. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:343-349. [PMID: 32820415 PMCID: PMC7718352 DOI: 10.1007/s40037-020-00614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Work meaning has gained attention as an important contributor to physician job engagement and well-being but little is known about how faculty participation in medical school learning communities might influence this phenomena. Our study goals were to determine how physician faculty members may derive meaning from serving as mentors for longitudinal learning communities of medical students, to understand how that meaning may impact other areas of their work, and relate our findings to existing literature and theoretical frameworks. METHODS The research team conducted, recorded, transcribed, and coded 25 semi-structured telephone interviews of faculty mentors from four US medical schools with curricular learning communities. The team used an iterative interview coding process to generate final themes and relate these themes to existing literature. RESULTS The authors identified five themes of meaning faculty derive from participation as learning community mentors: "I am a better professional," "I am more connected," "I am rejuvenated," "I am contributing," and "I am honored." A sixth theme, "I am harmed," encompassed the negative aspects of the learning community faculty experience. The authors found that their identified themes related closely to the theoretical framework for pathways to meaningful work proposed by Rosso et al. DISCUSSION The alignment of the themes we identified on the experience of learning community faculty to existing literature on work meaning corroborates the theoretical framework and deepens understanding of beneficial and harmful learning community effects on faculty. As learning communities become increasingly common within medical schools, this understanding may be important for leaders in academic medicine considering potential indirect benefits of this educational model.
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Affiliation(s)
- Danielle Roussel
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Paul R Gordon
- Department of Family & Community Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - James M Wagner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michelle Bardack
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Maya G Sardesai
- Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Jorie M Colbert-Getz
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Klee D, Hirko K. Outdoor walking rounds: combining resident education and wellness. CLINICAL TEACHER 2020; 18:51-54. [PMID: 32856400 DOI: 10.1111/tct.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is challenging to achieve quality teaching on a busy resident service. Teams must balance the competing drivers of patient care, clinical efficiency, patient satisfaction and resident learning. Our novel outdoor walking rounds improve both the quality of resident instruction and their physician wellness without negatively affecting patient care. METHODS Our team meets outside for attending rounds on the sidewalks or hiking trails near our hospital. The residents present their clinical plans as we walk. We are able to achieve more in-depth clinical discussions and teaching than with traditional rounds conducted inside. Residents were surveyed to compare their experiences with traditional rounds. RESULTS Twenty-seven residents were surveyed over 5 years (29.6% were first-year residents, 33.3% were second-year residents and 37.0% were third-year residents): 81% of residents indicated that walking rounds improved the time dedicated to teaching; 100% of residents believed that the quality of teaching had improved; 70% of residents indicated that walking rounds improved their sense of physician wellness; and 59% of residents identified that walking rounds were as efficient, or more efficient, than traditional rounds. DISCUSSION Striving to provide in-depth resident clinical teaching without negatively affecting the quality and efficiency of patient care is a tall order. Outdoor walking rounds are a teaching method that combines dedicated non-distracted time for resident teaching with exercise. Our study indicates that this teaching method improves the quantity and quality of dedicated teaching time, improves resident physician wellness and does so in an innovative way that maintains efficient patient care.
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Affiliation(s)
- David Klee
- Munson Family Medicine Residency, Traverse City, Michigan, USA.,Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kelly Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine Michigan State University East Lansing Michigan USA
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Scher E, Whitehouse S, Van Harn M, Bollinger J, Stevens B, Macki K, Saoud D, Baker-Genaw K. Does physician engagement affect satisfaction of patients or resident physicians? J Healthc Leadersh 2019; 11:75-80. [PMID: 31354375 PMCID: PMC6572657 DOI: 10.2147/jhl.s201060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose: This study examined whether change in physician engagement affected outpatient or resident physician satisfaction using common US measures. Methods: Surveys were administered by Advisory Board Survey Solutions for staff physician engagement, Press Ganey for Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) for outpatient satisfaction, and Accreditation Council for Graduate Medical Education (ACGME) for the ACGME Resident/Fellow Survey. Survey sample sizes were 685, 697, and 763 for physician engagement and 621, 625, and 618 for resident satisfaction in 2014–2016, respectively; only respondents were available for CGCAHPS (24,302, 34,328, and 43,100 for 2014–2016, respectively). Two groups were analyzed across 3 years: (1) percentage of “engaged” staff physicians versus percentage of outpatient top box scores for physician communication, and (2) percentage of “engaged” staff physicians versus percentage of residents “positive” on program evaluation. For resident evaluation of faculty, the number of programs that met/exceeded ACGME national compliance scores were compared. Univariate chi-squared tests compared data between 2014, 2015, and 2016. Results: For 2014–2016, “engaged” physicians increased from 34% (169/497) to 44% (227/515) to 48% (260/542) (P<0.001) whereas CGCAHPS top box scores for physician communication remained unchanged at 90.9% (22,091/24,302), 90.8% (31,088/34,328), and 90.9% (39,178/43,100) (P=0.869). For the second group, “engaged” physicians increased from 33% (204/617) to 46% (318/692) to 50% (351/701) (P<0.001) and residents “positive” on program evaluation increased from 86% (534/618) in 2014 to 89% (556/624) in 2015 and 89% (550/615) in 2016 (P=0.174). The number of specialties that met/exceeded national compliance for all five faculty evaluation items grew from 44% (11/25) in 2014 to 68% (17/25) in 2015 and 64% (16/25) in 2016 (P=0.182). Conclusion: For our medical group, improvement in physician engagement across time did not coincide with meaningful change in the outpatient experience with physician communication or resident satisfaction with program and faculty.
