Study demands and resources affect academic well-being and life satisfaction of undergraduate medical students in the Netherlands.

INTRODUCTION: Medical students report poor academic well-being in a context of high study demands. Study Demands-Resources theories have outlined mediating processes involving high study demands and low resources to mitigate academic well-being, which is subsequently associated with diminished overall well-being (i.e. life satisfaction). Furthermore, academic well-being and life satisfaction are also affected by interactions between study demands and resources (referred to as moderating processes). However, these mediating and moderating processes clarifying medical students' well-being still need to be investigated. Therefore, this study investigated the mediating role of academic well-being in the associations of study demands and resources with life satisfaction and the moderating role of study demands and resources in relation to academic well-being and life satisfaction among undergraduate medical students. METHODS: In this cross-sectional survey study, 372 undergraduates from Dutch medical schools participated. The survey included the Study Demands-Resources Scale (workload, growth opportunities and peer support) as well as questionnaires on academic well-being (Utrecht Burnout Scale for students and Utrecht Work Engagement Scale-Student Form) and overall well-being (single item on life satisfaction). Based on Study Demands-Resources theories, (moderated) mediation analyses were performed. RESULTS: Mediating processes were found as growth opportunities were indirectly associated with higher life satisfaction through lower academic burnout and higher academic engagement. Furthermore, workload was indirectly associated with lower life satisfaction through higher academic burnout. This association was moderated as it became weaker with more perceived peer support. DISCUSSION: A high workload and limited growth opportunities are associated with suboptimal academic well-being and life satisfaction. Perceiving support from peer students slightly buffers the unfavourable effect of workload on academic burnout and subsequently life satisfaction. To promote academic well-being and life satisfaction in medical students, universities can consider to reduce the workload, to create a supportive learning environment and to offer development opportunities.

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.

Changes in work conditions and well-being among healthcare professionals in long-term care settings in the Netherlands during the COVID-19 pandemic: a longitudinal study.

BACKGROUND: Healthcare professionals working in long-term care facilities reported heavy job demands and a lack of job resources during the 2019 coronavirus disease (COVID-19) pandemic. However, how job demands and resources in these facilities changed during the pandemic, and how possible changes affected professionals' work-related well-being, remains unclear. Thus, we explored changes in job demands and resources in the face of surging COVID-19 infection rates, and investigated associations of these changes with changes in burnout and work engagement, among healthcare professionals working in long-term care facilities in the Netherlands. METHODS: This longitudinal study was conducted with healthcare professionals working in five long-term care facilities in the Netherlands. Data were collected in early and late 2021, when infection rates in long-term care facilities were low and high (mean, 29.1 and 275.4 infections/day), respectively. In total, 173 healthcare professionals completed the validated Job Demands and Resources Questionnaire, Copenhagen Burnout Inventory, and Utrecht Work Engagement Scale at both timepoints. We performed paired-samples t tests to examine changes in job demands and resources, and fixed-effects linear regression analyses to examine associations of within-person changes in job demands and resources with those in burnout and work engagement. RESULTS: Healthcare professionals perceived increased workloads, associated with increased burnout and decreased work engagement during the study period. Within-person increases in perceived collegial support were associated positively with work engagement and negatively with burnout symptoms. CONCLUSIONS: Healthcare professionals in long-term care facilities perceived increased workloads in the wake of surging infection rates during the COVID-19 pandemic, resulting in increased burnout and decreased work engagement. These changes in burnout and work engagement were also perceived in response to declining collegial support. Efforts to protect the work-related well-being of healthcare professionals working in long-term care facilities in the pandemic context that focus on workload reduction and the promotion of collegial support may be most beneficial.

Nursing home staff perceptions of well-being during the COVID-19 pandemic: A qualitative study.

