This summer we had a very fruitful gathering at the intimate Rogano conference for “Medical Education” scholars in Scotland. A somewhat larger delegation of our group (Sofiya Abedali, Joost van den Berg, Benny van Lier, Milou Silkens, Kiki Lombarts and Rosa Bogerd) visited the conference. Most of us presented our own work and were able to gather some great ideas from our peers. It was great to meet up with our international colleagues at the Royal College for Physicians and Surgeons in Glasgow! We want to thank the organization and we can’t wait for next year’s edition in Basel.

While night shifts are crucial for patient care, they threaten doctors’ well-being and performance. How exactly? This study by Maarten Debets et al. looked into doctors’ feelings surrounding night shift. We focused on doctors’ alertness, contentedness and calmness scores before and after night shifts. Using a sample of over 200 surgeons and gynaecologists and their residents, we were able to define some specific doctor profiles, which varied before (3 profiles) and after (4 profiles) night shifts. Alertness reduced most during night shifts, but age, specialty, sleep, shift duration and the number of consecutive shifts also associated with alertness, contentedness and calmness changes. Read the full publication here.

Physicians are constantly being approached to invest in their leadership skills. This is said to be necessary to meet the “challenges of the future of health care”. Consequently, a vast array of leadership programs has emerged. The question of what effects these physician leadership programs have on the organizations they work in is therefore more than relevant.
A systematic literature review seems a good start to answering this question. But leadership programs vary so widely that you can’t get very far with a simple survey of the literature. You can’t lump one-day courses with full MBA programs, monodisciplinary ones with multidisciplinary ones, and in-company training programs with those offered outside hospital walls. We see the same variety in the organizational outcomes studied: how do you compare the effects on finances, staff turnover, turnover and job satisfaction, for example?

To answer the research question posed, Maarten Debets et al. therefore opted for a so-called realist review. This is not – as in a systematic review – about studying the effect of X (leadership program) on Y (organizational outcomes), but unraveling under which contexts (C), which mechanisms (M) contribute to which outcomes (O). In this study, we developed a leadership program theory in which we uncovered 5 so-called CMOs that help explain how, why and under what circumstances physician leadership programs can have an impact on the hospital organization. You can read the result of this mega-job in this BMC Health Serv publication.

In this interview for De Cardioloog, Jose PS Henriques and Rosa Bogerd explain the results of our research into the well-being of Dutch cardiologists and its influencing factors. Through the link below you can read why we think well-being should be centralized as part of physicians’ professionalism and how meaningful patient contact plays an important role.

De Cardioloog | Werkgerelateerd welzijn onder Nederlandse cardiologen

Self-criticism and perfectionism are common in the medical profession and pose a potential threat to physicians’ professional fulfillment and, thus, the quality of care they are able to deliver. In this recently published study, Rosa Bogerd et al. investigated whether a “self-kindness” attitude was related to professional satisfaction. They found that self-kindness promotes physicians’ resilience and allows them to better manage their own work-life balance, thereby creating room for greater professional satisfaction. The full article can be found here.

Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being.
With the start of the new year, Kirsten Dabekaussen et al., published their new research on “Medical Professionals’ Perceptions of Unprofessional Behaviour in the Clinical Workplace”. The full article can be found here.

New year, new projects, new energy!

But first, we’d like to reflect on everything we’ve achieved in 2022 for performance, vitality and compassion in health care and medical education. We proudly present our Year Impression 2022! A collection in ‘numbers and narratives’ of all things our research group has committed to in the past year. 

Read all about our publications, excursions, awards and newest tools. Access our interactive overview of 2022 through the link above. 

A great way to start off the year: The study on Work-Related Well-Being Among Dutch Cardiologists – A National Survey (ScienceDirect) by Rosa Bogerd et al. was published in Current Problems in Cardiology. The study presents the results of a broad research project into work-related well-being amon Dutch cardiologists. Work-life interference and high workload affect the well-being of Dutch cardiologists negatively. However, this research also shows that promoting resources such as positive patient interaction and work autonomy are effective in fostering work-related well-being of cardiologists. The figure below presents an overview of the results.

