Individual perspectives and mental maps of working conditions and intention to stay of physicians in academic medicine

Introduction

Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. The purpose of the three studies reported here is to find out what specific factors are relevant for the intention to stay and turnover intention of physicians in academic medicine -and what measures might have a positive impact on employee retention.

Methods

In an interview study combining qualitative and quantitative methods, we investigated how the individual mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In total, 178 physicians from German university hospitals, residents, and physicians, in 15 departments of anesthesiology were interviewed and surveyed. In a first study, chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics, and rated according to their valence. In a second study, assistant physicians during and after their training period talked about strengths, weaknesses, and potential improvements of working conditions. Answers were segmented, ordered, rated, and used to develop a "satisfaction scale." In a third study, physicians participated in a computer-led repertory grid procedure composing 'mental maps' of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay.

Results

Comparing the interview results with recommendation rates and intention to stay show that high workload and poor career perspectives are linked to a negative attitude. A positive attitude towards work environment and high intention to stay is based on sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay.

Discussion

The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known "hygiene factors" and whereas job satisfaction is due to individual aspects.

Digital transition in rural emergency medicine: Impact of job satisfaction and workload on communication and technology acceptance

BACKGROUND

Tele-emergency physicians (TEPs) take an increasingly important role in the need-oriented provision of emergency patient care. To improve emergency medicine in rural areas, we set up the project 'Rural|Rescue', which uses TEPs to restructure professional rescue services using information and communication technologies (ICTs) in order to reduce the therapy-free interval. Successful implementation of ICTs relies on user acceptance and knowledge sharing behavior.

METHOD

We conducted a factorial design with active knowledge transfer and technology acceptance as a function of work satisfaction (high vs. low), workload (high vs. low) and point in time (prior to vs. after digitalization). Data were collected via machine readable questionnaires issued to 755 persons (411 pre, 344 post), of which 304 or 40.3% of these persons responded (194 pre, 115 post).

RESULTS

Technology acceptance was higher after the implementation of TEP for nurses but not for other professions, and it was higher when the workload was high. Regarding active communication and knowledge sharing, employees with low work satisfaction are more likely to share their digital knowledge as compared to employees with high work satisfaction. This is an effect of previous knowledge concerning digitalization: After implementing the new technology, work satisfaction increased for the more experienced employees, but not for the less experienced ones.

CONCLUSION

Our research illustrates that employees' workload has an impact on the intention of using digital applications. The higher the workload, the more people are willing to use TEPs. Regarding active knowledge sharing, we see that employees with low work satisfaction are more likely to share their digital knowledge compared to employees with high work satisfaction. This might be attributed to the Dunning-Kruger effect. Highly knowledgeable employees initially feel uncertain about the change, which translates into temporarily lower work satisfaction. They feel the urge to fill even small knowledge gaps, which in return leads to higher work satisfaction. Those responsible need to acknowledge that digital change affects their employees' workflow and work satisfaction. During such times, employees need time and support to gather information and knowledge in order to cope with digitally changed tasks.

A phase II trial of gemcitabine(G), capecitabine (C), and bevacizumab (B) in patients (pts) with metastatic renal cell carcinoma (RCC)

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Background: RCC is resistant to most traditional DNA and DNA repair targeted chemotherapy; although modest response rates to nucleotide analog based therapy, including GC, have been reported. Bevacizumab has activity in RCC. We thus performed a single center phase II trial of GCB in pts with metastatic RCC. Methods: Eligibility included clear cell or unclassified histologies, performance status 0–1, measurable disease, normal organ function and no prior treatment with VEGF binding agents or pyramidine analogs. Following significant hematotoxicity in the first 7 of 8 pts, chemotherapy was modified to G 1,000 mg/m2 (days 1, 8), C 1,000 mg po bid (days 1–14) and B 15 mg/kg (day 1) on a 21 day cycle with disease re-evaluation every 3 cycles. Primary endpoint was objective response rate (ORR) using a Bayesian continuous reassessment method designed to detect an improvement in the ORR from a 15% historical rate to 27%. Maximum planned enrollment = 55. Results: 30 pts enrolled from March 2005-May 2008 of which 29 were evaluable: 1 never treated. Pt characteristics: male 83%, median age 58 (36–82), prior nephrectomy 83%, prior radiation 52%, prior cytokine therapy 28%, prior VEGFR tyrosine kinase inhibitor 69%. MSKCC prognostic group: good 24%, intermediate 66%, poor 10%. 7 pts had a partial response (24%). Median overall and progression free survival were 9.8 mo (95%CI: 6.2, 14.9) and 5.3 mo (95%CI: 3.9, 9.9). Grade 3 or 4 toxicities: leucopenia 17%, neutropenia 31%, thrombocytopenia 7%, anemia 14%, proteinuria 3%, rash/hand foot syndrome 7%, fatigue 21%. Average change in mean arterial pressure after 2 cycles: 5.6 (p = 0.040). Serious adverse events: bowel perforation resulting in death 1 pt (3%), sepsis 1 pt (3%), PE/DVT 3 pts (10%), seizure 1 pt (3%). Conclusions: The trial was terminated early despite not meeting protocol criteria for success or futility due to slow accrual and the fact that the historical response rate on which the trial was based became irrelevant with emerging data using sequential VEGF pathway directed therapies. Nevertheless, the observed progression free and overall survival compare favorably to other phase II trials in this population.

