A job-satisfaction measure for internal medicine residency program directors

Job characteristics that enrich clinician-educators' career: a theory-informed exploratory survey

Clinician educators (CEs) play a vital role in helping academic institutions achieve the missions of patient care, education and research. The driving forces that motivate pediatric CEs in professional growth and personal satisfaction remain unexplored. An exploratory survey research to investigate the job characteristics and factors that motivate CEs to pursue professional growth with personal satisfaction. Using the Job Characteristics Model (JCM) as a framework, we developed a 22-item survey comprised of the JCM derived Job Diagnostic Survey, Global Job Satisfaction scales and demographics. We collected data from January 2020 to March 2020 from self-identified pediatric CEs (with and without educational leadership roles) through a survey recruitment service. Given no data on total number of CEs in the survey pool, response rate was unknown. Job characteristics in the core job dimensions of meaningfulness, autonomy, and performance feedback, as well as, the derived Motivating Potential Score (MPS), were analyzed using descriptive statistics and regression models. From 201 respondents, including 55 education leaders, >70% were satisfied with patient care, teaching, and mentoring while <40% were satisfied with administrative and scholarly activities. Meaningfulness (in some areas), autonomy (patient care/teaching), and internal feedback (all areas) had significant effects on job satisfaction. In regression analysis, skill variety, feedback, and years of experience were associated with higher job satisfaction, and the MPS was a predictor of total job satisfaction. The JCM can be utilized to understand CE's motivations and needs within their workplace and guide professional development via job enrichment efforts.

A tool to assess the quality perception of healthcare employees

PURPOSE

The purpose of this project was to determine the validity and reliability of the Healthcare Quality Perception (HQP) questionnaire tool designed to capture employees' perceptions of healthcare quality in Indian hospitals.

DESIGN/METHODOLOGY/APPROACH

Two hundred employees in private and public sector hospitals in India were randomly selected and given the HQP tool. It consisted of 38 Likert-scale items and six different subscales: (1) Planning and Documentation (n = 7); (2) Employee Participation in Quality Management Activities (n = 5); (3) Existence of Policies/Procedures/Guidelines (n = 5); (4) Quality and Patient Safety Management (n = 9); (5) Perceived Effect of Quality Improvement (n = 7) and (6) Training and Development Opportunities (n = 5). 156 completed questionnaires were received, demonstrating a 78% response rate. HQP tool subjected to statistical analysis to measure its reliability and validity. A p-value of less than 0.05 was considered as "significant."

FINDINGS

Factor analysis pulled out six factors that conjointly demonstrated 66.4 % of the variance in healthcare professionals' (HCPs') perception of healthcare service quality in selected Indian hospitals. The overall Cronbach's alpha coefficient was measured at 0.959 for internal consistency reliability. This study demonstrates that the identified six critical factors are important determinants influencing HCPs' perception of the quality of healthcare services in private and public sector hospitals in India.

ORIGINALITY/VALUE

This study provides evidence for the reliability and validity of the newly developed HCP Scale for the assessment of employee perception of the quality of services offered in selected hospitals in India, with potential applications in other contexts.

Burnout and distress among internal medicine program directors: results of a national survey

BACKGROUND

Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors.

OBJECTIVE

To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations.

DESIGN AND PARTICIPANTS

The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs.

MAIN MEASURES

The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included.

KEY RESULTS

Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p = 0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations.

CONCLUSIONS

The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

Results from a transitional-year program director survey: identifying crucial issues and concerns

BACKGROUND

Transitional Year (TY) programs meet an important need by preparing residents for specialties that accept individuals after an initial preparatory year. To our knowledge, no surveys to date have been conducted to identify attributes of TY programs and concerns of TY program directors.

PURPOSE

The purpose of this study was to review TY program characteristics and identify critical issues and concerns of TY program directors (TYPDs).

METHODS

A web-based, 22-question survey was sent to all 114 TYPDs of programs accredited by the Accreditation Council for Graduate Medical Education between January and April 2011. The survey included open-formatted and closed-formatted questions addressing program and institution demographics, program director time, administrative support, satisfaction, and future plans.

RESULTS

The survey response rate was 86%. The median age of TY programs was 28 years, with few new programs. More than 80% of TY programs were conducted at community hospitals and university-affiliated community hospitals. Of the responding TYPDs, 17% had served less than 2 years, and 32% had served 10 years or more. Common sponsoring TY programs included internal medicine (88%), general surgery (42%), family medicine (25%), emergency medicine (24%), and pediatrics (18%). Overall, TYPDs were satisfied with their positions. They expressed concerns about inadequate time to complete duties, salary support, and administrative duties assigned to program coordinators. Forty-nine percent of TYPDs reported they planned to leave the position within the next 5 years.

CONCLUSIONS

Our survey provides useful information to assist institutions and the graduate medical education community in meeting the needs of TYPDs and strengthening TY programs.

