Work engagement in health professions education. Med Teach 2017;39:1110-1118. [PMID: 28830279 DOI: 10.1080/0142159x.2017.1359522]

The effect of interprofessional education on the work environment of health professionals: a scoping review

To explore the existing literature on the effect of Interprofessional Education (IPE) on the work environment of health professionals. The research question was systematized according to the PCC (Population, Concept, and Context) format. A scoping review was performed. A search of multiple bibliographic databases identified 407 papers, of which 21 met the inclusion criteria. The populations of the 21 studies reviewed were composed of professionals in the fields of medicine, nursing, psychology, occupational therapy, physiotherapy, and social work, among others. The study contexts were both academic and nonacademic hospitals, mental health institutions, and community settings, and the topics examined were organizational climate, organizational culture, organizational attachment and job satisfaction. The findings from the reviewed studies showed positive effects of IPE interventions on organizational climate and culture, but the results on job satisfaction and organizational attachment were mixed (i.e., positive and no effects following IPE interventions). Research on IPE is worth more attention as IPE could be an effective alternative for the fulfillment of the Quadruple Aim and achieving the third of the United Nations Sustainable Development Goals, aimed at improving health and well-being. It seems critical for IPE to be positioned as a trend in global health, aiming at boosting human health resources as one of its building blocks and calling the attention of health decision-makers.

Junior doctors receiving supervisor and peer support are more work-engaged professionals who express their voice for quality improvement

PURPOSE

In daily practice, junior doctors can contribute to quality improvement by providing innovative suggestions for change, referred to as voice behavior. Junior doctors are more likely to engage in voice behavior when they receive sufficient support from supervisors and peers. Such support has also been associated with less burnout and more work engagement. However, whether less burned-out and more work-engaged junior doctors demonstrate more voice behaviors in the face of sufficient supervisor and peer support is unclear. Therefore, we studied whether and how associations of supervisor and peer support with junior doctors' voice behaviors are mediated by burnout and work engagement.

MATERIALS & METHODS

Participants were 301 junior doctors that completed a web-based survey including validated questionnaires on supervisor and peer support, burnout, work engagement, and voice behavior.

RESULTS

Supervisor and peer support were associated with lower levels of burnout and higher levels of work engagement. Work engagement, but not burnout, mediated the associations of supervisor and peer support with voice behaviors.

CONCLUSIONS

Junior doctors who received more supervisor or peer support were more work-engaged and reported more voice behaviors. Thus, supervisor and peer support should be cultivated to facilitate junior doctors' roles as work-engaged professionals in quality improvement.

Factors influencing work engagement among male nurses: A structural equation model

AIM

To investigate the male nurses' engagement in nursing work and the influencing factors.

DESIGN

A cross-sectional study.

METHODS

A cross-sectional survey was conducted in 13 hospitals in China to collect data from 328 male nurses from August to October 2021. A structural equation model design was tested with validated measurement instruments.

RESULTS

The work engagement of male nurses in China was at a medium level. There was a high correlation of the male nurses' work engagement with career identity (r = 0.764, p < 0.01), career success (r = 0.735, p < 0.01) and social support (r = 0.477, p < 0.01). The linear multivariate regression analysis showed that career satisfaction (β = 0.393), career identity (β = 0.392) and subjective support (β = 0.116) entered regression equation of male nurses' work engagement (all p < 0.05). The structural equation model results showed that career identity and social support were the influencing factors of the male nurses' work engagement and the model explained variation of 66.4% variables.

CONCLUSION

To know the male nurses' work engagement and influencing factors in China has certain enlightening significance for male nurses themselves and nursing manager. On the one hand, it is necessary to enhance the male nurses' career recognition to nursing work. On the other hand, the society should provide more aid and support to the male nurses. Therefore, the male nurses could devote more into nursing work and promote the nursing development.