AIMS: To explore how nursing home staff perceived their work environment during the COVID-19 pandemic and how this impacted their well-being. DESIGN: A qualitative interview study. METHODS: Interviews were held with twenty-two registered nurses and assistant nurses from five nursing homes in the Netherlands between April 2021 and July 2021. The interviews were analysed using qualitative content analysis. The Standards for Reporting Qualitative Research (SRQR) were followed. RESULTS: Five themes emerged from the interviews and indicated that working during the COVID-19 pandemic impacted perceived well-being of nursing home staff. Three themes concerned experiences at work: eroding care, additional roles and workplace support. Specifically, the increased workload with additional tasks, the constant stream of new guidelines and constrictive personal protective equipment caused discomfort and anxiety. Two other themes concerned experiences outside of work: work-life interference and social interactions and status. The nurses reported that when they returned home after work, they were tired and worried about spreading the virus while facing limited social interactions and support. CONCLUSION: The social distancing measures due to the COVID-19 pandemic negatively impacted nursing home staff well-being by increasing demands in the absence of adequate resources. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The well-being needs of nurses should receive continued attention to ensure the sustainability of healthcare during future crises. PATIENT OR PUBLIC CONTRIBUTION: The nursing home managers participated in recommending the topics to be covered during interviews. IMPACT: What problem did the study address? The pressure of stressful working conditions on the well-being of nurses during the pandemic. What were the main findings? Nurses created strategies to cope with declining well-being. However, the available resources did not alleviate the increased demands caused by the pandemic. Where and on whom will the research have an impact? This study is important for healthcare organizations to understand how the COVID-19 pandemic affected nurses so that they may better prepare for future crises.

[Structurally supporting health care professionals' well-being: the relevance of a national program Caring for Healthcare Professionals.] / Het welzijn van zorgprofessionals onder druk.

Stressful working conditions in health care put the well-being of healthcare professionals at risk. This well-being is increasingly being supported by diverse initiatives in the Netherlands. However, these initiatives are dispersed across micro-, meso- and macro-levels and not equally accessible to all health care professionals. A national, integral approach is lacking in which initiatives across levels are more effectively combined. Therefore, we suggest the initiation of a national program "Caring for Healthcare Professionals", which structurally supports the well-being of healthcare professionals. We reflect on science- and practice-based insights from interventions in three domains: (a) workplace management, (b) self-care, and (c) treatment and recovery. We propose to translate the lessons learned in these domains into a national program combining best practices, aiming to structurally support healthcare professionals' well-being.

Health care professionals' perceptions of unprofessional behaviour in the clinical workplace.

BACKGROUND: Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. OBJECTIVE: To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. METHODS: Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. RESULTS: Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). CONCLUSIONS: Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.

Structural equation modelling analysis on relationships of job demands and resources with work engagement, burnout and work ability: an observational study among physicians in Dutch hospitals.

OBJECTIVE: To investigate to what extent work engagement mediates the relationships of job resources with work ability, and to what extent burnout mediates the relationships of job demands and resources with work ability. DESIGN: Multicentre observational study. SETTING: Academic and non-academic hospitals in the Netherlands. PARTICIPANTS: Physicians (n=385) participated in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: We measured work ability with selected items from the validated Questionnaire of Experience and Evaluation of Work 2.0 (QEEW V.2.0), work engagement with the Utrecht Work Engagement Scale and burnout with the exhaustion subscale of the Oldenburg Burnout Inventory. The job demand 'workload' and job resources 'development opportunities', 'participation in decision-making', 'inspirational leadership' and 'relationships with colleagues' were measured using the QEEW V.2.0. The job demand 'bureaucratic burden' was measured with the Three Item Red Tape scale. A structural equation model was built to answer our research question. RESULTS: Work engagement mediated relationships of job resources with physicians' work ability, and burnout mediated relationships of job resources and demands with work ability. Development opportunities (ß=0.39, SE=0.12, p<0.001), participation in decision-making (ß=0.18, SE=0.08, p=0.028) and relationships with colleagues (ß=0.19, SE=0.19, p=0.002) were positively related to work engagement. Development opportunities (ß=-0.20, SE=0.08, p=0.004) were negatively related and workload (ß=0.51, SE=0.19, p<0.001) was positively related to burnout. Work engagement (ß=0.22, SE=0.04, p<0.001) was positively related and burnout (ß=-0.56, SE=0.06, p<0.001) was negatively related to work ability. CONCLUSIONS: Physicians' work engagement and burnout mediated the relationships of various job demands and resources with their work ability. More work-engaged and less burned-out physicians reported better work ability. Hospitals may attenuate excessive workloads and facilitate development opportunities, participation in decision-making and good collegial relationships to enhance physicians' occupational well-being and performance.

Study-related wellbeing, behavior, and attitudes of university students in the Netherlands during emergency remote teaching in the context of COVID-19: A longitudinal study.