Academic job satisfaction questionnaire: Construction and validation in Saudi Arabia

Background:

Colleges and universities are becoming increasingly accountable for teaching outcomes in order to meet rigorous accreditation standards. Job satisfaction (JS) seems more difficult to measure in the academic field in view of the complexity of roles, duties and responsibilities.

Objectives:

To compile and determine the psychometric properties of a proposed Academic Job Satisfaction Questionnaire (AJSQ) suitable for university faculty, and amenable to future upgrading.

Materials and Methods:

A 46-item five-option Likert-type draft questionnaire on JS was distributed for anonymous self-reporting by all the academic staff of five colleges in University of Dammam (n=340). The outcome measures were (1) factor analysis of the questionnaire items, (2) intra-factor α-Coefficient of Internal Consistency Reliability, (3) inter-factor correlations, (4) comparison of psychometric properties in separately analyzed main faculty subgroups.

Results:

The response rate was 72.9 percent. Factor analysis extracted eight factors which conjointly explained 60.3 percent of the variance in JS. These factors, in descending order of eigenvalue, were labeled “Authority”, “Supervision”, “Policies and Facilities”, “My Work Itself”, “Interpersonal Relationships”, “Commitment”, “Salary” and “Workload”. Cronbach's-α ranged from 0.90 in Supervision to 0.63 in Salary and Workload. All inter-factor correlations were positive and significant, ranging from 0.65 to 0.23. The psychometric properties of the instrument in separately analyzed subgroups divided by sex, nationality, college and clinical duties produced fairly comparable findings.

Conclusion:

The AJSQ demonstrated good overall psychometric properties in terms of construct validity and internal consistency reliability in both the overall sample and its separately analyzed subgroups. Recommendation: To replicate these findings in larger multicenter samples of academic staff.

HIV stigma and nurse job satisfaction in five African countries

This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sample, as in the other 2. Job satisfaction scores differed significantly among the 5 countries, and these differences were consistent across all subscales. A hierarchical regression showed that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influence on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These results provide new areas for intervention strategies that might enhance the work environment for nurses in these countries.

Who are surgery program directors and what do they need?

OBJECTIVE

The goals of this study are to define the demographics of program directors (PDs), characterize professional responsibilities and scholarly activities, assess career goals and perceptions, and determine what resources PDs have and how they use them.

METHODS

A cross-sectional, confidential, Institutional Review Board (IRB)-approved, Internet-based survey was sent to general surgery PDs. PDs were identified from lists of known residencies from the Association of Program Directors in Surgery (APDS) and the Accreditation Council for Graduate Medical Education (ACGME). E-mail follow-up was used to contact nonresponders and partial responders. Demographic data were analyzed with descriptive statistics.

RESULTS

The response rate was 58%. The mean age was 51.3 +/- 8.2 years. Most respondents were male (89.7%), Caucasian (86.9%), and fellowship trained (63.7%). Few PDs have teaching credentials (11%), but most PDs have sought additional training in teaching (63%). PDs work a total of 73 hours per week. They spend about 41 hours per week on clinical duties and about 22 hours per week on program director duties. PDs have an average of 4-5 support staff members; 81.5% of PDs have an assistant program director (APD). A few PDs have formal protected time (38.7%). Most PDs feel they have support for professional development and feel supported by their chairperson (90.8% and 94.1%, respectively). Lower job satisfaction scores were observed in measures of feeling valued by colleagues and in the availability of institutional resources.

CONCLUSION

Most surgery PDs are fellowship trained, are currently conducting research, have an APD in their program, and feel supported by their chairperson. Most PDs do not have protected time, and some feel insufficient institutional resources are available for their responsibilities.

Developing and testing an instrument for identifying performance incentives in the Greek health care sector

BACKGROUND

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

METHODS

A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure.

RESULTS

Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied.

CONCLUSION

Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system.

The effect of two models of supervision on selected outcomes

PURPOSE

To evaluate the effect of training in two different supervisory models on the supervision itself, the quality of care, and job satisfaction of nurses in different service settings in a district health service (DHS) in South Africa.

DESIGN

As part of a larger health systems study, the results of supervision training were evaluated. The quantitative study was done in three health districts in South Africa.

METHODS

The modified matrix (MM) model of supervision was taught and implemented in District A, the Centre for Health and Social Studies (CHESS) model in District B, and the control was District C. Checklists based on direct observation and record reviews were used to measure quality of care (quality of hand-over between shifts, nursing records, management of chronic diseases, and implementation of universal precautions). Questionnaires were used to measure perception of supervision and patient satisfaction. Chi-square analysis was done.

FINDINGS AND CONCLUSIONS

Supervision ratings before and after the interventions differed significantly in the total sample, but not by district. In the district with the MM model, care for people with chronic diseases improved significantly, but other measures did not. The supervision training had some influence, but more measures of effectiveness of supervision training are needed.