On November first, Rosa Bogerd and Sofiya Abedali visited the APH Annual Meeting at Theater de Meervaart in Amsterdam. The theme of the day was Digitalization. Interesting keynotes were given on artificial intelligence in big data and potential ethical issues. During the break, Rosa Bogerd, as junior council member of the Quality of Care program, had the honor to participate as jury member and rate posters. Sofiya Abedali was a wonderful sparring partner in this! The day ended with a beautiful dance performance. We were inspired by this day and are happy to be affiliated to Amsterdam Public Health Research Institute.  

On October 25th, we came together in the Agnietenkapel in Amsterdam where Iris Jansen defended her dissertation titled ‘Interactions that matter. Understanding Residents’ Professional Growth Through Workplace Relationships’. During the promotion ceremony, she exchanged ideas with her honorable opponents about residents’ learning practices, the role nurses have in this, and the role of compassion in healthcare. Dr. Jansen answered all and every question with conviction and enthusiasm. We congratulate Dr. Iris Jansen, and her team, on this great achievement. 

This August, we went to beautiful Lyon for a week of conferences! Two days at the Rogano Meeting, and three days at AMEE 2022. Our research group  presented current research dilemma’s to critical friends at the Rogano Meeting. This meeting reminded us that everyone is a learner, dumb questions do not exist and that sometimes you have to go to France to meet your Dutch colleagues.

At AMEE 2022, we connected with our community of researchers in medical education from all over the world. PP&CC alumna Alina Smirnova presented her current research which she did in collaboration with Prof. Kiki Lombarts about a novel method of using electronic health record data to assess residents’ performance in pediatric emergency medicine. The paper is called: “Using Resident Sensitive Quality Measures derived from electronic health record data to assess residents’ performance in pediatric emergency medicine.” Through also participating in symposia, research presentations, and networking events we got to take part in the big conversations. In three days, we got up to speed on trends and new developments in medical education research and got inspiring input for our own research projects.

We have returned home energized from seeing our research colleagues in person, with new inspiration about medical education research, and renewed inspiration to write stories, not studies.

We are so proud! In the annual election of the Faculty of Medicine (UvA), ‘our’ post-doc Joost van den Berg, also internist- geriatrician resident, was elected as the best clinician (within the clerkships). We fully agree with this choice by the student association MFAS and we congratulate him for this well-deserved title! 

On June 16, the symposium WaanZinnige Zorg?! took place at the Tobacco Theatre, Amsterdam.
What a day! We look back on an event full of remarkable stories, reflections, knowledge and inspiration about insane and insanely good experiences in healthcare. In a dialogue, we discussed topics such as professionalism, compassion and vitality of physicians.

Through different eyes you see more
From the patient perspective, Marielle den Engelsman reminded us of the importance of compassion and attention to the person behind the patient. Mimic allowed us to experience the power of music in creating insane experiences for the patient. A thought-provoking example of exploring new and complementary ways to deliver good care.

The amazing interview
Karen Kruijthof interviewed Maarten Debets and Iris Jansen about their research into patient care and training of specialists.
‘It takes a village to raise a resident’
Iris Jansen discussed the importance of a supportive training climate, and emphasized that doctors, nurses and patients all play a role in the development of the residents.
‘Let’s take the bull by the horns’
Maarten Debets spoke about the approach to vitality of physicians, and argued for shifting piled up health and vitality interventions to creating an integral approach with attention to individual resilience and adaptation of the culture within an organization.

Are you agile?
Prof. Dr. Yvonne Steinert talked to us about why we feel resistance to change, how we feel resistance to change, how a growth mindset determines how we deal with change, and the importance of good leadership in change processes.
We can only learn from experience if we recognize events as opportunities for learning’. She shared her expertise on the importance of agility, and how everyone can work on their own agility.

Getting started with knowledge exchange
The inspiring lectures were followed by interactive sessions in which participants worked practically on the themes of vitality, professionalism and compassion.

Arts & Auto spoke with Prof. Kiki Lombarts about the rise of women in medicine, the 3 pillars of professional performance, being a digital nomad in (post) COVID time and her tendency to binge watch. At Arts & Auto, they call this “the warm interview“. That means as much as ‘read something about Kiki as a person too’.

