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.

Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap.

PURPOSE: Velopharyngeal insufficiency (VPI) is common (20-30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for velopharyngeal insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. MATERIALS AND METHODS: Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. RESULTS: Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip-palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P < 0.0001) and by parents (2.1 ± 0.9 vs 3.2 ± 0.7; P < 0.0001). Mean level of resonance improved significantly (0.7 ± 0.9 vs 2.0 ± 1.0; P < 0.0001), and velopharyngeal closure improved in 83% postoperatively. CONCLUSION: The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.