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Role of the support material on laser desorption/ionization mass spectra

We report the results of experimental studies on the effects of sample supports in laser desorption/ionization mass spectrometry (LDI-MS). LDI time-of-flight (TOF) mass spectra obtained for C(60) and insulin samples deposited onto standard stainless steel substrate and/or onto some non-metallic materials (glass, scotch tape, floppy disc foil, Teflon foil, photocopy film), all recorded under identical, typical experimental conditions, have been compared with regard to their intensity and quality. The LDI investigations show that compared with stainless steel, glass and floppy disc foil sample supports boost (2-3.5 times) ion yields for C(60)(+) and C(60)(-) ions, respectively. The stainless steel and scotch tape sample supports are the best for the mass resolution of positive ions and the formation of (C(60))(n)(-) (n <or= 4) cluster ions, respectively. In the case of detection of insulin by matrix-assisted laser desorption/ionization (MALDI) we did not observe significant differences in sensitivity for the support materials tested. A mechanism of ion formation in the desorption plume is suggested.

Tunneling anisotropic magnetoresistance in Co/AlOx/Au tunnel junctions

We observe spin-valve-like effects in nanoscaled thermally evaporated Co/AlOx/Au tunnel junctions. The tunneling magnetoresistance is anisotropic and depends on the relative orientation of the magnetization direction of the Co electrode with respect to the current direction. We attribute this effect to a two-step magnetization reversal and an anisotropic density of states resulting from spin-orbit interaction. The results of this study points to future applications of novel spintronics devices involving only one ferromagnetic layer.

Probing spin accumulation in Ni/Au/Ni single-electron transistors with efficient spin injection and detection electrodes

We have investigated spin accumulation in Ni/Au/Ni single-electron transistors assembled by atomic force microscopy. The fabrication technique is unique in that unconventional hybrid devices can be realized with unprecedented control, including real-time tunable tunnel resistances. A grid of Au disks, 30 nm in diameter and 30 nm thick, is prepared on a SiO2 surface by conventional e-beam writing. Subsequently, 30 nm thick ferromagnetic Ni source, drain, and side-gate electrodes are formed in similar process steps. The width and length of the source and drain electrodes were different to exhibit different coercive switching fields. Tunnel barriers of NiO are realized by sequential Ar and O2 plasma treatment. By use of an atomic force microscope with specially designed software, a single nonmagnetic Au nanodisk is positioned into the 25 nm gap between the source and drain electrodes. The resistance of the device is monitored in real time while the Au disk is manipulated step-by-step with angstrom-level precision. Transport measurements in magnetic field at 1.7 K reveal no clear spin accumulation in the device, which can be attributed to fast spin relaxation in the Au disk. From numerical simulations using the rate-equation approach of orthodox Coulomb blockade theory, we can put an upper bound of a few nanoseconds on the spin-relaxation time for electrons in the Au disk. To confirm the magnetic switching characteristics and spin injection efficiency of the Ni electrodes, we fabricated a test structure consisting of a Ni/NiO/Ni magnetic tunnel junction with asymmetric dimensions of the electrodes similar to those of the single-electron transistors. Magnetoresistance measurements on the test device exhibited clear signs of magnetic reversal and a maximum tunneling magnetoresistance of 10%, from which we deduced a spin polarization of about 22% in the Ni electrodes.

High resolution measurements of kinetic energy release distributions of neon, argon, and krypton cluster ions using a three sector field mass spectrometer

Using a newly constructed three sector field mass spectrometer (resulting in a BE1E2 field configuration) we have measured the kinetic energy release distributions of neon, argon, and krypton cluster ions. In the present study we used the first two sectors, B and E1, constituting a high resolution mass spectrometer, to select the parent ions in terms of mass, charge, and energy, and studied the decay of those ions in the third field free region. Due to the improved mass resolution we were able to extend earlier studies carried out with a two sector field machine, where an upper size limit arose from the fact that several isotopomers contribute to a decaying parent ion beam when the cluster size exceeds a certain value. Furthermore we developed a new data analysis. It allows us to model also fragment ion peaks that are a superposition of different decay reactions and thus we can determine the average kinetic energy release for all decay reactions of a given cluster ion. In a further step we used these results to determine the binding energies of cluster ions Rg(n) (n> or =10) by applying finite heat bath theory. The smaller sizes have not been included in this analysis, because the validity of finite heat bath theory becomes questionable below n approximately 10. The present average kinetic energy releases and binding energies are compared with other experiments and various calculations.