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Affiliation(s)
- Eric Scher
- Department of Medical Education, Henry Ford Health System, Detroit, MI, USA.,Department of Medicine, Henry Ford Medical Group, Detroit, USA
| | - Sarah Whitehouse
- Department of Medical Education, Henry Ford Health System, Detroit, MI, USA
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, USA
| | - John Bollinger
- Care Experience Department, Henry Ford Health System, Detroit, USA
| | - Bret Stevens
- Department of Medical Education, Henry Ford Health System, Detroit, MI, USA
| | - Kathy Macki
- Human Resources, Henry Ford Health System, Detroit, USA
| | - Deborah Saoud
- Human Resources, Henry Ford Health System, Detroit, USA
| | - Kimberly Baker-Genaw
- Department of Medical Education, Henry Ford Health System, Detroit, MI, USA.,Department of Medicine, Henry Ford Medical Group, Detroit, USA
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Lases LSS, Arah OA, Busch ORC, Heineman MJ, Lombarts KMJMH. Learning climate positively influences residents' work-related well-being. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:317-330. [PMID: 30519786 PMCID: PMC6483960 DOI: 10.1007/s10459-018-9868-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
An optimal learning climate is crucial for the quality of residency training and may also improve residents' well-being and empathy. We investigated the associations of learning climate with residents' work-related well-being. A multicenter questionnaire study was performed among 271 surgery and gynaecology residents in 21 training programs from September 2012 to February 2013. Residents were asked to complete work-related well-being measurements: work engagement (Utrecht Work Engagement Scale), job and specialty satisfaction (measures from Physician Worklife Study), and physician empathy (Jefferson Scale of Physician Empathy). The Dutch Residency Educational Climate Test was used to evaluate learning climate. Multivariate adjusted linear regression analyses were used to estimate associations of learning climate with work-related well-being measures. Well-being measures were completed by 144 residents (53.1%). Learning climate was evaluated by 193 residents, yielding 9.2 evaluations per training program on average. Overall learning climate score was positively associated with work engagement [regression coefficient b = 0.58; 95% confidence interval (CI) 0.18-0.98; p = 0.004] and job satisfaction (b = 0.80; 95% CI 0.48-1.13; p < 0.001). No associations were found between learning climate and empathy and specialty satisfaction. Residents' work engagement and job satisfaction are positively related to the learning climate and may be further enhanced by improved learning climates of training programs.
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Affiliation(s)
- Lenny S S Lases
- Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Surgery, Isala, Zwolle, The Netherlands.
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Olivier R C Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maas Jan Heineman
- Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Dominguez LC, Dolmans D, de Grave W, Sanabria A, Stassen LP. Job Crafting to Persist in Surgical Training: A Qualitative Study From the Resident's Perspective. J Surg Res 2019; 239:180-190. [PMID: 30844632 DOI: 10.1016/j.jss.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/30/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Attrition in surgical training, a result of poor well-being at work, continues to rise. Work engagement and persistence, the other side of the coin, depend on the proactivity of residents to optimize the demands and resources in the workplace to achieve a better fit with the environment. This type of proactivity refers to job-crafting. In this study, we sought to explore the specific mechanisms underlying residents' job-crafting to enhance work engagement and persistence, as well as the role of supervisors in this endeavor. MATERIALS AND METHODS We used a constructivist-grounded theory design. We conducted semistructured interviews of active residents. During the analysis of verbatim protocols, we developed codes and categories and identified the main themes (job-crafting mechanisms) related to work engagement and persistence. We anticipated procedures to engage in reflexivity. RESULTS The residents showed six job-crafting mechanisms (build trust with supervisors, manage proactively, seek help, see errors and frustrations as learning opportunities, find a suitable work-life balance, and seek challenges actively). The supervisors contributed to residents' job-crafting with four mechanisms (earning the trust of the residents, providing guidance and support, allowing residents to fulfill tasks befitting a surgeon in training, and offering increasingly challenging tasks to residents). CONCLUSIONS Work engagement and persistence in training are active processes that depend on the ability of residents to take advantage of resources and challenges and to diminish hindering demands at the workplace. Future research should focus on the perspectives of the supervisor, as well as on the effectiveness of job-crafting interventions, to enhance work engagement.