Introduction: During the COVID-19 pandemic, emergency remote teaching was implemented at all conventional Dutch universities; however, the degree of limitations in on-campus teaching and learning varied during the pandemic dependent on the strictness of the measures. In the present study, it will be investigated how study-related experiences of university students changed in the face of varying limitations in on-campus teaching and learning. Methods: The study had a longitudinal natural experiment design with three points of measurement during the academic year 2020-2021: November-December 2020 (t1; campuses partially open), March 2021 (t2; campuses fully closed) and June-July 2021 (t3; campuses partially open). In total, 680 Dutch university students (65.9% female; age: M = 21 years, SD = 2.06) filled in online surveys measuring study-related wellbeing (academic burnout and study-engagement), study-related behavior (study effort), and study-related attitudes (education satisfaction, online self-efficacy, and attitudes toward online education). Results: Overall, students reported moderate levels of academic burnout, study engagement, study effort, education satisfaction, and online self-efficacy; their attitudes toward online education were rather negative. Students' study-related wellbeing and education satisfaction decreased in the period when on-campus teaching and learning was impossible (t2) compared to periods in which on-campus teaching and learning was possible at a low level with several restrictions (t1 and t3). Students' attitudes toward online education and online self-efficacy slightly increased at the end of the academic year (t3); however, the attitudes toward online education remained negative. Discussion: The findings indicate that students' academic burnout, study engagement, and education satisfaction varied over the course of the academic year in the context of changing limitations in on-campus teaching and learning. To facilitate positive study-related experiences, universities are advised to offer as much on-campus education as possible in times of pandemics.

Supporting resident well-being on and outside the ICU during the COVID-19 pandemic: the use and value of institutional interventions and individual strategies.

During the COVID-19 pandemic, resident well-being has been shown to be at risk, which may interfere with residents' process of professional development during their educational trajectory. Therefore, we developed a well-being program for residents, aimed to help residents maintain their well-being during the COVID-19 pandemic. We explored residents' perceptions of their well-being as well as their perceived support of the well-being program during the COVID-19 pandemic. We invited all internal medicine residents and residents working in the ICU (N = 203) of one academic medical center to participate. The well-being program included a combination of (1) well-being measurements and (2) organizational support. The repeated well-being measurements involved a well-being survey on six measurement points from April to June 2020, and organizational support combined the provision of institutional interventions and promotion of individual strategies to help residents maintain their well-being during a pandemic. In total, 103 residents (50.1%) participated, showing that residents working in the ICU reported significantly lower levels of mental well-being than residents not working on the ICU. Furthermore, residents did not perceive the institutional interventions to benefit their well-being, while residents' reported engagement in individual strategies was significantly positively associated with their well-being. As ICU residents reported lower levels of mental well-being, well-being programs need to address ICU-specific stressors while enhancing supervision and peer support. Furthermore, the individual strategies of the well-being program should be tailored to residents' well-being needs as these were positively associated with resident well-being.

Designing a system for performance appraisal: balancing physicians' accountability and professional development.

BACKGROUND: In many healthcare systems, physicians are accustomed to periodically participate in individual performance appraisals to guide their professional development. For the purpose of revalidation, or maintenance of certification, they need to demonstrate that they have engaged with the outcomes of these appraisals. The combination of taking ownership in professional development and meeting accountability requirements may cause undesirable interference of purposes. To support physicians in their professional development, new Dutch legislation requires that they discuss their performance data with a non-hierarchical (peer)coach and draft a personal development plan. In this study, we report on the design of this system for performance appraisal in a Dutch academic medical center. METHODS: Using a design-based research approach, a hospital-based research group had the lead in drafting and implementing a performance appraisal protocol, selecting a multisource feedback tool, co-developing and piloting a coaching approach, implementing a planning tool, recruiting peer coaches and facilitating their training and peer group debriefings. RESULTS: The system consisted of a two-hour peer-to-peer conversation based on the principles of appreciative inquiry and solution-focused coaching. Sessions were rated as highly motivating, development-oriented, concrete and valuable. Peer coaches were considered suitable, although occasionally physicians preferred a professional coach because of their expertise. The system honored both accountability and professional development purposes. By integrating the performance appraisal system with an already existing internal performance system, physicians were enabled to openly and safely discuss their professional development with a peer, while also being supported by their superior in their self-defined developmental goals. Although the peer-to-peer conversation was mandatory and participation in the process was documented, it was up to the physician whether or not to share its results with others, including their superior. CONCLUSIONS: In the context of mandatory revalidation, professional development can be supported when the appraisal process involves three characteristics: the appraisal process is appreciative and explores developmental opportunities; coaches are trustworthy and skilled; and the physician has control over the disclosure of the appraisal output. Although the peer-to-peer conversations were positively evaluated, the effects on physicians' professional development have yet to be investigated in longitudinal research designs.