Effect of impurities on the matrix-assisted laser desorption/ionization mass spectra of insulin

The effect of impurity (sodium sulfate Na2SO4; copper sulfate CuSO4; potassium ferrocyanide K4Fe(CN)6; and triammonium citrate (NH4)3C6H5O7) concentration on the positive matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) spectra of insulin is described. 2,5-Dihydroxybenzoic acid was used as a desorption matrix. The estimated maximum concentrations of tested salts for which no insulin signal was observed were determined.

Electron ionization study of ammonia micro-clusters

An electron impact ion source on a double focusing sector field mass spectrometer was used to investigate ammonia micro-clusters produced by the adiabatic free jet expansion of ammonia gas. The appearance energies for [NH(3)](n)(+), n </= 9, ions have been determined. Results of measurements of appearance pressures of selected clusters are described for a range of operating conditions. An empirical formula describing the ammonia clusters production is proposed. Copyright 2000 John Wiley & Sons, Ltd.

Synthesis and antibiotic activity of 1-cycloalkoxymethyl-4-dimethylaminopyridinium and 1-[(1-alkoxy)ethyl]-4-dimethylaminopyridinium chlorides

DMAP reacts readily with chloromethylcycloalkyl ethers and alpha-chloroethyl alkyl ethers to give stable (1a-1e) and unstable (2a-2h) pyridinium chlorides. Reaction of these chlorides with NaOH produces the corresponding 4-pyridones. All the chlorides synthesized showed antibiotic activity. Particularly high activity against microbes representing cocci, rods, fungi, and bacilli was shown by 1-cyclododecyloxymethyl-4-dimethylaminopyridinium chloride 1d and 1-[(1-dodecyloxy)ethyl]-4-dimethylaminopyridinium chloride 2f.

[Actions of new iminium compounds against bacteria and fungi. 30. 3-alkoxymethyl-1-hexyl-, 3-alkylthiomethyl-1-hexyl-, 3-alkoxymethyl-1-octyl- and 3-alkylthiomethyl-1-octylbenzimidazolium chlorides]

Syntheses and antimicrobial activity of the title compounds are described. They were obtained by reaction of 1-hexyl- or 1-octylbenzimidazol with chloromethylalkyl ether or chloromethylalkyl sulfide. The antibacterial properties were tested on 13 strains of bacteria and fungi. The best antibacterial activity was exhibited by chlorides with octylthiomethyl and decyloxymethyl groups.

[Iminium compounds against bacteria and fungi. 29. 3-Alkoxymethyl-1-ethyl-, 3-alkylthiomethyl-1-ethyl-, 3-alkoxymethyl-1-butyl-, and 3-alkylthiomethyl-1-butylbenzimidazolium chloride]

Syntheses and antimicrobial activity of 3-alkoxymethyl-1-ethyl-, 3-alkylthiomethyl-1-ethyl-, 3-alkoxymethyl-1-butyl-, and 3-alkylthiomethyl-1-butylbenzimidazolium chlorides are described. The compounds were obtained by reaction of 1-ethyl- or 1-butylbenzimidazole with chloromethylalkyl ethers or chloromethylalkyl sulfide. Antibacterial properties were tested on 13 strains of bacteria and fungi. 3-Dodecylthio-methyl-1-ethyl-benzimidazolium chloride exhibited the highest antibacterial activity.

[Actions of new iminium compounds on bacteria and fungi. 27. Synthesis of 1-n-decyl-2-phenyl-3-(n-alkylthiomethyl)- and 1-n-decyl-2-phenyl-3-(n-alkoxymethyl)imidazolium chlorides]

The imidazolium compounds 1-3 were prepared by quaternization of 1-decyl-2-phenylimidazole with the pertinent chloromethyl-n-alkyl ethers. 1-3 were tested for their antibacterial and antimycotic efficacies.

[Synthesis and action of 1-n-hexyl-2-phenyl-3-(n-alkoxymethyl)- and 1-n-hexyl-2-phenyl-3-(6-n-alkylthiomethyl)imidazolium chlorides]

The synthesis of quaternary imidazolium chlorides was performed by reaction of 1-n-hexyl-2-phenyl-imidazole with chloromethylalkyl ether or chlormethylalkyl sulfide. The antibacterial properties of the compounds obtained was tested on 13 strains of bacteria and fungi. Chlorides with octyl- and decylthiomethyl moiety indicated the best antibacterial activity.