Amsterdam UMC, Vrije University Amsterdam, Department of Research in Education, VUmc School of Medical Scienc-es, Institute for Education and Training, Amsterdam, the Netherlands.
Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Int J Med Educ. 2021 Dec 3;12:245-256. doi: 10.5116/ijme.618a.463c.
To explore factors influencing work motivation negatively and the role of the fulfillment of basic psychological needs, described by the self-determination theory of motivation, as a possible coping mechanism for medical specialists.
A qualitative study was conducted in an academic medical center in the United States. Twelve medical specialists from different disciplines were recruited through convenience, snowball, and purposive sampling and shadowed for two days each. Semi-structured interviews were conducted afterwards. Data were transcribed, and thematic analysis was used for coding. Themes were finalized through discussion and consensus.
Medical specialists experience three main themes that are identified as stressors; 1) administrative tasks, so-called "administrative jungle", 2) delays and inefficiencies, and 3) poor patient outcomes. To be able to cope with these stressors, medical specialists construct different copingnarratives. Two coping narratives could be linked to autonomy: a narrative of acceptance and a narrative of reinstating autonomy. One coping narrative could be linked to relatedness: a narrative of relationships. No coping narrative could be linked to competence.
The results indicate that coping narratives about autonomy and relatedness are used to cope with moments of pressure, demand, or difficulty, so that patient care can continue to be the first priority. Becoming aware of these coping narratives, using them and reflecting on one's own can help medical specialists in successfully coping with stressors in their work lives. In turn, this can improve specialists wellbeing and performance for patient care as motivation remains.
探讨影响工作动机的负面因素，以及满足基本心理需求（由动机的自我决定理论描述）作为医学专家可能的应对机制的作用。
在美国的一所学术医学中心进行了一项定性研究。通过便利、滚雪球和目的性抽样招募了来自不同学科的 12 名医学专家，每位专家跟踪观察两天。随后进行半结构化访谈。转录数据，并使用主题分析进行编码。通过讨论和达成共识确定主题。
医学专家经历了三个被确定为压力源的主要主题；1）行政任务，所谓的“行政丛林”，2）延迟和效率低下，3）不良的患者结果。为了能够应对这些压力源，医学专家构建了不同的应对叙事。两种应对叙事可以与自主性相关联：接受叙事和重新建立自主性叙事。一种应对叙事可以与相关性相关联：关系叙事。没有应对叙事可以与能力相关联。
研究结果表明，关于自主性和相关性的应对叙事用于应对压力、需求或困难时刻，以便患者护理能够继续成为首要任务。意识到这些应对叙事，使用它们并反思自己可以帮助医学专家在工作生活中成功应对压力源。反过来，这可以提高专家的幸福感和患者护理绩效，因为动机仍然存在。