The impact of an additional nurse assistant during evening shifts on nurses' perceptions of job demands, job resources and well-being.

AIM: Workloads and other job demands jeopardize nurses' well-being, especially during evening shifts when there are less resources than during the day. The current study aims to shed light on how the addition of a nurse assistant to ward staffing during evening shifts has an impact on nurses' perceptions of job demands, job resources, and well-being. DESIGN: We performed a pre-post pilot study, whereby we compared nurses' perceptions of job demands, job resources, and well-being before and after the addition of a nurse assistant to ward staffing during evening shifts. METHODS: All nurses at the ward of a top-clinical hospital (N = 28) completed a baseline and follow-up survey including validated measures on job demands (workload and physical demands), job resources (autonomy and task clarity), and well-being (recovery from work and sleep problems). RESULTS: Compared with baseline, nurses reported fewer job demands (lower workloads and fewer physical demands) and sleep problems at follow-up. No statistically significant changes in job resources (autonomy and task clarity) and recovery difficulties were found. CONCLUSIONS: We found preliminary evidence that the addition of a nurse assistant during evening shifts could reduce workloads, physical demands, and sleep problems among nurses. IMPACT: This study highlighted that heavy job demands and sleep problems associated with evening shifts may be addressed by adding a nurse assistant to the nursing team. Future studies with larger samples and a control group are needed to provide better estimates of the magnitude of the beneficial effects and of the cost-effectiveness of an intervention of this kind.

Developing and piloting a well-being program for hospital-based physicians.

BACKGROUND: Demanding working conditions in medical practice pressurise the well-being of physicians across all career stages, likely harming patients and healthcare systems. Structural solutions to harmful working conditions are necessary as well as interventions to support physicians in contemporary practice. We report on developing and piloting a team-based program for physicians to improve their working conditions and well-being. APPROACH: Program development steps involved: a preparatory phase, needs assessment, and program design. The program consisted of (1) a feedback tool addressing working conditions and well-being, and an intervention including (2a) a facilitated team dialogue and (2b) a team training on communication and collaborative job crafting. In the program's pilot, 377 physicians from 48 teams in 14 Dutch hospitals used the feedback tool. Four teams participated in the team dialogue. Two teams performed the team training. EVALUATION: Physicians indicated that the program was a useful format to gain insight into their working conditions and well-being, and possibly to improve their well-being collaboratively. REFLECTION: We provide seven critical reflections on developing and piloting our program, accompanied by recommendations for developing well-being interventions. Our development approach, program components, and recommendations may support physicians and other healthcare professionals in demanding work environments.

Associations between job demands, job resources and patient-related burnout among physicians: results from a multicentre observational study.

OBJECTIVES: To investigate associations of job demands and resources with patient-related burnout among physicians. DESIGN: Multicentre observational study. SETTING: Fifty medical departments at 14 (academic and non-academic) hospitals in the Netherlands. PARTICIPANTS: Four hundred sixty-five physicians (71.6% response rate), comprising 385 (82.8%) medical specialists and 80 (17.2%) residents. MAIN OUTCOME MEASURES: Job demands (workload and bureaucratic demands), job resources (participation in decision making, development opportunities, leader's inspiration, relationships with colleagues and patients)-measured with the validated Questionnaire of Experience and Evaluation of Work and Physician Worklife Survey-and patient-related burnout, measured using the validated Copenhagen Burnout Inventory. RESULTS: Patient-related burnout was positively associated with workload (b=0.36; 95% CI, 0.25 to 0.48; p<0.001) and negatively associated with development opportunities (b=-0.18; 95% CI, -0.27 to -0.08; p<0.001) and relationships with patients (b=-0.12; 95% CI, -0.22 to -0.03; p=0.01). Relationships with patients moderated the association between bureaucratic demands and patient-related burnout (b=-0.15; 95% CI, -0.27 to -0.04; p=0.01). CONCLUSIONS: Physicians with high workloads and few development opportunities reported higher levels of patient-related burnout. Those with positive patient relationships were less likely to experience patient-related burnout, even in the presence of excessive bureaucracy. Therefore, positive physician-patient relationships may be supported to reduce the likelihood of physicians' patient-related burnout. However, the specific support needed to effectively reduce patient-related burnout may vary per healthcare context and thus requires intensified research across healthcare systems and settings.

Variability of residents' ratings of faculty's teaching performance measured by five- and seven-point response scales.