The effects of job characteristics on physicians' orientation toward lifelong learning

With the rapidly growing body of medical knowledge, physicians must engage in lifelong learning. Physicians' orientation toward lifelong learning is of crucial importance. This study aimed to explore the effects of job characteristics on physicians' lifelong learning. A multicenter study collecting data from physicians from three medical centers in Taiwan was performed. A total of 321 physicians were surveyed with the Chinese version of the Job Content Questionnaire (C-JCQ) and the revised Jefferson Scale of Physician Lifelong Learning (JeffSPLL) to assess their job characteristics (i.e., job demands, job control, social support) and orientation toward lifelong learning. Exploratory factor analysis was employed to validate both questionnaires. Hierarchical regression was utilized to explore the relationship of job characteristics and predictors with physicians' lifelong learning. The results revealed that job demands (β = 0.10), job control (β = 0.19), social support from supervisors (β = 0.16), the interaction of job demands × job control (β =  - 0.11) and the interaction of job demands × social support from colleagues (β = 0.13) were significantly (p < .05, p < .001) related to lifelong learning. Moreover, physicians in the active group (high demand, high control) possessed a stronger orientation toward lifelong learning (mean = 3.57) than those in the low-strain group (mean = 3.42), high-strain group (mean = 3.39) and passive group (mean = 3.20). In conclusion, examining physicians' job demands, job control and social support helps us to understand their orientation toward lifelong learning and may provide insight to improve educational strategies.

Student engagement in health professions education: AMEE Guide No. 152

This guide aims to support our colleagues to have comprehensive understanding of student engagement in health professions education. Despite the universal agreement about the significance of student engagement, there is lack of uniformity in conceptualizing and operationalizing this emerging construct. We review the theoretical basis explaining student engagement from three main perspectives: behavioral, psychological, and socio-cultural. In addition, we propose a contemporary and comprehensive framework for the student engagement in higher education, which is applicable to health professions education contexts. Drawing from this framework, we explain the conceptualization of the construct and its preceding factors, mediators, dimensions, spheres, and outcomes of student engagement. The proposed framework introduces student 'engagement through partnerships' as a novel component compared with the existing models of student engagement in higher education. This way, we are proposing a mixed model that not only considers the student as a 'customer' but also as a 'partner' in education. Engagement of students through partnerships include four areas: (1) provision of the education program, (2) scholarly research, (3) governance and quality assurance, and (4) community activities. This guide will provide practical applications on how to improve student engagement in health professions education. Finally, we highlight the current gaps in areas of research in the student engagement literature and suggested plans for future directions.[Box: see text].

Professional Identity Makes More Work Well-Being Among In-Service Teachers: Mediating Roles of Job Crafting and Work Engagement

Though the positive association between well-being and professional identity among employees is well-document, the internal mechanism underlying this association is known little. Guided by self-determination theory (SDT) and the job demands-resources (JD-R) model, this study examined the roles of job crafting and work engagement in mediating the association between professional identity and workplace well-being. We surveyed 2090 teachers (including Primary, Middle, and High School teachers) (M age = 39.42 years; SD = 8.72). Teachers completed a series of questionnaires, such as the Teachers' Professional Identity Scale, Employee's Workplace Well-being Scale, Job Crafting Scale, and Utrecht Work Engagement Scale. We controlled age, teaching age, and gender covariates to get conservative predictions. Multiple mediation analyses were utilized in this study to prove that: (a) professional identity was positively linked to workplace well-being; (b) both job crafting and work engagement take mediator roles in associating the relationships between professional identity and workplace well-being; and (c) a serial indirect pathway (professional identity → job crafting → work engagement → workplace well-being) emerged. These findings explore the factors that affect well-being and point to potential ways in enhancing teachers' workplace well-being even when the task is severe.

Supporting health professional educators in the workplace: A scoping review

PURPOSE

Clinical educators frequently request additional support for educating pre-qualification health professions students despite having access to professional development programs to build education knowledge and skills. The breadth of 'additional support' options remains unclear. The aim of this review is to explore what is known about support options for health professional educators in the workplace through the lens of learning organisations.

MATERIALS AND METHODS

A scoping review was conducted searching Ovid Medline, CINAHL, ProQuest and PsycINFO electronic databases from 1 January 2005 up to 21 October 2020 for studies that identified support strategies for clinical educators of pre-qualification students in the workplace. Relevant data were charted, summarised thematically and synthesised with reference to support type and implementation level.

RESULTS

Fifty relevant records related to medicine, nursing and allied health clinical education were included. Twelve support themes and five cross-cutting support categories were identified across four implementation levels of healthcare systems.

CONCLUSIONS

A diversity of support for clinical educators beyond professional development was identified. Future research combined with leadership and commitment from the healthcare and education sectors is needed to better understand the applicability, efficacy and resourcing of any newly integrated support to ensure it is sustainable and improves clinical educator capability.

