The vitality of doctors and other healthcare professionals is important for the quality of healthcare. Doctors’ vitality has become a much-discussed topic in the media and in scientific research in recent years. The research paints a clear picture. Doctors’ vitality is increasingly coming under pressure from demanding and changing working conditions such as the high pressure on production, the emotional burden of the work and the increased administrative burden. Both research and clinical practice often focus on reduced vitality (such as burnout) and the associated negative consequences for patient care. Nowadays, however, increasing attention is being paid to improving working conditions and doctors’ vitality. The research group Professional Performance & Compassionate Care carried out a project called ‘Professionaliteit in Vitaliteit’ [Professionalism in Vitality] and is currently promoting educational projects to increase doctors’ vitality.
Professionalism in Vitality
In 2016 we, together with VeiligheidNL and Medox, received a grant from the Dutch Ministry of Social Affairs and Employment for the project ‘Professionalism in Vitality’. This project involved the development of an evidence-based vitality module which was subsequently piloted. Its aim was to facilitate doctors and departments in improving their working conditions and vitality. We completed the project successfully in September 2017. The vitality programme we developed comprises a) a vitality measurement, b) a facilitated group discussion of the results, and c) a team training course in communication and team job crafting. Contact us for more information.
The research group is represented in education in the Bachelor’s Degree programme ‘Opmaat naar de Praktijk’ [Prelude to Clinical Practice] and in residency training (DOO). In the undergarduate programme, Bachelor students discuss with interns the concept of vitality and what they – and hospitals – do to be able to work (and continue to work) with enthusiasm and energy. For residents a two-day course ‘The Vital Resident’ is offered, providing scientific evidence regarding professional performance and work-related well-being. In the course, these doctors practise exploring and improving their own vitality.
Increasing numbers of PhD candidates at the AMC and in other teaching hospitals are experiencing problems associated with their study programmes. There are complaints about supervision, about the content of research and about the PhD candidates’ well-being. The quality of PhD candidates’ programmes therefore need to be improved.
The ReSQuE (Research Supervision Quality Evaluation) project is attempting to contribute to improving the quality of the programmes by focusing on the educational climate. The assumption is that improving the educational climate will help to improve the quality of the programmes. In line with the project, research will be conducted into the programme and the supervision of PhD candidates at the AMC. The research aims to monitor the educational climate in research groups. A measurement instrument focusing on the various elements of the educational climate in research groups will also be developed in the project. The measurement instrument will be used to monitor the educational climate.
The project is currently at the stage of developing the instrument. Information on the various elements which are important for the educational climate in research groups has been gathered using focus groups. These elements will later become the different themes in the measurement instrument. We are currently working on scientifically and theoretically substantiating the elements that have been found. The next step will be to draw up items.
You can track the project and its status through the website.
From 2020, a new requirement for the individual re-registration of medical specialists (a.k.a. revalidation or Maintenace of Certification) will come into force. From then on, specialists will be obliged to evaluate their personal performance once every five years with the help of feedback from colleagues in their immediate working environment, and to discuss the results which emerge with an independent coach. This is known as the IFMS requirement: Individual Performance of Medical Specialists.
At the AMC, professional performance researchers have developed an IFMS approach at the request of the Executive Board and in conjunction with medical specialists, heads of departments and the HR department. In this model:
- The primary focus is on the professional development of the specialist. The specialist and the professional development coach will work on a specific development goal in a session lasting two hours.
- The coaches are mainly medical specialists working at the AMC. The medical specialists can choose their own coaches but they may not choose someone from their own division.
- The coaches have been trained to conduct an appreciative, positive and solution-driven developmental interview in line with the DANA method developed by Annemiek Nooteboom in conjunction with the research group Professional Performance & Compassionate Care.
- Supervised periodical peer review meetings are arranged for the coaches.
- Feedback will be gathered using evidence-based tools (such as INCEPT, SETQ).
- The IFMS activities will be evaluated by means of scientific research.
The approach has been recorded in a protocol. Various UMCs have gratefully made use of the AMC model. Please contact us if you are interested in hearing more about it.
Quality of Care and Quality of Caring: developing a compassion intervention for physicians
Compassion is crucial for the quality of healthcare. How do physicians in training (residents) and patients describe compassion within Amsterdam UMC? How can compassion be fostered and developed? This project – financed by the research institute Amsterdam Public Health, program Quality of Care (APH QoC) aimed at developing a compassion intervention for residents and sought answers to these questions.
The project consisted of four parts: (1) a literature review, (2) interviews with both patients and residents, (3) a co-creation session and (4) designing the intervention. We will now briefly present the first results. After finishing the project, we will describe the process and outcomes of the project in an extensive report, which will be publicly available.
- Literature review
The literature review was the foundation of our project. It summarizes compassion literature on the following themes: the definition of compassion, common barriers and facilitators for residents to provide compassionate care and methods to develop or maintain compassion.