In April this year, Rosa Bogerd had the honor to go to Florianopolis, Brazil, thanks to APH Quality of Care’s travelgrant. She visited Naarai Camboim, PhD candidate at the university of Florianopolis, who is planning on validating the SETQ Questionnaire in Brazil for her PhD trajectory. The visit marked the start of a fruitful collaboration! Together with Eric from Perito, Naarai and Rosa visited multiple hospitals in the state of Santa Catarina to introduce and discuss the SETQ questionnaire and its potential follow-up. The visits ended up in very enthusiastic reactions and the first pilots with the Brazilian SETQ questionnaire are planned to start in August this year. Curious about how this project continues? Keep an eye on our website!

During the COVID-19 pandemic, resident well-being was at risk. We therefore developed a well-being program aimed to help them maintain their health during the crisis. In this study we inquired residents’ perceptions of their well-being and how they managed to stay well. The results are now available. Supporting resident well-being on and outside the ICU during the COVID-19 pandemic: the use and value of institutional interventions and individual strategies.

How to combine physicians’ accountability requirements and their professional development aspirations? Using a design-based approach, the Amsterdam Medical Center designed a new system integrating and balancing the two. Buy-in from medical specialists and an incremental implementation process contributed to the final design, which was found to be positively received by the hospital-based physicians. Read the publication by Elisa Bindels, PhD et al here.

What happens to performance improvement potential when doctors overrate themselves? Mirja van der Meulen, PhD et al. answer this question in their latest study. Please click here for the results.

Kiki Lombarts returned from California, where she spent a full academic year as the Presence-CASBS 2020-21 fellow at Stanford University. CASBS is the renowned Center for Advanced Study in the Behavioral Sciences. The Presence program, led by Stanford Medicine’s Prof. Abraham Verghese, is dedicated to humanising healthcare.

Kiki is back in Amsterdam where she continues her work in professional performance, compassion, well-being and the feminization of medicine.

We invite you to the very first (but definitely not last) edition of APH Junified! APH Junified is a yearly returning event exclusively for APH junior researchers (including PhD candidates and post docs). The first edition, themed ‘Next Generation Researchers’, takes place on September 2 at Rosarium, Amsterdam.

More details on the program will soon be published on the APH website, so stay tuned.
We look forward meeting you all very soon!

Kevin Eva – Editor in Chief of the journal Medical Education – interviewed Iris Jansen in a podcast about her article “An act of performance: Exploring residents’ decision-making processes to seek help”. You can listen the conversation of 12 minutes via iTunes or the website.

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.

In times of change we may need it more than ever: a moment of silence and reflection. Barbara Doelenamn – one of our partners – contributes to this by offering a daily meditation through the International Compassion Community. As true researchers of Professional Performance & Compassionate Care we too will participate and investigate this for at least 6 months. All healthcare providers, and others interested, are welcome to join.

The assessment of physicians’ professional performance is of great importance. Not only does the public want to know that their physicians are fit-to-practice, but we also want to help physicians improve their professional performance. An often used method to assess physicians, are questionnaires. With these questionnaires physicians can gather feedback from multiple respondents: also known as multisource feedback. Yet to use these questionnaire for the assessment of physicians we need to make sure that they are providing valid data. The thesis “Assessment of physicians’ professional performance using questionnaire-based tools” has been written to investigate this matter. Within this thesis several topics are enlightened: “What kind of evidence for the validity of using questionnaire-based tools for the assessment of physicians is there already?”, “Do physicians who deliver high-quality health care receive high scores from their colleagues?” and “Does the professional performance of physicians actually improve after receiving multisource feedback?”. To find out more about these topics, and the answer to these questions: please click here!

Mirja van der Meulen defended her thesis in Maastricht.

In this multicenter observational study we investigated associations of job demands and resources with patient-related burnout among physicians. We found that physicians  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. Read the paper by R. Scheepers, PhD et al, published in BMJ Open.

PhD candidate Maarten Debets and colleagues compared the ratings of anesthesiology residents about their supervisor’s teaching performance (SETQ) measured by five- and seven-point response scales. More specifically, we looked at the variability of the ratings and how residents used the additional response categories. Both the five and seven-point answer scales provide valid measurements of the faculty’s teaching performance. However, the seven-point answer scale offers residents the opportunity for a more nuanced evaluation. Residents mainly made use of this opportunity for the positive response categories. Switching from five- to seven-point scales can be beneficial. Read the article Variability of residents’ ratings of faculty’s teaching performance measured by five- and seven-point response scales, here!