Impact of faculty well-being on medical student education

Purpose

The prevalence of physician burnout has risen and negatively impacts patient care, healthcare costs, and physician health. Medical students are heavily influenced by the medical teams they rotate with on the wards. We postulate that faculty well-being influences student perception of clerkships.

Methods

Medical student evaluations core clerkships at one academic institution were compared with results of faculty well-being scores over 2 years (2018-2020). Linear mixed models were used to model each outcome adjusting for year, mean faculty distress score, and the standard deviation (SD) of WBI mean distress scores. Clerkships and students were treated as random effects.

Results

Two hundred and eighty Well-Being Index evaluations by faculty in 7 departments (5 with reportable means and standard deviations), and clerkship evaluations by 223 students were completed. Higher faculty distress scores were associated with lower student evaluation scores of the clerkship (- 0.18 per unit increase in distress, std. err = 0.05, p < 0.01). Increased SD (variability) of faculty distress was associated with higher student overall ratings (0.49 points per unit increase in variability, std. err = 0.11, p < 0.01), as was year with 2019-2020 having lower overall ratings (- 0.17, std. err = 0.06, p < 0.01). Findings were similar for ratings of faculty teaching: mean faculty distress (- 0.15, std. err = 0.25), SD faculty distress (0.33, std. err = 0.12), 2019-2020 vs. 2018-2019 (- 0.19, std. err = 0.06) (all p < 0.01).

Conclusions

Physician well-being is not only associated with quality of patient care and physician health, but also with medical student perceptions of clinical education. These findings provide yet another indirect benefit to improved physician well-being: enhanced undergraduate medical educational experience.

Organizational culture as a mediator of credible leadership influence on work engagement: empirical studies in private hospitals in East Java, Indonesia

The success of health services in hospitals depends on the work engagement of medical and non-medical personnel in providing quality services for patients. Engaged employees will be more proactive, take the initiative to collaborate with others, and are committed to achieving high-quality performance. A leader's ability in an organization is a major factor in building a work ethic in the organization, instilling values, norms, and ethics through organizational culture into employee work behavior, such as work engagement. Credibility leadership is the practice of leading an organization through a positive culture change. Credible leadership can increase work engagement through an organizational culture emphasized by education and organizational leaders. The study aimed to analyze the influence of leadership credibility and organizational culture on work engagement by sampling medical and non-medical personnel at two private hospitals in Madiun City. The hypothesis was tested using structural equation modeling (SEM) and path analysis. The results of hypothesis testing show that: (1) credible leadership has a significant positive influence on organizational culture; (2) organizational culture has a significant positive influence on work engagement; (3) organizational culture is the perfect mediator of credible leadership influences on work engagement. This study's results confirm that leaders' role in shaping a positive organizational culture through good credible leadership practices, while organizational culture can increase employee work engagement.

Work engagement and associated factors among dental nurses in China

BACKGROUND

Work engagement is affected by many factors. The level of work engagement among dental nurses is unknown.

METHODS

A cross-sectional questionnaire survey was conducted among 215 dental nurses. The Utrecht Work Engagement Scale, Chinese Nurse Stressors Scale, Work-related Acceptance and Action Questionnaire, Multi-dimensional Scale of Perceived Social Support, and General Well-Being Schedule were applied to measure Chinese nurses' work engagement, job stress, psychological flexibility, perceived social support and subjective well-being, respectively. Univariate analysis was used to identify the relationships of work engagement with demographic and psychological characteristics. Hierarchical linear regression analysis was applied to test the variance in work engagement accounted for by factors related to work engagement in the univariate analysis.

RESULTS

The level of work engagement among Chinese dental nurses was moderate or above. Work engagement was positively associated with perceived social support, psychological flexibility and subjective well-being but negatively correlated with job stress. The hierarchical regression analysis showed that age, job stress, psychological flexibility and subjective well-being were significantly correlated with work engagement, though perceived social support was not, all of those psychological variables together explained 34.7% of the variance in work engagement.

CONCLUSIONS

Dental nurses in China had an acceptable level of work engagement in terms of vigour, dedication and absorption. Increased job stress resulted in lower work engagement. Nurses who had higher levels of perceived social support, psychological flexibility and subjective well-being also had higher work engagement. It is necessary to understand the job stress of nurses, strengthen nurses' social support, relieve nurses' job stress, improve nurses' psychological flexibility and subjective well-being, which will improve nurses' work engagement levels.