BACKGROUND: Medical faculty's teaching performance is often measured using residents' feedback, collected by questionnaires. Researchers extensively studied the psychometric qualities of resulting ratings. However, these studies rarely consider the number of response categories and its consequences for residents' ratings of faculty's teaching performance. We compared the variability of residents' ratings measured by five- and seven-point response scales. METHODS: This retrospective study used teaching performance data from Dutch anaesthesiology residency training programs. Questionnaires with five- and seven-point response scales from the extensively studied System for Evaluation of Teaching Qualities (SETQ) collected the ratings. We inspected ratings' variability by comparing standard deviations, interquartile ranges, and frequency (percentage) distributions. Relevant statistical tests were used to test differences in frequency distributions and teaching performance scores. RESULTS: We examined 3379 residents' ratings and 480 aggregated faculty scores. Residents used the additional response categories provided by the seven-point scale - especially those differentiating between positive performances. Residents' ratings and aggregated faculty scores showed a more even distribution on the seven-point scale compared to the five-point scale. Also, the seven-point scale showed a smaller ceiling effect. After rescaling, the mean scores and (most) standard deviations of ratings from both scales were comparable. CONCLUSIONS: Ratings from the seven-point scale were more evenly distributed and could potentially yield more nuanced, specific and user-friendly feedback. Still, both scales measured (almost) similar teaching performance outcomes. In teaching performance practice, residents and faculty members should discuss whether response scales fit their preferences and goals.

The Surgical Hazardous Attitudes Reflection Profile (SHARP) Instrument - A Prototype Study.

OBJECTIVE: There is growing recognition that surgeons' non-technical skills are crucial in guaranteeing optimal quality and safety of patient care. However, insight in relevant attitudes underlying these behavioral skills is lacking. Hazardous attitudes potentially cause risky behavior, which can result in medical errors and adverse events. A questionnaire offering surgeons insight in their attitudinal profile is still missing and would be instrumental in risk reduction. Therefore, the aim of this study is to develop a prototype of a reliable and valid instrument to measure hazardous attitudes among surgeons. DESIGN: To measure hazardous attitudes, a prototype of the Surgical Hazardous Attitudes Reflection Profile (SHARP) tool was designed using a mixed methods approach, consisting of (1) 2 focus group discussions, (2) a modified Delphi analysis, and (3) a survey followed by (4) statistical analysis of the psychometric properties. Statistical analysis included exploratory factor analysis with varimax rotation, calculation of internal consistency reliability coefficients, and interscale correlations. SETTING: Fourteen hospitals across the Netherlands were recruited to guarantee demographic variety and the inclusion of academic, tertiary, and general hospitals. PARTICIPANTS: Nineteen experts participated in the 2 focus groups, and 19 in the modified Delphi study. In total, 302 surgeons (54.1%) completed the SHARP. RESULTS: In total, 302 surgeons (54.1%) completed the SHARP. Exploratory factor analysis resulted in 6 subscales measuring attitude towards (1) authority (α = 0.78), (2) self-performance (α = 0.69), (3) performance feedback (α = 0.61), (4) own fitness to perform (α = 0.54), (5) uncertainty (α = 0.51), and (6) planned procedures (α = 0.48). CONCLUSIONS: This study resulted in a prototype instrument identifying 6 potential hazardous attitudes in surgeons. Attitudes towards "authority" and "self-performance" can now be validly and reliably measured. Further research is required to optimize the prototype version of the instrument and could usefully explore the plausible relations between hazardous attitudes and clinical outcomes.

The impact of mindfulness-based interventions on doctors' well-being and performance: A systematic review.

OBJECTIVES: The well-being of doctors is at risk, as evidenced by high burnout rates amongst doctors around the world. Alarmingly, burned-out doctors are more likely to exhibit low levels of professionalism and provide suboptimal patient care. Research suggests that burnout and the well-being of doctors can be improved by mindfulness-based interventions (MBIs). Furthermore, MBIs may improve doctors' performance (eg in empathy). However, there are no published systematic reviews that clarify the effects of MBIs on doctor well-being or performance to inform future research and professional development programmes. We therefore systematically reviewed and narratively synthesised findings on the impacts of MBIs on doctors' well-being and performance. METHODS: We searched PubMed and PsycINFO from inception to 9 May 2018 and independently reviewed studies investigating the effects of MBIs on doctor well-being or performance. We systematically extracted data and assessed study quality according to the Medical Education Research Study Quality Instrument (MERSQI), and narratively reported study findings. RESULTS: We retrieved a total of 934 articles, of which 24 studies met our criteria; these included randomised, (un)controlled or qualitative studies of average quality. Effects varied across MBIs with different training contents or formats: MBIs including essential mindfulness training elements, or employing group-based training, mostly showed positive effects on the well-being or performance of doctors across different educational and hospital settings. Doctors perceived both benefits (enhanced self- and other-understanding) and challenges (time limitations and feasibility) associated with MBIs. Findings were subject to the methodological limitations of studies (eg the use of self-selected participants, lack of placebo interventions, use of self-reported outcomes). CONCLUSIONS: This review indicates that doctors can perceive positive impacts of MBIs on their well-being and performance. However, the evidence was subject to methodological limitations and does not yet support the standardisation of MBIs in professional development programmes. Rather, health care organisations could consider including group-based MBIs as voluntary modules for doctors with specific well-being needs or ambitions regarding professional development.

