An act of performance: Exploring residents' decision-making processes to seek help

CONTEXT: Residents are expected to ask for help when feeling insufficiently confident or competent to act in patients' best interests. While previous studies focused on the perspective of supervisor-resident relationships in residents' help-seeking decisions, attention for how the workplace environment and, more specifically, other health care team members influence these decisions is limited. Using a sociocultural lens, this study aimed to explore how residents' decision-making processes to seek help are shaped by their workplace environment. METHODS: Through a constructivist grounded theory methodology, we purposively and theoretically sampled 18 residents; 9 juniors (postgraduate year 1/2) and 9 seniors (postgraduate year 5/6) at Amsterdam University Medical Centers. Using semi-structured interviews, participating residents' decision-making processes to seek help during patient care delivery were explored. Data collection and analysis were iterative; themes were identified using constant comparative analysis. RESULTS: Residents described their help-seeking decision-making processes as an 'act of performance': they considered how asking for help could potentially impact their assessments. They described this act of performance as the product of an internal 'balancing act' with at its core the non-negotiable priority for providing safe and high-quality patient care. With this in mind, residents weighed up demonstrating the ability to work independently, maintaining credibility, and becoming an accepted member of the health care team when deciding to seek help. This 'balancing-act' was influenced by sociocultural characteristics of the learning environment, residents' relationships with supervisors, and the perceived approachability of other health care team members. CONCLUSIONS: This study suggests that sociocultural forces influence residents to experience help-seeking as an act of performance. Especially a safe learning environment resulting from constructive relationships with supervisors and the approachability of other health care team members, lowered the barriers to seek help. Supervisors could address these barriers by having regular conversations with residents about when to seek help

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

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’ patientrelated burnout. Howeve