Achieving Operational Excellence Through Artificial Intelligence: Driving Forces and Barriers

This paper presents an in-depth literature review on the driving forces and barriers for achieving operational excellence through artificial intelligence (AI). Artificial intelligence is a technological concept spanning operational management, philosophy, humanities, statistics, mathematics, computer sciences, and social sciences. AI refers to machines mimicking human behavior in terms of cognitive functions. The evolution of new technological procedures and advancements in producing intelligence for machines creates a positive impact on decisions, operations, strategies, and management incorporated in the production process of goods and services. Businesses develop various methods and solutions to extract meaningful information, such as big data, automatic production capabilities, and systematization for business improvement. The progress in organizational competitiveness is apparent through improvements in firm's decisions, resulting in increased operational efficiencies. Innovation with AI has enabled small businesses to reduce operating expenses and increase revenues. The focused literature review reveals the driving forces for achieving operational excellence through AI are improvement in computing abilities of machines, development of data-based AI, advancements in deep learning, cloud computing, data management, and integration of AI in operations. The barriers are mainly cultural constraints, fear of the unknown, lack of employee skills, and strategic planning for adopting AI. The current paper presents an analysis of articles focused on AI adoption in production and operations. We selected articles published between 2015 and 2020. Our study contributes to the literature reviews on operational excellence, artificial intelligence, driving forces for AI, and AI barriers in achieving operational excellence.

Early Education Care from Its Practitioners to Achieve Sustainability

(1) Background: Early intervention professionals are involved in the reconceptualisation of their service due to the exceptional situation caused by the COVID-19 epidemic, within the family context and aware of the children’s needs, with an impact on their emotional well-being to ensure sustainability. An analysis of their socio–emotional profile and training is increasingly needed to face their professional development effectively; (2) Methods: In this study, 209 early intervention professionals participated (n = 209), with an average age of 37.62 (±9.02). The following instruments were used: Satisfaction with Life Scale (SWLS), Wong Law Emotional Intelligence Scale (WLEIS-S) and the Utrecht Work Engagement Scale (UWES-9). The purpose of the study was to examine the relationship between early intervention (EI) and engagement as predictors of greater life satisfaction using Structural Equation Modelling (SEM). (3) Results: There exists a relationship between some dimensions of the instruments used (p < 0.01). The model obtained good structural validity (χ² = 3.264; Root Mean Square Error of Approximation (RMSEA) =.021; Goodness-of-Fit Index (GFI) = 0.991; Comparative Goodness of Fit Index (CFI) = 0.999; Incremental Fit Index (IFI) = 0.999). Subsequently, the results described above were verified through Bayesian statistics, thereby reinforcing the evidence provided; (4) Conclusions: Findings highlight the importance of providing professionals with emotional tools and strategies, from the educational context, in order to carry out their activity effectively and ensure the sustainability within the current situation, while remaining fully engaged.

[Relationship Between Stress Experience and Stress Behavior - Measured with the Differential Stress Inventory and Burnout Symptoms in the MBI]

OBJECTIVE

The aim of the study was to determine the relationship of the different DSI categories and stress types of stressor behaviour and experience on burnout in an occupational group.

METHODS

The Maslach Burnout Inventory (MBI) and the Differential Stress Inventory (DSI) were presented to 185 subjects. As a result, a classification into DSI types and the comparison of the MBI categories were performed.

RESULTS

Different types of stress behavior show differences in burnout dimensions. Four subjects (2.2 %) offered a high burnout. DSI type II is especially vulnerable to suffering from burnout symptoms.

CONCLUSION

Individuals with different degrees of stress triggers and manifestations as well as available coping strategies or risks of stress stabilization have different levels of MBI dimensions and thus different risks for burnout. Knowledge about the type of DSI could be included in the design of prevention interventions to reduce the risk of mental health impairment.

Effects of effort-reward imbalance, job satisfaction, and work engagement on self-rated health among healthcare workers

BACKGROUND

Healthcare workers, who protect and improve the health of individuals, are critical to the success of health systems and achieving national and global health goals. To respond effectively to the healthcare needs of populations, healthcare workers themselves must be in a good state of health. However, healthcare workers face various psychosocial pressures, including having to work night shifts, long working hours, demands of patient care, medical disputes, workplace violence, and emotional distress due to poor interactions with patients and colleagues, and poor promotion prospects. Constant exposure to these psychosocial hazards adversely impacts healthcare workers' health. Consequently, this study aimed to examine the influence of effort-reward imbalance, job satisfaction, and work engagement on self-rated health of healthcare workers. The results would be conducive to providing policy guidance to improve the health of healthcare workers.

