What's up doc? Physicians' reflections on their sustainable employability throughout careers: a narrative inquiry

BACKGROUND

Physicians have complex and demanding jobs that may negatively affect their sustainable employability (SE) and quality of care. Despite its societal and occupational relevance, empirical research on physicians' SE is scarce. To further advance our understanding of physicians' SE, this study explores how physicians perceive their employment context to affect their SE, how physicians self-regulate with the intent to sustain their employability, and how self-regulations affect physicians' SE and their employment context.

METHODS

Twenty Dutch physicians from different specialisms were narratively interviewed between March and September 2021 by a researcher with a similar background (surgeon) to allow participants to speak in their own jargon. The interviews were analyzed collaboratively by the research team in accordance with theory-led thematic analysis.

RESULTS

According to the interviewees, group dynamics, whether positive or negative, and (mis)matches between personal professional standards and group norms on professionalism, affect their SE in the long run. Interviewees self-regulate with the intent to sustain their employability by (I) influencing work; (II) influencing themselves; and (III) influencing others. Interviewees also reflect on long-term, unintended, and dysfunctional consequences of their self-regulations.

CONCLUSIONS

We conclude that physicians' SE develops from the interplay between the employment context in which they function and their self-regulations intended to sustain employability. As self-regulations may unintentionally contribute to dysfunctional work practices in the employment context, there is a potential for a vicious cycle. Insights from this study can be used to understand and appraise how physicians self-regulate to face complex challenges at work and to prevent both dysfunctional work practices that incite self-regulation and dysfunctional consequences resulting from self-regulations.

Enlisting in the army in the Jewish Ultraorthodox community and the consequences for wellbeing

Israeli law requires citizens to enlist in the army at 18 years old. However, the Jewish Ultraorthodox community has a longstanding agreement with the state that members of this community will not have to enlist in the army, given its spiritual leaders' strong opposition. Still, there are young men who go against the communal norms and enlist. In the current study we investigated these young men and the contribution of their self-esteem (a personal resource), their sense of community (a communal resource), and the community members' attitudes toward them (societal conditional regard, both positive and negative, and stigma) to their wellbeing. The current study consisted of 153 participants between the ages of 20 and 55 (M = 29.64, SD = 6.89). A path analysis model indicated the protective role played by self-esteem and sense of community in participants' wellbeing, and the risk factor posed by societal conditional negative regard and stigma. Moreover, self-esteem was found to mediate between income and wellbeing, whereas sense of community was found to mediate between societal conditional negative regard and wellbeing, and between stigma and wellbeing. The discussion highlights the complexity of the protective role played by sense of community against the risk of experiencing societal conditional negative regard and stigma. It also addresses the importance of promoting intervention programs during the army service of these young men, with a focus on promoting their self-esteem and on the presence of a spiritual leadership that legitimizes working, serving in the army, and yet still being part of the community.

"They didn't have any idea what drugs were": Pathways to substance use disorders among ultraorthodox Jewish males

BACKGROUND

Substance use disorders (SUDs) are a worldwide phenomenon with very negative consequences, and belonging to a religious community is considered to be a protective factor against them. The pathways to SUDs have been investigated in many studies with the aim of helping us better understand this phenomenon and promoting effective intervention programs to prevent and manage it. However, there is a lack of knowledge regarding SUDs in closed religious communities such as the Ultraorthodox Jewish community.

METHOD

To fill this gap, in the current study we investigated the pathways to SUDs among 14 young men from the Ultraorthodox Jewish community in Israel who were diagnosed as having an SUD in the past and who had been in sustained remission for at least a year. Semi-structured, in-depth interviews consisting of open-ended questions were conducted.

RESULTS

The findings highlighted two main themes: (a) A lack of support and attention from various systems, where participants reported sense of otherness or lack of belonging to family, educational institutions and community; a lack of responsiveness from those systems; a sense of rejection or exclusion; and a longing for belonging, and (b) A light in the darkness - someone who cares, in which the interviewees received some assistance, either in the period before or during drug use.

CONCLUSION

Findings point to the unique experience of Ultraorthodox young men in their addiction process and shed light on the failure of the abovementioned systems to help these young men cope. Findings are discussed in the context of the theoretical perspectives of social capital theory and exclusion. Implications for intervention and policy are outlined.