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Affiliation(s)
| | - Diana Dolmans
- Department of Educational Development and Research, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Willem de Grave
- Department of Educational Development and Research, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, Universidad de la Sabana, Chía, Colombia
| | - Laurents P Stassen
- Department of Surgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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van den Berg JW, Verberg CPM, Scherpbier AJJA, Jaarsma ADC, Arah OA, Lombarts KMJMH. Faculty's work engagement in patient care: impact on job crafting of the teacher tasks. BMC MEDICAL EDUCATION 2018; 18:312. [PMID: 30567540 PMCID: PMC6300023 DOI: 10.1186/s12909-018-1411-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND High levels of work engagement protect against burnout. This can be supported through the work environment and by faculty themselves when they try to improve their work environment. As a result, they can become more engaged and better performers. We studied the relationship between adaptations by physicians to improve their teaching work environment, known as job crafting, and their energy levels, or work engagement, in their work as care provider and teacher. Job crafting encompasses seeking social (i) and structural (ii) resources and challenges (iii) and avoiding hindrances (iv). METHODS We established a cross-sectional questionnaire survey in a cohort of physicians participating in classroom and clinical teaching. Job crafting and work engagement were measured separately for physicians' clinical and teaching activities. We analyzed our data using structural equation modelling controlling for age, gender, perceived levels of autonomy and participation in decision making. RESULTS 383 physicians were included. Physicians' work engagement for patient care was negatively associated with two job crafting behaviors in the teaching roles: seeking structural resources (classroom teaching: ß = - 0.220 [95% CI: -0.319 to - 0.129]; clinical teaching: ß = - 0.148 [95% CI: -0.255 to - 0.042]); seeking challenges (classroom teaching: ß = - 0.215 [95% CI: -0.317 to - 0.113]; clinical teaching:, ß = - 0.190 [95% CI: -0.319 to - 0.061]). Seeking social resources and avoiding hindrances were unaffected by physicians' work engagement for patient care. CONCLUSIONS High engagement for teaching leads to job crafting in teaching. High engagement for patient care does not lead to job crafting in teaching.
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Affiliation(s)
- Joost W. van den Berg
- Professional Performance research group, Department of Medical Psychology, Academic Medical Center (AMC-UvA), Meibergdreef 15, 1105AZ Amsterdam, the Netherlands
| | | | | | - A. Debbie C. Jaarsma
- Center for Research & Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Onyebuchi A. Arah
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California USA
| | - Kiki M. J. M. H. Lombarts
- Professional Performance research group, Department of Medical Psychology, Academic Medical Center (AMC-UvA), Meibergdreef 15, 1105AZ Amsterdam, the Netherlands
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Bakke KE, Miranda SP, Castillo-Angeles M, Cauley CE, Lilley EJ, Bernacki R, Bader AM, Urman RD, Cooper Z. Training Surgeons and Anesthesiologists to Facilitate End-of-Life Conversations With Patients and Families: A Systematic Review of Existing Educational Models. JOURNAL OF SURGICAL EDUCATION 2018; 75:702-721. [PMID: 28939306 DOI: 10.1016/j.jsurg.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/17/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Despite caring for patients near the end-of-life (EOL), surgeons and anesthesiologists report low confidence in their ability to facilitate EOL conversations. This discrepancy exists despite competency requirements and professional medical society recommendations. The objective of this systematic review is to identify articles describing EOL communication training available to surgeons and anesthesiologists, and to assess their methodological rigor to inform future curricular design and evaluation. METHODS This PRISMA-concordant systematic review identified English-language articles from PubMed, EMBASE, and manual review. Eligible articles included viewpoint pieces, and observational, qualitative, or case studies that featured an educational intervention for surgeons or anesthesiologists on EOL communication skills. Data on the study objective, setting, design, participants, intervention, and results were extracted and analyzed. The Newcastle-Ottawa Scale was used to assess methodological quality. RESULTS Database and manual search returned 2710 articles. A total of 2268 studies were screened by title and abstract, 46 reviewed in full-text, and 16 included in the final analysis. Fifteen studies were conducted exclusively in academic hospitals. Two studies included attending surgeons as participants; all others featured residents, fellows, or a mix thereof. Fifteen studies used simulated role-playing to teach and assess EOL communication skills. Measured outcomes included knowledge, attitudes, confidence, self-rated or observer-rated communication skills, and curriculum feedback; significance of results varied widely. Most studies lacked adequate methodological quality and appropriate control groups to be confident about the significance and applicability of their results. CONCLUSIONS There are few quality studies evaluating EOL communication training for surgeons and anesthesiologists. These programs frequently use role-playing to teach and assess EOL communication skills. More studies are needed to evaluate the effect of these interventions on patient outcomes. However, evaluating the effectiveness of these initiatives poses methodological challenges.