METHODS

We analysed the data of 1327 participants from The Chinese Sixth National Health and Services Survey in Sichuan Province that was conducted from August 2018 to October 2018. Structural equation modelling was used to test the hypothesized relationships among the variables.

RESULTS

Only 40.1% of healthcare workers rated their health as 'relatively good' or 'good'. Effort-reward imbalance had a significant negative correlation with self-rated health (β = - 0.053, 95% CI [- 0.163, - 0.001]). The associations of effort-reward imbalance and work engagement with self-rated health were both mediated by job satisfaction (95% CI [- 0.150, - 0.050] and [0.011, 0.022]), and work engagement mediated the relationship between effort-reward imbalance and self-rated health (95% CI [- 0.064, - 0.008]).

CONCLUSION

In order to improve the health of healthcare workers, administrators should balance effort and reward and provide opportunities for career development and training. In addition, health managers should help healthcare workers realize the significance and value of their work and keep them actively devoted to their work through incentive mechanisms.

Burnout Syndrome in Paediatric Oncology Nurses: A Systematic Review and Meta-Analysis

Purpose: To determine levels of burnout among paediatric oncology nurses, and the risk factors that may influence its development. Method: A literature review with meta-analysis was conducted, via a search in the PubMed, CINHAL, Scopus, ProQuest (Health and Medical Complete), Scielo and PsycINFO databases, using the search equation: "Nurs* AND burnout AND oncology AND pediatric". Results: The final sample of selected studies was of eight articles. All were quantitative studies of paediatric oncology nurses, using the Maslach Burnout Inventory, written in English or Spanish. No search restrictions were established on the year of publication. The eight studies reported moderate-high levels of burnout in each of its three dimensions. These dimensions were all related to the characteristics of the profession, in terms of complexity, shifts and workload, and to sociodemographic variables such as marital status, work experience, age and gender. The prevalence meta-analytical estimation for a sample of n = 361 nurses were 37% for high emotional exhaustion, 16% for high depersonalisation and 27% for low personal fulfilment. Conclusions: Most paediatric oncology nurses present moderate-high levels of burnout. Therefore, strategies and interventions should be identified and implemented to protect these workers from the syndrome.

[The Role of Personal Resources in Coping]

BACKGROUND

Stress reactions can be a result of occupational and everyday stress, which are perceived individually. The insufficient compensation of stress can lead to various diseases. Personality traits play an important role in this. Stress reactions can lead to health problems and diseases. Therefore it is important to reduce stress. The aim of this study was to examine the role of personality traits in dealing with stress perception and coping.

MATERIAL AND METHOD

The questionnaire on Differential stress inventory (DSI) differentiated 217 subjects into 5 types of DSI. The survey compared these 5 types along their personality traits via the Freiburg Personality Inventory (FPI-R).

RESULTS

The DSI types showed significant differences in the expression of the personality traits. This applies the everyday stress, professional and private interactions with other people and the existential and future fears. People with pronounced physical disorders in the FPI showed physical and/or emotional-cognitive stress manifestation as well as a sense of helplessness. Life satisfaction is negatively related to stressors, for example through everyday life.

CONCLUSION

The survey revealed the importance of personality traits in coping with job strain. Occupational health diagnostics should be integrated in occupational health care and prevention. The occupational physician or the prevention team appear here to be significant, as they see workers falling through the classic family doctor model. In the prevention team, personality traits can be supplemented by psychologists. Personal resources can be imparted or reinforced to prevent physical disorders.

