How medical learners and educators decide what counts as mistreatment: A qualitative study.

INTRODUCTION: The mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less-than-ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment. METHODS: Using constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of 'definitely', 'maybe' and 'definitely not' maltreatment across a variety of axes including experience level, clinical setting and type of interaction. RESULTS: Our data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient. CONCLUSIONS: Only the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense-making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.

Good, Bad, and Ugly Leadership Patterns: Implications for Followers' Work-Related and Context-Free Outcomes.

This research responds to calls for a more integrative approach to leadership theory by identifying subpopulations of followers who share a common set of perceptions with respect to their leader's behaviors. Six commonly researched styles were investigated: abusive supervision, transformational leadership (TFL), contingent reward (CR), passive and active management-by-exception (MBE-P and MBE-A, respectively), and laissez faire/avoidant (LF/A). Study hypotheses were tested with data from four independent samples of working adults, three from followers (N = 855) and a validation sample of leaders (N = 505). Using latent profile analysis, three pattern cohorts emerged across all four samples. One subpopulation of followers exhibited a constructive pattern with higher scores on TFL and CR relative to other styles. Two cohorts exhibited destructive patterns, one where the passive styles of MBE-A, MBE-P and LF/A were high relative to the other styles (passive) and one where the passive styles co-occurred with abusive supervision (passive-abusive). Drawing on conservation of resources theory, we confirmed differential associations with work-related (i.e., burnout, vigor, perceived organizational support and affective organizational commitment) and context-free (i.e., physical health and psychological well-being) outcomes. The passive-abusive pattern was devastating for physical health, yet passiveness without abuse was damaging for psychological well-being. Interestingly, we find a clear demarcation between passiveness as "benign neglect" and passiveness as an intentional and deliberate form of leadership aimed at disrupting or undermining followers-hence, the two faces of passiveness: "bad" and "ugly." We discuss the novel insights offered by a pattern (person)-oriented analytical strategy and the broader theoretical and practical implications for leadership research.

Why do few medical students report their experiences of mistreatment to administration?

INTRODUCTION: Over 50% of medical students worldwide report experiencing mistreatment and abuse during their clinical education, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide whether to formally report these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. METHODS: Using Constructivist Grounded Theory, we interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Data were analysed in an iterative fashion, using focused and theoretical forms of coding. RESULTS: The decision of whether to report mistreatment is only one phase in the process that students report experiencing when encountering mistreatment. This process can be understood as a journey consisting of five phases: Situating, Experiencing and Appraising, Reacting, Deciding and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. DISCUSSION: Student perceptions of trust or mistrust in their educational institution are highly influential when it comes to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organisational trust between students and the medical school.

The Participation of People with Disabilities in the Workplace Across the Employment Cycle: Employer Concerns and Research Evidence.

Despite legislation on diversity in the workplace, people with disabilities still do not experience the same access to work opportunities as do their counterparts without disabilities. Many employers have been shown to harbor sincere yet ill-founded views about the work-related abilities of people with disabilities; these negative views are often a result of interrelated concerns that permeate the entire employment cycle. In this paper, we provide evidence-based responses to 11 specific concerns that employers have about people with disabilities, from pre-employment and entry experiences to the final dissolution of the employment relationship. At each stage of the employment cycle, we summarize and evaluate the relevant empirical evidence and provide recommendations for organizations committed to creating more effective, equitable, and inclusive workplaces for all individuals. We also suggest avenues for future research.

Supporting Arthritis and Employment Across the Life Course: A Qualitative Study.

OBJECTIVE: To examine the need for and availability and use of formal and informal workplace resources and to uncover differences across the life course in adults with arthritis. METHODS: Focus groups and interviews were conducted with young (aged 18-34 years; n = 7), middle-aged (35-54 years; n = 13), and older adults (≥55 years; n = 25) with a diagnosis of inflammatory arthritis, osteoarthritis, or other rheumatic disease. Participants were asked about their employment experiences, formal and informal workplace resource needs, and availability and use of workplace resources. Differences based on chronological, functional, psychosocial, organizational, and lifespan dimensions of age were examined. A modified grounded theory approach was used to inductively analyze the data. RESULTS: Young, middle-aged, and older adult participants required similar workplace resources. Across all participants, scheduling modifications tended to be the most needed workplace resource. In contrast, the perceived availability and use of formal workplace resources differed among participants. Young adult participants and those who were newer to their jobs reported that workplace resources were less available and utilized. Middle-aged and older adults reported greater availability of workplace resources. Scheduling accommodations and at-work modifications were the workplace resources that were used most by middle-aged and older adults, respectively. CONCLUSION: Similar workplace resources could meet the employment needs of individuals with arthritis across the life course. Attention should be paid to young adults and those who are new to their jobs, because they may perceive more barriers to accessing formal workplace resources and be susceptible to work disability.

Transitions that matter: life course differences in the employment of adults with arthritis.

PURPOSE: To understand the similarities and differences in the employment participation of people living with arthritis across the life course. METHOD: Focus groups and interviews were conducted with young (ages 18-34 years, n = 7), middle-aged (ages 35-54 years, n = 13) and older adults (>55 years, n = 25) with arthritis. Participants were asked about the impact of arthritis on employment, experiences with health-related changes, career progression and social role involvement. A modified grounded theory approach was used to inductively analyze the data. RESULTS: Young adults indicated the school-to-work transition as being influential in their employment and described the need to direct their time and energy toward finding work that accommodated health and met career aspirations. Middle-aged adults described how the transition from good health to an arthritis diagnosis disrupted involvement in diverse social roles. However, they often downplayed the impact of arthritis on employment. Older adults described the work-to-retirement transition and their decline in physical functioning as contributing to changing involvement in the labor market. CONCLUSION: Transitions related to health, career progression and social role involvement shaped employment experiences, and represent opportunities for future research and practice that is tailored to life course issues. Implications for rehabilitation Little is known about the work experiences of young- and middle-aged adults with arthritis and how they compare to their older counterparts. Life course theory offers an important framework for research and practice by providing a perspective to enhance our understanding of how employment participation differs across phases of life. Salient and diverse changes related to health, career and social role involvement were identified at each life phase and shaped employment. Rehabilitation practitioners should pay special attention to a client's age, life phase and work history as a strategy to enhance the delivery of interventions that promote work participation.

