Efforts, rewards and professional autonomy determine residents' experienced well-being

The well-being of residents, our future medical specialists, is not only beneficial to the individual physician but also conditional for delivering high-quality patient care. Therefore, the authors further explored how residents experience their own well-being in relation to their professional and personal life. The authors conducted a qualitative study based on a phenomenological approach. From June to October 2013, 13 in-depth interviews were conducted with residents in various training programs using a semi-structured interview guide to explore participants' experience of their well-being in relation to their professional life. The data were collected and analyzed through an iterative process using the thematic network approach. Effort-reward balance and perceived autonomy were dominant overarching experiences in influencing residents' well-being. Experiencing sufficient autonomy was important in residents' roles as caregivers, as learners and in their personal lives. The experienced effort-reward balance could both positively and negatively influence well-being. We found two categories of ways that influence residents' experience of well-being; (1) professional lives: delivering patient care, participating in teamwork, learning at the workplace and dealing with the organization and (2) personal lives: dealing with personal characteristics and balancing work-life. In residents' well-being experiences, the effort-reward balance and perceived autonomy are crucial. Additionally, ways that influence residents' well-being are identified in both their professional and personal lives. These dominant experiences and ways that influence well-being could be key factors for interventions and residency training adaptations for enhancing residents' well-being.</p

Workplace mentoring of residents in generic competencies by an independent coach

INTRODUCTION: During postgraduate education in pulmonology, supervisors are responsible for training residents in generic competencies such as communication, professionalism and collaboration, but their focus commonly lies more on medical-technical competencies. As an alternative approach to supporting residents to develop generic skills, we developed a personal mentoring program with a non-medical professional as mentor. In this study, the residents' experiences with the mentoring program were evaluated. METHODS: After an introductory session in which individual learning goals were established, pulmonology residents received at least six, 60-90-minute, individual, mentoring sessions largely consisting of feedback after being observed during daily clinical activities, over a period of 9 months. The residents' experiences with mentoring were explored through in-depth interviews followed by a qualitative content analysis. RESULTS: From March to November 2016, ten residents in pulmonology completed the program. Despite initial scepticism, mentoring encouraged residents to reflect deeply on their professional interactions. This caused an increased awareness of the effects of their communication and behaviour on patients. Experimenting with communication and different behaviours in subsequent interactions felt rewarding and contributed to further development, resulting in increased self-confidence and job satisfaction. DISCUSSION: Mentoring residents by non-medical coaching was associated with improved residents' proficiency in generic competencies

Explaining how faculty members act upon residents' feedback to improve their teaching performance

Responsiveness to feedback is a complex phenomenon that requires and receives attention. However, knowledge on the responsiveness of faculty members to residents' feedback on their teaching performance is lacking. Excellent teaching performance is essential to ensure patient safety and residents' learning in residency training. This study aims to increase our understanding of how faculty staff react to and act upon residents' feedback on their teaching performance. This multi-specialty, multi-institution interview study was conducted to gain insight into: (i) how teaching faculty proceed after they have received residents' feedback on their teaching performance, and (ii) the factors that influence their progression. Between August and December 2011, 24 faculty members who had received formative feedback on their teaching performance through valid and reliable feedback systems participated in this study. They reflected upon their (re)action(s) during individual semi-structured interviews. The interview protocol and analysis were guided by a comprehensive transtheoretical framework describing and explaining stages and processes of behavioural change. Faculty staff involved in residency training used residents' feedback to different extents to adapt or improve their teaching performance. Important tipping points in the processes of change necessary for faculty staff to put feedback into practice were: experiencing negative emotions in themselves or recognising those in residents as a result of failure to act upon feedback; realising that something should be done with or without support from others, and making a strong commitment to change. In addition, having the confidence to act upon feedback and recognising the benefits of change were found to stimulate faculty members to change their teaching behaviour. The responsiveness of faculty members to residents' feedback on their teaching performance varies. The adapted transtheoretical framework explains how and why faculty members do or do not proceed to action after receiving residents' feedback. Given this, organising residents' feedback for faculty staff in a systematic way is a first step and is necessary to effect potential improvements in teaching performanc

Evaluating Mind Fitness Training and Its Potential Effects on Surgical Residents' Well-Being:A Mixed Methods Pilot Study

