Physician exhaustion and work engagement during the COVID-19 pandemic: A longitudinal survey into the role of resources and support interventions.

BACKGROUND: Physicians increasingly show symptoms of burnout due to the high job demands they face, posing a risk for the quality and safety of care. Job and personal resources as well as support interventions may function as protective factors when demands are high, specifically in times of crisis such as the COVID-19 pandemic. Based on the Job Demands-Resources theory, this longitudinal study investigated how monthly fluctuations in job demands and job and personal resources relate to exhaustion and work engagement and how support interventions are associated with these outcomes over time. METHODS: A longitudinal survey consisting of eight monthly measures in the period 2020-2021, completed by medical specialists and residents in the Netherlands. We used validated questionnaires to assess job demands (i.e., workload), job resources (e.g., job control), personal resources (e.g., psychological capital), emotional exhaustion, and work engagement. Additionally, we measured the use of specific support interventions (e.g., professional support). Multilevel modeling and longitudinal growth curve modeling were used to analyze the data. RESULTS: 378 medical specialists and residents were included in the analysis (response rate: 79.08%). Workload was associated with exhaustion (γ = .383, p < .001). All job resources, as well as the personal resources psychological capital and self-judgement were associated with work engagement (γs ranging from -.093 to .345, all ps < .05). Job control and psychological capital attenuated the workload-exhaustion relationship while positive feedback and peer support strengthened it (all ps < .05). The use of professional support interventions (from a mental health expert or coach) was related to higher work engagement (estimate = .168, p = .032) over time. Participation in organized supportive group meetings was associated with higher exhaustion over time (estimate = .274, p = .006). CONCLUSIONS: Job and personal resources can safeguard work engagement and mitigate the risk of emotional exhaustion. Professional support programs are associated with higher work engagement over time, whereas organized group support meetings are associated with higher exhaustion. Our results stress the importance of professional individual-level interventions to counteract a loss of work engagement in times of crisis.

Medical students' career decision-making stress during clinical clerkships.

OBJECTIVES: Many medical students experience career decision-making stress in the final phase of training. Yet, the factors that induce or reduce career decision-making stress and how progression in their clerkships relates to these factors are unknown. This knowledge gap limits the possibilities for medical schools to develop and implement interventions targeting students' career decision-making stress. This study explores content, process, and context factors that may affect career decision-making stress. METHODS: Using cross-sectional survey data from medical master students (n = 507), we assessed content (future work self), process (choice irreversibility, time pressure, career decision-making self-efficacy), and context (supervisory support, medical school support, study load, competition) factors and their relationships with career decision-making stress. The hypothesized relationships were tested with structural equation modelling. RESULTS: A clearer future work self and higher career decision self-efficacy were associated with lower career decision-making stress, while experienced time pressure, competition, and study load were associated with higher career decision-making stress. Choice-irreversibility beliefs, supervisory support, and medical school support were unrelated to career decision-making stress. As students' clerkships progressed, they gained a clearer future work self, but also experienced more time pressure. DISCUSSION: Clinical clerkships help students to form a clearer future work self, which can diminish career decision-making stress. Yet, students also experience more time pressure as the period of clerkships lengthens, which can increase career decision-making stress. A school climate of high competition and study load seems to foster career decision-making stress, while school support hardly seems effective in diminishing this stress.

Simply effective? The differential effects of solution-focused and problem-focused coaching questions in a self-coaching writing exercise.