Physicians’ work-related well-being  is crucial for the quality of care. Maarten Debets et al. describe how they developed, piloted and evaluated a well-being program for physicians, published in Perspectives on Medical Education. In this paper the authors present the lessons learned in this process and they present 7 practical tips for others who want to design well-being interventions for health care professionals. The paper can be found here.

We are more than proud that Kiki Lombarts has the honor to be a fellow at the Center for Advanced Study in the Behavioral Sciences (CASBS) at Stanford University for the full academic year 2020-2021. Her position is supported by Stanford Medicine’s Presence Program lead by Prof. dr Abraham Verghese. The mission of the Presence Program is to humanize healthcare. Kiki Lombarts will support the program and hopes to ultimately contribute to improving patient care and physicians’ professional fulfillment. She will definitely enjoy  a year of inspiration and reflection.

Joining efforts the research group PP&CC and software developer NEBU were able to design, and now launch!,  our new online platform for easy, safe and evidence-based evaluations of physicians’ professional performance. Hurray to the Perito platform!
Perito supports medical specialists and residents in their continues professional development using our validated, research-based (and well-known) tools such as SETQ, D-RECT, TeamQ and INCEPT questionnaire. We are extremely proud of our new platform, and we are now able to offer our measurement tools and deliver the results in attractive performance reports. If you are interested in using our tools please contact us or take a look at our website: www.peritoprofessionalperformance.nl.

How nice to close off 2019 with this new publication on The impact of mindfulness-based interventions on doctors’ well-being and performance. This systematic review was conducted by researchers Renee Scheepers, Helga Emke, Ronald Epstein and Kiki Lombarts.

Physicians’ work engagement and their experienced meaning of work go hand in hand. This is one of the conclusions from the national kick-off meeting on happiness and well-being of young doctors. Professors Kiki Lombarts and Antoinette de Bont analysed the data and report their preliminary results here (sorry, only in Dutch). The academic work on work engagement and well-being will continue in 2020. More importantly, the new generation of young doctors will actively keep striving for meaningful work and professional fulfillment. Spending time with patients seems to be the key in these efforts.

We look back on a successful conference of the Dutch Association of Medical Education (NVMO) in Rotterdam, the Netherlands. The Professional Performance researchers made several contributions:

• Prof. Kiki Lombarts presented the ‘patient safety study’, a study led by colleague and first author Milou Silkens, PhD. This study focussed on the question whether residents’ patient safety behaviour can be explained by learning and patient safety climates.
• Iris Jansen, PhD candidate, talked about her latest publication: to what extent is teamwork effectiveness of clinical teaching teams associated with residents’ learning climate.
• Iris and Kiki, together with Renee Stalmeijer, PhD, moderated a workshop entitled ‘Roll up your sleeves! Working on the learning climate’. In this workshop participants ‘worked on’ the learning climate within and between stakeholder specific groups. This resulted in valuable conversations and having more insight in each other’s perspective. We thank all the (51!) participants.

Hope to see you at next year’s NVMO Conference!

Tonight was the launch of the 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).

Hi everyone! My name is Rosa Bogerd, I am 26 years old and I am pleased to introduce myself as the newest member of the research group Professional Performance & Compassionate Care, at the department of Medical Psychology within the Amsterdam UMC. As a junior researcher I am hoping to develop my skills and knowledge within the research field of Compassionate Care and I am very excited about being a part of the team. Over a year ago I completed my Masters in Public Administration: Governance of Healthcare (Innovation) and my Masters in Philosophy, Bioethics and Health. Since I have been working outside of the medical academic field for a little year, I can now truly say that I am glad to be back! I have always been interested in the multiple facets, different dynamics and complexity of healthcare (systems). Combined with a strong tendency towards the ethical aspects and dilemmas of health and healthcare, I can only say that I am honored to be a part of the beautiful and inspiring Compassion Project. Let’s start!

The pursuit for high quality surgical care brings us to surgeons’ attitudes. Inspired by the work done for pilots, we looked at hazardous attitudes of surgeons, such as macho and anti-authorian behaviours. We developed a prototype tool to measure such attitudes. A new publication by Kirsten Dabekaussen, Renee Scheepers, Erik Heineman en Kiki Lombarts.