Background Residents' well-being is essential for both the individual physician and the quality of patient care they deliver. Therefore, it is important to maintain or possibly enhance residents' well-being. We investigated (i) the influence of mind fitness training (MFT) on quality of care-related well-being characteristics: work engagement, empathy, work satisfaction and stress perception and explored (ii) residents' perceptions of MFT. Methods A multicenter study was conducted in eight Dutch teaching hospitals, from September 2012 to February 2014, using mixed methods-that is, quantitative and qualitative approaches to data collection and analysis. Eighty-nine surgical residents were invited to participate in pre- and post-intervention questionnaire surveys. Twenty-two residents participated in MFT and were additionally invited to evaluate the training by post-intervention interviews including open questions. Results At baseline 22 (100 %) residents in intervention group and 47 (70.2 %) residents in control group, and post-intervention 20 (90.9 %) residents in intervention group and 41 (66.1 %) residents in control group completed the questionnaires. In intervention-group, residents' specialty satisfaction increased by 0.23 point on 5-point Likert scale (95 % CI 0.23-0.24, P <0.001) while stress scores decreased by -0.94 point on 10-point scale (95 % CI -1.77 to -0.12, P = 0.026). No substantial changes were observed in control group. Participation in MFT was positively associated with residents' empathy (b = 7.22; 95 % CI 4.33-10.11; P <0.001) and specialty satisfaction scores (b = 0.42; 95 % CI 0.18-0.65; P = 0.001). Residents positively evaluated MFT with median scores of 6.80 for training design and 7.21 for outcome (10-point scale). Residents perceived improvement in focusing skills and reported being more aware of their own state of mind and feeling calmer and more in control. Conclusion Mind fitness training could improve residents' empathy, specialty satisfaction, stress perception, and focusing skills, and was positively received by surgical residents

Hospital-wide education committees and high-quality residency training : A qualitative study

High-quality residency training is of utmost importance for residents to become competent medical specialists. Hospital-wide education committees have been adopted by several healthcare systems to govern postgraduate medical education and to support continuous quality improvement of residency training. To understand the functioning and potential of such committees, this study examined the mechanisms through which hospital-wide education committees strive to enable continuous quality improvement in residency training. Focus group studies with a constructivist grounded theory approach were performed between April 2015 and August 2016. A purposeful sample of hospital-wide education committees led to seven focus groups. Hospital-wide education committees strived to enable continuous quality improvement of residency training by the following mechanisms: creating an organization-wide quality culture, an organization-wide quality structure and by collaborating with external stakeholders. However, the committees were first and foremost eager to claim a strategic position within the organization they represent. All identified mechanisms were interdependent and ongoing. From a governance perspective, the position of hospital-wide education committees in the Netherlands is uniquely contributing to the call for institutional accountability for the quality of residency training. When implementing hospital-wide education committees, shared responsibility of the committees and the departments that actually provide residency training should be addressed. Although committees vary in the strategies they use to impact continuous quality improvement of residency training, they increasingly have the ability to undertake supporting actions and are working step by step to contribute to high-quality postgraduate medical educatio

Group Assessment of Resident Performance: Valuable for Program Director Judgment?

Background: Group discussion of resident performance is an emerging assessment approach in postgraduate medical education. However, groups do not necessarily make better decisions than individuals. Objective: This study examined how group meetings concerning the assessment of residents take place, what information is shared during the meetings, and how this influences program directors' judgment of resident performance. Methods: In 2017, the researchers observed 10 faculty group meetings where resident performance was discussed and interviewed the program directors within a month after the meetings. We used a thematic framework analysis to identify themes from the transcribed meetings and interviews. Results: The information shared by group members during the meetings had 2 aims: (1) forming a judgment about the residents, and (2) faculty development. Most group members shared information without written notes, most discussions were not structured by the program director, the major focus of discussions was on residents with performance concerns, and there was a lack of a shared mental model of resident performance. The program directors who benefited most from the meetings were those who thought group members were engaged and summarized the information after every discussion. Conclusions: Unstructured discussions and a lack of a shared mental model among group members impede effective information sharing about resident performance with a developmental approach. Structured discussions with an equal amount of discussion time for every resident and creating a shared mental model about the purpose of the discussions and the assessment approach could enhance use of a developmental approach to assessing resident performance

Flowchart of different steps in developing and validating TeamQ measurement instrument.

<p>Flowchart of different steps in developing and validating TeamQ measurement instrument.</p

Characteristics of the participants in the modified Delphi procedure.

<p>Characteristics of the participants in the modified Delphi procedure.</p