Physicians' Perceptions of Psychological Safety and Peer Performance Feedback.

INTRODUCTION: For continuous professional development, it is imperative that physicians regularly receive performance feedback from their peers. Research shows that professionals are more proactive in learning and knowledge sharing with peers in teams with more psychological safety. Psychological safety has however not been studied in relation to peers' performance feedback. This study investigated the association between physicians' perceptions of psychological safety and performance feedback received from their peers. METHODS: We invited physicians of cardiology, gastroenterology, obstetrics and gynecology, otorhinolaryngology, pulmonology, neurology, and neurosurgery departments of an academic medical center to participate. Physicians evaluated psychological safety using Edmondson's seven-item validated scale and performance feedback using the adapted four-item feedback subscale of the validated System for Evaluation of Teaching Qualities, including corrective and positive feedback, explanations of feedback, and suggestions for improvement from peers. We analyzed the data using multilevel linear regression analyses adjusted for physicians' sex, years since being certified a medical specialist, and months working in the clinic under the study. RESULTS: This study included 105 physicians (86.8% participated). Psychological safety was positively associated with physicians' perceptions of performance feedback from peers (B = 0.54, 95% confidence interval = 0.34-0.73, P-value <.001). CONCLUSIONS: Physicians who experienced more psychological safety were more likely to receive corrective and positive performance feedback from peers, explanations of feedback, and suggestions for improvement. Medical teams should consider investing in psychological safety to encourage performance feedback from peers, and thus support physicians' continuous professional development and their efforts to provide high-quality patient care.

Physicians' professional performance: an occupational health psychology perspective.

INTRODUCTION: Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be facilitated by work engagement and how work engagement is facilitated by job resources and personality traits. METHODS: First, we conducted a systematic review on the impact of physician work engagement and related constructs (e. g. job satisfaction) on physicians' performance in patient care. We additionally investigated physician work engagement and job resources in relation to patient care experience with physicians' performance at ten outpatient clinics covering two hospitals. In a following multicentre survey involving 61 residency training programs of 18 hospitals, we studied associations between physician work engagement and personality traits with resident evaluations of physicians' teaching performance. RESULTS: The findings showed that physician work engagement was associated with fewer reported medical errors and that job satisfaction was associated with better communication and patient satisfaction. Autonomy and learning opportunities were positively associated with physician work engagement. Work engagement was positively associated with teaching performance. In addition, physician work engagement was most likely supported by personality trait conscientiousness (e. g. responsibility). CONCLUSION: Given the reported associations of physician work engagement with aspects of their professional performance, hospitals could support physician work engagement in service of optimal performance in residency training and patient care. This could be facilitated by worker health surveillance, peer support or promoting job crafting at the individual or team level.

Work engagement in health professions education.

Work engagement deserves more attention in health professions education because of its positive relations with personal well-being and performance at work. For health professions education, these outcomes have been studied on various levels. Consider engaged clinical teachers, who are seen as better clinical teachers; consider engaged residents, who report committing fewer medical errors than less engaged peers. Many topics in health professions education can benefit from explicitly including work engagement as an intended outcome such as faculty development programs, feedback provision and teacher recognition. In addition, interventions aimed at strengthening resources could provide teachers with a solid foundation for well-being and performance in all their work roles. Work engagement is conceptually linked to burnout. An important model that underlies both burnout and work engagement literature is the job demands-resources (JD-R) model. This model can be used to describe relationships between work characteristics, personal characteristics and well-being and performance at work. We explain how using this model helps identifying aspects of teaching that foster well-being and how it paves the way for interventions which aim to increase teacher's well-being and performance.