Work engagement in medical students: An exploratory analysis of the relationship between engagement, burnout, perceived stress, lifestyle factors, and medical student attitudes

There is a need to expand the current focus of burnout in medical trainees so that we can understand not only trainee distress but also trainee well-being. Work engagement as measured by the Utrecht Work Engagement Scale-15 (UWES-15) is a positive construct that is conceptually related to burnout and is a component of the Job Demands-Resources Model (JD-R). We sought to explore the relationship of work engagement to burnout, perceived stress, lifestyle factors, and medical student attitudes to testing whether work engagement could serve as a positive construct to study medical student well-being. We surveyed 287 1st and 2nd-year medical students at a large academic medical center in the United States. Our survey consisted of demographic measures, UWES-15, Burnout Measure short version, Perceived Stress Scale-4, lifestyle factors, and medical student attitudes. Statistical analysis revealed work engagement is negatively correlated with burnout and perceived stress. Work engagement and its subscales are correlated to exercise, sleep, drugs and alcohol use, maintaining relationships, and financial stress. Work engagement is negatively correlated with thoughts of dropping out and questioning the decision to enter medical school. Work engagement can be a useful measure to assess medical student well-being and identify areas for intervention.

Health science student teachers' perceptions of teacher competence: A qualitative study

BACKGROUND

Health science teacher competence is multifaceted and continuously changing according to national and international healthcare standards. Organizational restructuring and emphasis on cost effectiveness is changing the scope of health science teachers' practical work and their role in healthcare (worldwide).

AIM

This study aimed to describe student teachers' perceptions of the competencies needed to work as an educator in the healthcare field. Objective of study was to gain new knowledge which can be used in the development of teacher education programs in nursing science and to define a broader definition of the health science educators.

METHODS

A qualitative study was conducted. Data were collected from 23 Finnish students completing a master's degree in teaching in the healthcare context using focus group interviews. The data were analyzed by inductive content analysis.

RESULTS

The student teachers identified eight main categories of teacher competence: leadership and management competence; evidence-based practice competence; subject competence; ethical competence; pedagogical competence; collaboration competence; internationalization competence; and continuous professional development competence.

CONCLUSION

This study identified essential teacher competencies that can be evaluated among students to develop health science teacher curricula. The findings can be used in follow-up studies or comparative research to investigate competence differences between novice and experienced teachers.

Job Crafting to Persist in Surgical Training: A Qualitative Study From the Resident's Perspective

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.

Perceived job demands and resources of newly qualified midwives working in primary care settings in The Netherlands

OBJECTIVE

The objective of this study is to identify perceived job demands and job resources of newly qualified midwives (NQMs), working in primary midwifery care during their first years in practice.

DESIGN/SETTING

A qualitative study, with semi-structured group interviews was conducted. Midwives working less than three years in primary midwifery care in the Netherlands were invited to join a focus group interview.

MEASUREMENTS AND FINDINGS

Five focus group interviews were with 31 participants. Interviews were transcribed and analyzed. Data were analyzed thematically by using the different characteristics of the Job Demands Resources model. Working as a locum midwife is demanding for Dutch NQMs, due to a large number of working hours in different practices and a lack of job security. Decision-making and adapting to local guidelines and collaborations demand a high cognitive load. These aspects of the work context negatively impact NQMs' work and private life. Working with clients and working autonomously motivates the newly graduates. Support from colleagues and peers are important job resources, although colleagues are also experienced as a job demand, due to their role as employer. Strictness in boundaries, flexibility and sense of perspective are NQMs' personal resources. On the other hand, NQMs perceived perfectionism and the urge to prove oneself as personal demands.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Dutch NQMs' first years in primary midwifery care are perceived as highly demanding. In primary care, NQMs usually work as locum midwives, self-employed and in different practices. Working in different practices requires not only working with different client populations and autonomous decision-making, but also requires adaptation to different local working arrangements. Building adequate support systems might help NQMs finding a balance between work and private life by having experienced midwives available as mentors. Furthermore, training and coaching of NQMs help them to become aware of their personal resources and demands and to help them strengthen their personal resources. Improving NQMs' working position through secure employments require changes in the organization of maternity care in the Netherlands.

The role of feedback in ameliorating burnout

PURPOSE OF REVIEW

Assessment of the current literature surrounding interventions directed toward the prevention of burnout in the field of medicine and particularly in anesthesiology.

RECENT FINDINGS

Recently, burnout has been noted to lead to medication errors and subsequently increased harm to our patients. On a personal level, burnout can lead to depression and even suicide amongst physicians. Strategies to prevent burnout amongst anesthesiologists that have been studied in the literature include multisource feedback, mentorship and early recognition.

SUMMARY

There remains no clear or definitive intervention to prevent burnout for physicians. However, changing our environment to embrace mentorship, the continual exchange of feedback and the fostering self-care could startlingly improve our work environment.