Effects of Team Emotional Authenticity on Virtual Team Performance.

Members of virtual teams lack many of the visual or auditory cues that are usually used as the basis for impressions about fellow team members. We focus on the effects of the impressions formed in this context, and use social exchange theory to understand how these impressions affect team performance. Our pilot study, using content analysis (n = 191 students), suggested that most individuals believe that they can assess others' emotional authenticity in online settings by focusing on the content and tone of the messages. Our quantitative study examined the effects of these assessments. Structural equation modeling (SEM) analysis (n = 81 student teams) suggested that team-level trust and teamwork behaviors mediate the relationship between team emotional authenticity and team performance, and illuminate the importance of team emotional authenticity for team processes and outcomes.

Peer mentoring of adults with spinal cord injury: a transformational leadership perspective.

PURPOSE: Drawing from the tenets of transformational leadership theory, the purpose of this study was to examine the nature of effective peer mentoring of adults with a spinal cord injury (SCI) from the perspective of mentees. METHODS: The study utilised a qualitative methodology (informed by a social constructionist approach), involving 15 adult mentees with a SCI (mean age = 47.2; mean time since injury = 14.5 years), in which data were obtained via semi-structured interviews. RESULTS: The results revealed that effective mentoring, as used by mentors with SCIs, closely aligns with the core components of transformational leadership. Specifically, all four dimensions of transformational leadership (idealised influence, inspirational motivation, individualised consideration and intellectual stimulation) as displayed by mentors with a SCI were evident in their interactions with mentees. Participants who perceived their mentors to use transformational leadership behaviours reported increases in motivation, self-confidence, hope and overall well-being, relatedness with their mentor, greater comfort/acceptance of their situation, a redefined sense of their limitations, as well as greater engagement in various life pursuits. CONCLUSIONS: Displays of transformational leadership by peer mentors (i.e. transformational mentoring) were reported by mentees to be associated with a range of adaptive psychological and behavioural outcomes. The results have the potential to inform the development and dissemination of peer mentor-based interventions and initiatives. Implications for Rehabilitation Within the context of spinal cord injury (SCI) rehabilitation, positive peer mentorship is reflected in mentors' use of transformational leadership behaviours (idealised influence, inspirational motivation, individualised consideration and intellectual stimulation). When SCI peer mentors use transformational leadership behaviours, mentees report a redefined sense of their limitations, and increased self-confidence, hope, motivation, acceptance, participation and overall well-being. The results of this study have the potential to inform future longitudinal and experimental research concerning the (causal) effects of peer mentoring on mentee outcomes. In particular, research should examine the effects of peer-mentorship training, informed by the tenets of transformational leadership theory, in relation to the mentee outcomes assessed in this qualitative study.

Leadership styles, emotion regulation, and burnout.

This study investigated the potential impact of leadership style on leaders' emotional regulation strategies and burnout. Drawing on the full-range model of leadership and Conservation of Resources (COR) theory, we tested whether transformational, contingent reward, management by exception-active and -passive, or laissez-faire leadership exert direct effects on leaders' reported use of surface acting, deep acting, and genuine emotion. In turn, we hypothesized and tested the indirect effect of leadership on burnout through surface acting. Three waves of data from 205 leaders were analyzed using OLS regression. Transformational leadership predicted deep acting and genuine emotion. Contingent reward predicted both surface and deep acting. Management by exception-active and -passive predicted surface acting, and laissez faire predicted genuine emotion. The indirect effects of management by exception-active and -passive on burnout through surface acting were not significant. Indirect effects of transformational leadership and laissez-faire on burnout through genuine emotion, however, were significant. This study provides empirical evidence for the hypothesized relationships between leadership style, emotion regulation, and burnout, and provides the basis for future research and theory building on this topic.

Dollars and sense: the financial impact of Canadian wellness initiatives†.

The popular press reports anecdotal benefits of organizational initiatives that are designed to improve employees' work-life balance and wellness, but the long-term impact of these initiatives on firms' financial performance is unknown. Our longitudinal study of publicly traded Canadian organizations uses the strategic human resources management framework to explain why these initiatives may affect their financial performance. We use an exploratory factor analysis of three waves of archival data to identify two types of initiatives and regression to measure their impact on return on assets (ROA). Our findings suggest that, after 2 years, health promotion initiatives significantly decreased ROA, while work-life balance initiatives significantly increased it. Both effects became non-significant over the longer term.

Workplace aggression in teenage part-time employees.

Among adult employees, interpersonal injustice and abusive supervision predict aggression toward supervisors at work. The aim of this study was to assess whether similar relationships exist among teenage employees and, further, whether teenagers' reasons for working moderate these relationships. Multiple regression analyses on data from 119 teenage employees showed that financial and personal fulfillment reasons for working moderate the impact of interpersonal injustice and abusive supervision on aggression directed at workplace supervisors. These findings contribute to the understanding of workplace aggression by demonstrating that (a) teenagers engage in this workplace behavior, (b) the predictors are similar to those of adult aggression, and (c) reasons for working play a moderating role among this particular cohort. The possible long-term consequences of teenagers' use of aggression at work are discussed.