Urban diversity and epidemic resilience: The case of the COVID-19

The spread of the coronavirus pandemic offers a unique opportunity to improve our understanding of the role of urban planning strategies in the resilience of urban communities confronting a pandemic. This study examines the relationship between urban diversity and epidemiological resilience by empirically assessing the relation between the level of neighborhood homogeneity and the probability of being infected by the coronavirus. We focus on the ultra-Orthodox Jewish community in Israel, a relatively closed community that was disproportionately and severely affected by the pandemic. The findings indicate a monotonic but nonlinear relationship between the level of ultra-Orthodox prevalence in a neighborhood and a resident's probability of contracting COVID-19. As the fraction of ultra-Orthodox individuals in the neighborhood decreases, the fraction of infected population decreases significantly and more strongly that can be explained without recourse to urban diversity considerations. This relationship is found to be significant and strong, even when other variables are accounted for that had hitherto been perceived as central to coronavirus distribution, such as housing density, socioeconomic level of the neighborhood, and number of people per household. The findings are important and relevant to many societies around the globe in which a variety of populations have a separatist lifestyle.

You gotta fight! - Why norm-violations and outgroup criticism lead to confrontational reactions

Group members frequently face group-related discrepancies, such as other group members violating group norms or outgroup members criticising the ingroup. In response, they often engage in confrontational reactions like expressing disapproval or excluding the person causing the discrepancy. The present work tests the often voiced but rarely studied idea that group-related discrepancies are met with such confrontational responses because discrepancies elicit feelings of threat. Our approach is inspired by research on threat-regulation, which links certain negative emotions to the activation of specific threat-regulatory systems. Three experiments (N_total = 680) provide evidence suggesting that group-related discrepancies foster emotions consistent with an activation of the Fight-Flight-Freeze-System (especially anger-related emotions tied to fight-tendencies), emotions consistent with an activation of the Behavioural Inhibition System (i.e. anxiety-related emotions), and confrontational intentions. The effect of discrepancies on confrontational intentions was mediated by heightened anger-related emotions. This supports the idea that confrontational reactions are driven by experienced threat and that these reactions are rightfully called confrontational. We discuss our results in relation to research on ingroup norm-violations, outgroup criticism, and threat perception.

How to Make Health and Risk Communication on Social Media More "Social" During COVID-19

Social media have changed the way citizens participate in and express opinions about government policy. Social media serve organizations in achieving four main goals: interacting with citizens; fostering citizen participation; furthering open government; and analyzing/monitoring public opinion and activities. We contend that despite the importance of social media, international and local health organizations have been slow to adopt to them, primarily due to the discrepancy between intraorganizational discourse modes and the type of discourse suitable for dialogue with the public. In this perspective paper, we recommend strategies for such public dialogue based on understanding the challenges faced by organizations on the road to becoming more “social” in their social media presence and in their health and risk communication. Subsequently, we propose an integrative approach that combines three complementary paths: (1) putting the “social” back into health organizations’ culture by inserting more “social” content into the internal organizational discourse through consultation with experts from different fields, including those who diverge from the scientific consensus. (2) Using strategies to enable health organizations to respond to the public on social networks, based on health communications research and studies on emerging infectious disease (EID) communication. (3) Engaging the public on social media based on the participatory approach, which considers the public as a partner that understands science and can work with the organizations to develop an open and innovative pandemic realm by using crowdsourcing to solve complex global health problems. For each path, we define the current challenges, among which are (1) overcoming organizational groupthink and hidden profiles, (2) treating all unofficial information as misleading, and (3) insufficient public engagement in solving complex global problems. We then offer recommendations for dealing with each challenge.

Factional conflict in groups: How majorities and minorities relate to one another

Disagreement between numerically larger (majority) and smaller (minority) factions in groups is both common and consequential. For these reasons, there is a long tradition of social psychological interest in the causes and consequences of such disagreement. Early work focused on minority members’ movement toward the majority (majority influence) and majority members’ (negative) perceptions and evaluations of those who refused to move. Later work focused on similarities and differences between majority influence and its mirror opposite, minority influence, and on majority members’ (sometimes relatively positive) perceptions and evaluations of minority members. This paper summarizes current knowledge on these topics and suggests promising avenues for future research.