Coaching is a systematic and goal-oriented one-on-one intervention by a coach aimed to guide clients in their professional and personal development. Previous research on coaching has demonstrated effects on a number of positive outcomes, including well-being and performance, yet little is known about the processes that underlie these outcomes, such as the type of questions coaches use. Here, we focus on three different types of coaching questions, and aim to uncover their immediate and sustained effects for affect, self-efficacy, and goal-directed outcomes, using a between-subjects experiment. One hundred and eighty-three medical residents and PhD students from various medical centers and healthcare organizations in the Netherlands were recruited to participate in a self-coaching writing exercise, where they followed written instructions rather than interacting with a real coach. All participants were randomly allocated to one of three conditions: either one of two solution-focused coaching conditions (i.e., the success or miracle condition) or a problem-focused coaching condition. Self-report questionnaires were used to measure key outcomes of coaching, that is positive and negative affect, self-efficacy, goal orientation, action planning (i.e., quantity and quality) and goal attainment. Two follow-up measurements assessed if the effects of the self-coaching exercise led to problem-solving actions within an initial follow-up period of 14 days and a subsequent follow-up period of 10 days. Findings showed that participants experienced more positive affect, less negative affect, and higher approach goal orientation after the solution-focused coaching exercise compared to the problem-focused coaching exercise. In all conditions, goal attainment increased as a consequence of the self-coaching intervention. We discuss the implications of our findings for the science and practice of contemporary coaching.

Psychometric Validation of the Dutch Version of the Promotive and Prohibitive Voice Scale.

The aim of this three-study report was to validate the Dutch version of the promotive and prohibitive voice scale and to further embed the constructs of promotive and prohibitive voice within their nomological network. Promotive voice refers to the expression of suggestions for improving work practices, whereas prohibitive voice refers to the expression of concerns about practices and behaviors that are detrimental. In Study 1 (N = 121), confirmatory factor analyses (CFAs) provided evidence for the two-factor structure, which was replicated in the other two studies. In Study 2 (N T1 = 209/N T2 = 107), we investigated the convergent and discriminant validity of the promotive and prohibitive voice scale, and tested measurement invariance across gender and time. Results provided validity evidence, partial scalar invariance for gender, and scalar invariance across time. In Study 3 (N = 149), we expanded the nomological network of the promotive and prohibitive voice scales through their relationship with personal initiative, approach temperament, and risk propensity. Taken together, our results provide strong evidence for the validity of the Dutch version of the promotive and prohibitive voice scale.

Acting Proactively to Manage Job Insecurity: How Worrying About the Future of One's Job May Obstruct Future-Focused Thinking and Behavior.

An increasing number of people experience insecurity about the future of their job, making it more important than ever to manage this insecurity. While previous research suggests that proactive coping is a promising way to alleviate job insecurity, we suggest that, paradoxically, it may be particularly difficult to act proactively when feeling emotionally distressed about the future of one's job. Drawing on the principle of resource scarcity and the Conservation of Resources theory, we propose that affective job insecurity ignites a scarcity mindset that inhibits workers' future focus and cognitive functioning, thereby undermining proactive career behavior. Additionally, we examine whether income adequacy can compensate for these negative consequences of job insecurity. Results of a three-wave survey study among 108 self-employed professionals during the COVID-19 pandemic showed that initial affective job insecurity was negatively related to cognitive functioning but unrelated to future focus. Yet, the latter relationship was moderated by income adequacy: affective job insecurity was positively related to future focus when participants reported high income adequacy. In turn, future focus was positively related to proactive career behavior, which was subsequently related to lower cognitive job insecurity. Thus, while replicating the finding that workers can proactively manage their cognitive job insecurity, we also showed that initial affective job insecurity may obstruct people's cognitive functioning. We discuss how our results signal a Matthew effect, in which job insecure people with sufficient means are able to look ahead and proactively build resources to change their career, while job insecure people with insufficient means may fall behind.

Turning the tide: a quasi-experimental study on a coaching intervention to reduce burn-out symptoms and foster personal resources among medical residents and specialists in the Netherlands.