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Affiliation(s)
- Katherine E Bakke
- Department of Surgery, University of Massachusetts Medical School, Massachusetts, USA
| | - Stephen P Miranda
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth J Lilley
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rachelle Bernacki
- Department of Palliative Care and Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Angela M Bader
- Department of Surgery, University of Massachusetts Medical School, Massachusetts, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Center for Perioperative Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Scheepers RA. Physicians' professional performance: an occupational health psychology perspective. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:425-428. [PMID: 29064072 PMCID: PMC5732105 DOI: 10.1007/s40037-017-0382-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be facilitated by work engagement and how work engagement is facilitated by job resources and personality traits. METHODS First, we conducted a systematic review on the impact of physician work engagement and related constructs (e. g. job satisfaction) on physicians' performance in patient care. We additionally investigated physician work engagement and job resources in relation to patient care experience with physicians' performance at ten outpatient clinics covering two hospitals. In a following multicentre survey involving 61 residency training programs of 18 hospitals, we studied associations between physician work engagement and personality traits with resident evaluations of physicians' teaching performance. RESULTS The findings showed that physician work engagement was associated with fewer reported medical errors and that job satisfaction was associated with better communication and patient satisfaction. Autonomy and learning opportunities were positively associated with physician work engagement. Work engagement was positively associated with teaching performance. In addition, physician work engagement was most likely supported by personality trait conscientiousness (e. g. responsibility). CONCLUSION Given the reported associations of physician work engagement with aspects of their professional performance, hospitals could support physician work engagement in service of optimal performance in residency training and patient care. This could be facilitated by worker health surveillance, peer support or promoting job crafting at the individual or team level.
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Affiliation(s)
- Renée A Scheepers
- Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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van den Berg JW, Mastenbroek NJJM, Scheepers RA, Jaarsma ADC. Work engagement in health professions education . MEDICAL TEACHER 2017; 39:1110-1118. [PMID: 28830279 DOI: 10.1080/0142159x.2017.1359522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Work engagement deserves more attention in health professions education because of its positive relations with personal well-being and performance at work. For health professions education, these outcomes have been studied on various levels. Consider engaged clinical teachers, who are seen as better clinical teachers; consider engaged residents, who report committing fewer medical errors than less engaged peers. Many topics in health professions education can benefit from explicitly including work engagement as an intended outcome such as faculty development programs, feedback provision and teacher recognition. In addition, interventions aimed at strengthening resources could provide teachers with a solid foundation for well-being and performance in all their work roles. Work engagement is conceptually linked to burnout. An important model that underlies both burnout and work engagement literature is the job demands-resources (JD-R) model. This model can be used to describe relationships between work characteristics, personal characteristics and well-being and performance at work. We explain how using this model helps identifying aspects of teaching that foster well-being and how it paves the way for interventions which aim to increase teacher's well-being and performance.
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Affiliation(s)
- Joost W van den Berg
- a Institute of Education and Training, Professional Performance Research Group , Academic Medical Center (AMC-UvA) , Amsterdam , The Netherlands
| | | | - Renée A Scheepers
- a Institute of Education and Training, Professional Performance Research Group , Academic Medical Center (AMC-UvA) , Amsterdam , The Netherlands
| | - A Debbie C Jaarsma
- c Center for Education Development and Research in Health Professions , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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15
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Scheepers RA, Lases LSS, Arah OA, Heineman MJ, Lombarts KMJMH. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1472-1479. [PMID: 28471782 DOI: 10.1097/acm.0000000000001719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. METHOD The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. RESULTS Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. CONCLUSIONS Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.