- Interviews with patients and residents
In total, we interviewed six patients and ten residents (from various specialties and years of training) about their experiences with and views about compassionate care in Amsterdam UMC. Four researchers iteratively analysed the interviews using a template analysis. This means that the researchers individually identified the essential themes from the interviews. Next, the researchers discussed and clustered the themes. This resulted in a template consisting of codes which were used to analyse the other interviews. The templates and results from the analysis were discussed in detail during the project meetings.
Patients value compassion and its contribution to their (experiences with) healthcare: “During the procedure that resident sat next to me. And, yes, that was very comforting […] I found that very kind”. Patients also recognize room for improvement. For example, they would like residents to ask them what is really important to them. Most residents believe compassion is an essential part of their job: “It is one of the most important aspects of my job; it also gives me a sense of fulfilment”. However, residents also mentioned that providing compassionate care is sometimes difficult as they experience high work pressure and a lack of time.
- Co-creation session
On October 29th, we organized a session with patients, residents, researchers, and experts on compassion (interventions) to jointly define the outlines (content and format) of the compassion intervention. It was agreed upon that the intervention must address at least the following aspects: (a) residents’ assumptions, beliefs and emotions considering patients and patient care, (b) empathising with the patient and, (c) exploring the “right” amount of compassion. Moreover, the co-creation session seemed to be an intervention on its own; serving as a platform where patients and residents exchanged their ideas about and experiences with compassion.
- Intervention development
The intervention will be ready by the beginning of 2020, building on the information collected in the previous steps. For the design of the final intervention, we defined some guiding principles. First, the intervention should not be provided as an extra burden for residents; that is it should be embedded in current (educational) systems and time available to the residents. Second, we do not consider compassion as a new skill which residents are expected to “learn from scratch”. Moreover, we see compassion as a quality present in all of us; we may need to support the further discovering of this quality. Therefore, the intervention supports resident in applying compassion in daily practice.
A look into the future…
The project team is eager to continue the work on the compassion intervention. In 2020, we aim to pilot the intervention as part of the Residents Generic Competencies Curriculum (‘Discipline Overstijgend Onderwijs’). To implement the intervention on a larger scale, we will explore new funding opportunities. The outcomes of the project will result in two scientific articles: (1) the development and evaluation of the intervention, and (2) the meaning and experience of compassion of patients and residents. The collaboration has proven to be very energetic, fruitful, creative and productive. We can’t wait to go on!
Would you like to know more about this project? Feel free to contact: email@example.com
PhD candidate – PP&CC research group (AMC)
PhD candidate – PP&CC research group (AMC)
PhD candidate and lecturer – Medical Humanities (VUmc)
Junior Researcher – PP&CC research group (AMC)
Prof. dr. Kiki Lombarts
Professor Professional Performance – PP&CC research group (AMC)
Prof. dr. Bert Molewijk
Professor Clinical Ethics Support and Quality of Care – Medical Humanities (VUmc)
Prof. dr. Guy Widdershoven
Professor of Philosophy and Ethics of Medicine – Medical Humanities (VUmc)
Prof. dr. Dick Willems
Professor of Medical Ethics – (AMC)
Head of the education department – Medical Psychology (AMC)
Lonneke van Heurn- Nijsten
Coordinator of the residents’ general educational program – CEBE (AMC)
Happy in & at work! This new movement stands for the wellbeing of young physicians.
On the 20th of november was the launch of this new movement Happy in & at Work. The new generation of young doctors (residents and gp’s in training) organized a national debate on what determines professional fulfillment for them. The organizations of young medical specialists and young GPs call for all healthcare stakeholders to be part of this movement and help remove barriers for physicians’ wellbeing and make meaning in work a high priority. Doctors and patients alike will benefit form more mental fit and professionally fulfilled doctors. In preparation of the national launch the research group PP&CC wrote a paper The Wellbeing of The New Generation Doctors (Dutch). We will continue to be closely involved and look forward to the next steps.
The Dutch Association for Cardiologists (NVVC) is afraid that the well-being of her members is being jeopardized by the high work pressure (Dutch) cardiologists often experience. In order to act properly, the union’s Quality Committee aims to get insight in this well-being of her members. It planned to do an inventory which should function as the foundation for future recommendations and a so called “standard” for a healthy cardiology practice in the Netherlands. The inventory and accompanying research will be performed by PP&CC.
Rosa Bogerd will be in the lead of the inventory and presentation/ reporting of the results. Together with the team we made questionnaire, existing of the literature’s most prominent constructs related to burn-out and fulfilment, that will provide insight into well-being, work pleasure and professional fulfilment, work pressure, time for patients, resilience, feedback culture, team atmospheres, etc amongst Dutch cardiologists. The questionnaire was filled in by 320 cardiologists. After analyzing the data, not only will they be used in the association’s Quality of Care report, but they will also be published in a scientific paper.