Kiki Lombarts wrote the new book Physicians’ Professional Performance: Between Time and Technology. The book is a plea for doctors with cool heads and warm hearts. It is the result of Prof. Kiki Lombarts’ reflections on working with physicians for over 25 years in the Netherlands and abroad. Lombarts identifies three pillars of professional performance – i.e., the constant pursuit of excellence, humanistic practice, and accountability for one’s own actions – which seem to reflect a shared ideal of many physicians. According to her, these three pillars should be further explored by the medical profession and should be translated into medical training and practice, and into policies to monitor and promote the quality of patient care. Curious? You may order here!

Do you know je KeyLime, the podcasts series Key Literature in Medical Education? The four critical experts, Jason Frank, John Serbino, Linda Shnell and Lara Varpio read, review, debate and rate self-selected medical education research papers. Their approach is both razor-sharp and friendly, and they seem to have fun together in talking about research and their own med ed experiences. We are honoured that one of our papers, the Acad Med paper by Alina Smirnova et al was picked for their podcast: Defining and Adopting Clinical Performance Measures in Graduate Medical Education: Where are We Now and Where Are We Going? Our work received high ratings (thank you!). They titled the podcast: The Hitchhiker’s Guide to Clinical Performance Indicators. Sounds like a great compliment to us! Listening to KeyLime is a great way to keep up with the med educ literature.

The learning climate is not only a ‘hot’ topic in the Netherlands. In Colombia learning climate is also recognized as an important contributor to the quality of residency training. For measuring the learning climate Colombian colleageus translated and investigated the Dutch measurement tool DRECT (Dutch Residency Educational Climate Tool). Milou Silkens from our PP&CC research group collaborated with the Colombian researchers. Read the paper here. Spoiler: validity and reliability of the Spanish version of the DRECT could be confirmed for the Colombian context.

The first article of PhD-candidate Iris Jansen was published in Medical Teacher. Together with Kiki Lombarts, Renée Stalmeijer and Milou Silkens, she studied to what extent teamwork effectiveness within teaching teams is associated with (1) the overall learning climate of residents, and (2) its affective, cognitive and instrumental facets? Effective teamwork within teaching teams benefits overall learning climates, however, not all the separate facets. Curious about the findings? The article can be found here: Team up! Linking teamwork effectiveness of clinical teaching teams to residents’ experienced learning climate

We are very happy to announce that the APH-QoC research program committee 2019 awarded us a grant for our proposed project ‘Quality of care and quality of caring: developing a compassion training for physicians’. In the project we aim to develop a patient and physician-informed compassion intervention for residents.
The project will be executed in close collaboration with our colleagues at  the VUmc.

The validation study of the Group Monitor has been accepted for publication in the Journal of Continuing Education in Health Professions! This makes the Group Monitor the first evidence-based 360-degree feedback GROUP instrument. With the help of the Group Monitor, perceptions of the group performance of physician groups are gathered from four respondent groups: (1) the medical specialists of the physician group itself, (2) specialists from adjacent groups and departments, (3) support staff, such as nurses and secretarial staff, and (4) hospital managers. Thanks to all the authors who contributed: Elisa Bindels, Benjamin Boerebach, Mirja van der Meulen, Jeroen Donkers, Myra van den Goor, Albert Scherpbier, Kiki Lombarts and Sylvia Heeneman.

The Amsterdam Vondel Parc was the ideal environment for a workshop on Residents’ Vitality. In this second and last part of residents’ training on personal vitality, the greatest challege was to make some authentic choices for one’s own vitality or well-being. Kiki Lombarts and Maarten Debets were leading this session. For all participants the outcome was a personal vitality plan. And a bit more energy we hope 🙂

This April the article titled “Exploring Validity Evidence Associated With Questionnaire-Based Tools for Assessing the Professional Performance of Physicians: A Systematic Review” has been published in Academic Medicine PhD-candidate Mirja van der Meulen and her colleague Alina Smirnova, and their team members:Sylvia Heeneman, Mirjam oude Egbrink, Cees van der Vleuten en Kiki Lombarts. With this review the authors investigated how much validity evidence there is, for the use of questionnaire-based tools to evaluate practicing physicians. You can read the whole article here!