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Affiliation(s)
- Renée A Scheepers
- R.A. Scheepers is postdoctoral researcher, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. L.S.S. Lases is PhD candidate, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. O.A. Arah is professor, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, professor, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, and professor, UCLA Center for Health Policy Research, Los Angeles, California. M.J. Heineman is professor, Professional Performance Research Group, Center for Evidence-Based Education, and member, Board of Directors, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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16
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Scheepers RA, Arah OA, Heineman MJ, Lombarts KMJMH. How personality traits affect clinician-supervisors' work engagement and subsequently their teaching performance in residency training. MEDICAL TEACHER 2016; 38:1105-1111. [PMID: 27089424 DOI: 10.3109/0142159x.2016.1170774] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Clinician-supervisors often work simultaneously as doctors and teachers. Supervisors who are more engaged for their teacher work are evaluated as better supervisors. Work engagement is affected by the work environment, yet the role of supervisors' personality traits is unclear. This study examined (i) the impact of supervisors' personality traits on work engagement in their doctors' and teachers' roles and (ii) how work engagement in both roles affects their teaching performance. METHODS Residents evaluated supervisors' teaching performance, using the validated System for Evaluation of Teaching Qualities. Supervisors' reported work engagement in doctor and teacher roles separately using the validated Utrecht Work Engagement Scale. Supervisors' personality traits were measured using the Big Five Inventory's five factor model covering conscientiousness, agreeableness, extraversion, emotional stability and openness. RESULTS Overall, 549 (68%) residents and 636 (78%) supervisors participated. Conscientiousness, extraversion and agreeableness were positively associated with supervisors' engagement in their teacher work, which was subsequently positively associated with teaching performance. CONCLUSIONS Conscientious, extraverted, and agreeable supervisors showed more engagement with their teacher work, which made them more likely to deliver adequate residency training. In addition to optimizing the work environment, faculty development and career planning could be tailor-made to fit supervisors' personality traits.
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Affiliation(s)
- Renée A Scheepers
- a Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Onyebuchi A Arah
- a Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
- b Department of Epidemiology, The Fielding School of Public Health , University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
- c UCLA Center for Health Policy Research , Los Angeles , CA , USA
| | - Maas Jan Heineman
- a Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
- d Member of the Board of Directors, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Kiki M J M H Lombarts
- a Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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17
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van den Berg JW, Verberg CPM, Berkhout JJ, Lombarts MJMH, Scherpbier AJJA, Jaarsma ADC. A qualitative interview study on the positive well-being of medical school faculty in their teaching role: job demands, job resources and role interaction. BMC Res Notes 2015; 8:401. [PMID: 26329102 PMCID: PMC4556414 DOI: 10.1186/s13104-015-1393-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention for the well-being of medical school faculty is not only important for the prevention of attrition and burnout, but may also boost performance in their tasks in medical education. Positive well-being can be conceptualized as work engagement and this is associated with increased performance. In this study we explore how demands and resources from different tasks affect work engagement specifically for education. METHODS Between June and September 2013, we conducted a multisite semi-structured interview study with a diverse group of medical school faculty and used an open-coding strategy within the Work Engagement Model on the transcribed interviews. RESULTS We interviewed 16 faculty members whose teaching experience ranged from 7 to 38 years and whose professional tasks ranged from being solely an educator to being a physician, researcher, educator and administrator simultaneously. All participants were clear on the perceived demands and resources, although similar aspects of the work environment could be perceived oppositely between participants. Overarching themes were perceptions related to the organization or department, often described as a general and long-term effect and perceptions directly related to a task, often described as a direct and short-term effect on well-being. Furthermore, the demands and resources as resultant of fulfilling multiple tasks were described clearly by participants. CONCLUSIONS The ambiguous nature of the work environment in terms of demands and resources requires an individualized approach to supporting work engagement. Furthermore, faculty members perceive many resources from fulfilling multiple tasks in relation to their tasks in education. Faculty developers and administrators alike could use these findings to apply the concept of work engagement to their daily support of faculty in medical education.
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Affiliation(s)
- J W van den Berg
- Center for Evidence-Based Education, Academic Medical Center-University of Amsterdam, Meibergdreef 15, Room J1A-138, 1105 AZ, Amsterdam, The Netherlands.
| | - C P M Verberg
- Center for Evidence-Based Education, Academic Medical Center-University of Amsterdam, Meibergdreef 15, Room J1A-138, 1105 AZ, Amsterdam, The Netherlands.
| | - J J Berkhout
- Center for Evidence-Based Education, Academic Medical Center-University of Amsterdam, Meibergdreef 15, Room J1A-138, 1105 AZ, Amsterdam, The Netherlands.
| | - M J M H Lombarts
- Center for Evidence-Based Education, Academic Medical Center-University of Amsterdam, Meibergdreef 15, Room J1A-138, 1105 AZ, Amsterdam, The Netherlands.
| | - A J J A Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - A D C Jaarsma
- Center for Research and Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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