OBJECTIVES: Physician burn-out is increasing, starting already among residents. The consequences of burn-out are not limited to physicians' well-being, they also pose a threat to patient care and safety. This study investigated the effectiveness of a professional coaching intervention to reduce burn-out symptoms and foster personal resources in residents and specialists. DESIGN: In a controlled field experiment, medical residents and specialists received six coaching sessions, while a control group did not undergo any treatment. The authors assessed burn-out symptoms of exhaustion and cynicism, the personal resources psychological capital, psychological flexibility and self-compassion, as well as job demands and job resources with validated questionnaires (January 2017 until August 2018). The authors conducted repeated measures analyses of variance procedures to examine changes over time for the intervention and the control group. SETTING: Four academic hospitals in the Netherlands. PARTICIPANTS: A final sample of 57 residents and specialists volunteered in an individual coaching programme. A control group of 57 physicians did not undergo any treatment. INTERVENTION: Coaching was provided by professional coaches during a period of approximately 10 months aiming at personal development and growth. RESULTS: The coaching group (response rate 68%, 57 physicians, 47 women) reported a reduction in burn-out symptoms and an increase in personal resources after the coaching intervention, while no such changes occurred in the control group (response rate 35%, 42 women), as indicated by significant time × group interactions, all p<0.01. Specifically, physicians increased their psychological capital (ηp2=0.139), their self-compassion (ηp2=0.083), and reported significantly less exhaustion (ηp2=0.126), the main component of the burn-out syndrome. CONCLUSION: This study suggests that individual coaching is a promising route to reduce burn-out symptoms in both residents and specialists. Moreover, it strengthens personal resources that play a crucial role in the prevention of burn-out.

In the eye of the beholder: How proactive coping alters perceptions of insecurity.

Why do some workers experience less insecurity than others even when facing the same objectively insecure work situation? Combining appraisal theory with the construct of proactive coping, we propose that proactive career behavior represents a form of resource accumulation that mitigates the extent to which insecure work situations result in perceived insecurity. We hypothesize that proactive career behavior moderates the effect of an acute insecure work situation (time remaining before contract expiration) and a chronic insecure work situation (probability of digitalization) on control appraisals of these situations and, in turn, perceptions of job and employment insecurity. We tested this moderated mediation model in a 3-wave field study with 2 samples. First, workers in unstable temporary jobs (with no renewed contract, N = 227) perceived higher lack of control and hence higher job insecurity as their contract got closer to expiring. As hypothesized, this process was mitigated by proactive career behavior. Second, workers in stable jobs (with a renewed contract or a permanent contract, N = 205) perceived higher lack of control and hence higher employment insecurity, as their occupation had a higher probability of digitalization. In contrast to our hypothesis, proactive career behavior did not mitigate this effect. Results further replicated established relationships between perceived insecurity and later stress and career dissatisfaction. By moving up the causal chain and focusing on the emergence of insecurity rather than the more common emphasis on consequences of insecurity, our study uncovers the role of proactive coping in the job insecurity process. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Keep the fire burning: a survey study on the role of personal resources for work engagement and burnout in medical residents and specialists in the Netherlands.

OBJECTIVES: The high prevalence of burnout among medical residents and specialists raises concerns about the stressful demands in healthcare. This study investigated which job demands and job resources and personal resources are associated with work engagement and burnout and whether the effects of these demands and resources differ for medical residents and specialists. DESIGN: In a survey study among residents and specialists, we assessed job demands, job resources, personal resources, work engagement and burnout symptoms using validated questionnaires (January to December 2017). Results were analysed using multivariate generalised linear model, ordinary least squares regression analyses and path analyses. SETTING: Five academic and general hospitals in the Netherlands. PARTICIPANTS: A total number of 124 residents and 69 specialists participated in this study. Participants worked in the fields of pediatrics, internal medicine and neurology. RESULTS: The associations of job and personal resources with burnout and work engagement differed for residents and specialists. Psychological capital was associated with burnout only for specialists (b=-0.58, p<0.001), whereas psychological flexibility was associated with burnout only for residents (b=-0.31, p<0.001). Colleague support (b=0.49, p<0.001) and self-compassion (b=-0.33, p=0.004) were associated with work engagement only for specialists. CONCLUSION: This study suggests that particularly personal resources safeguard the work engagement and lessen the risk of burnout of residents and specialists. Both residents and specialists benefit from psychological capital to maintain optimal functioning. In addition, residents benefit from psychological flexibility, while specialists benefit from colleague support. Personal resources seem important protective factors for physicians' work engagement and well-being. When promoting physician well-being, a one-size-fits-all approach might not be effective but, instead, interventions should be tailored to the specific needs of specialists and residents.