Job satisfaction among program directors in obstetrics and gynecology: A national portrait

OBJECTIVES

The purpose of this study was to determine job satisfaction among program directors in obstetrics and gynecology with the use of a validated tool and to identify specific sources of dissatisfaction that might lead to job change.

STUDY DESIGN

The program director satisfaction and a global job satisfaction survey were sent to all program directors in the United States. Motivators for seeking a job change were assessed. The chi(2) test, Kruskal-Wallis test, correlation analysis, and multiple linear regression were used.

RESULTS

Seventy percent of 254 surveys were completed. Global job satisfaction (minimum, 4; maximum, 16) was 11.9+/-2.9; mean program director satisfaction score was 135+/-25.8 (minimum, 54; maximum, 200). Job satisfaction was highest in chairs, full professors, those whose age was >50 years, and those with >5 years of experience (P=.02) and in facets that were related to work with residents, colleagues, and patients. Dissatisfaction was highest with regard to salary, promotion opportunities, and resources. Forty-six percent of those who responded were considering a job change in 3 years; the most common reason for a job change that was cited was administrative hassles.

CONCLUSION

Although job satisfaction is high among program directors, administrative hassles may lead to high rate of rapid turnover.

Benchmarks of support in internal medicine residency training programs

PURPOSE

To identify benchmarks of financial and staff support in internal medicine residency training programs and their correlation with indicators of quality.

METHOD

A survey instrument to determine characteristics of support of residency training programs was mailed to each member program of the Association of Program Directors of Internal Medicine. Results were correlated with the three-year running average of the pass rates on the American Board of Internal Medicine certifying examination using bivariate and multivariate analyses.

RESULTS

Of 394 surveys, 287 (73%) were completed: 74% of respondents were program directors and 20% were both chair and program director. The mean duration as program director was 7.5 years (median = 5), but it was significantly lower for women than for men (4.9 versus 8.1; p =.001). Respondents spent 62% of their time in educational and administrative duties, 30% in clinical activities, 5% in research, and 2% in other activities. Most chief residents were PGY4s, with 72% receiving compensation additional to base salary. On average, there was one associate program director for every 33 residents, one chief resident for every 27 residents, and one staff person for every 21 residents. Most programs provided trainees with incremental educational stipends, meals while oncall, travel and meeting expenses, and parking. Support from pharmaceutical companies was used for meals, books, and meeting expenses. Almost all programs provided meals for applicants, with 15% providing travel allowances and 37% providing lodging. The programs' board pass rates significantly correlated with the numbers of faculty fulltime equivalents (FTEs), the numbers of resident FTEs per office staff FTEs, and the numbers of categorical and preliminary applications received and ranked by the programs in 1998 and 1999. Regression analyses demonstrated three independent predictors of the programs' board pass rates: number of faculty (a positive predictor), percentage of clinical work performed by the program director (a negative predictor), and financial support from pharmaceutical companies (also a negative predictor).

CONCLUSIONS

These results identify benchmarks of financial and staff support provided to internal medicine residency programs. Some of these benchmarks are correlated with board pass rate, an accepted indicator of quality in residency training. Program directors and chairs can use this information to identify areas that may benefit from enhanced financial and administrative support.

Job turnover and its correlates among residency program directors in internal medicine: a three-year cohort study

PURPOSE

In 1983, 43% of internal medicine residency program directors had held their positions for less than three years. The purposes of this study were to determine the job turnover rate for internal medicine program directors, and the characteristics of program directors and residency programs that are associated with job turnover.

METHOD

In October 1996, questionnaires were sent to all non-military internal medicine residency program directors in the continental United States listed by the Accreditation Council for Graduate Medical Education (ACGME). The questionnaire covered demographics, program characteristics, and job satisfaction. In October 1999, an updated ACGME list was used to contact programs to verify changes in program directors and determine the dates of change.

RESULTS

A total of 262 usable responses were received. At the beginning of the study, 49% of the respondents had been on the job for three years or less, and 74 (29%) were no longer program directors three years later. Overall job satisfaction was highly associated (p <.01) with turnover. Multivariate Cox regression modeling yielded four variables independently associated with turnover: low satisfaction with colleague relationships (hazard ratio = 3.2, 95% CI = 1.6-6.4), a high percentage of administrative work time (HR = 2.9, 95% CI = 1.4-6.2), perceiving the job as a "stepping stone" (HR = 1.8, 95% CI = 1.0-3.2), and having had formal training to deal with problem residents (HR = 0.6, 95% CI = 0.4-1.1). Respondents with burnout, with the titles of program director and chair or department chief, and with less than two years on the job had nonsignificant trends toward job turnover. Variables not associated with turnover included gender, rank, salary, and program size.

CONCLUSIONS

Yearly turnover for internal medicine residency program directors is substantial. The four independent predictors of turnover identified in this study should be of interest to institutions recruiting or retaining program directors and to aspiring program directors.