Home Personal Development Shocking Revelations: Unbelievable Influences on Residents’ Internal Motivation, Grit, and Well-being

Shocking Revelations: Unbelievable Influences on Residents’ Internal Motivation, Grit, and Well-being

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Shocking Revelations: Unbelievable Influences on Residents’ Internal Motivation, Grit, and Well-being

Phase 1: Quantitative Analysis

Demographic Characteristics of Participants

A total of 245 residents (35% response rate; 65% female) participated in the study out of the 700 residents who were invited. Table 1 presents the demographic characteristics of the participants.

Table 1 Participants’ Baseline Characteristics (N = 245)

Univariate and multivariate analyses revealed significant relationships between autonomy and gender, sleep time, and exercise time. Competence was significantly associated with gender and family burden. Sleep time and exercise were significantly associated with residents’ well-being (Supplement file).

Factors Related to Basic Psychological Needs, Grit, and Well-being

In terms of autonomy and relatedness, gender had a significant association (p = 0.04, p = 0.01, respectively) with female residents showing higher levels of autonomy and a greater sense of relatedness than male residents (Table 2.1). Family burden had a significant association with relatedness (p = 0.01) as residents with less family responsibility scored higher on relatedness compared to other residents (Table 2.2). Exercise time showed a significant association with autonomy, relatedness, and well-being (p = 0.04, p = 0.02, p < 0.001, respectively) (Table 2.3). Sleep time also showed a significant association with autonomy, relatedness, and well-being (p = 0.01, p = 0.04, p < 0.001, respectively) (Table 2.4).

Correlations Between Internal Motivation, Grit, and Well-being

Internal motivation, which included autonomy, competence, and relatedness, was strongly positively associated with grit (autonomy: r = 0.846; competence: r = 0.906; relatedness: r = 0.842; p < 0.001). Autonomy, competence, and relatedness were also positively correlated with well-being (r = 0.625, r = 0.510, and r = 0.602, respectively; p < 0.001). Grit showed a mild positive correlation with residency well-being (r = 0.464; p < 0.001) (Table 3).

Phase 2: Qualitative Analysis

A total of 30 residents were interviewed, 18 from major departments and 12 from minor departments. The thematic analysis revealed four domains: supporting learning environment, faculty member characters and action in teaching, curriculum design, and personal factors outside the workplace.

Creating a Positive Learning Environment

Residents described a positive learning environment as one where they felt appreciated, respected, and supported by faculty members, fellow residents, peers, seniors, juniors, other professionals, and patients. Teachers played a crucial role in fostering autonomy and creating an approachable environment. They encouraged residents to be authentic, express their opinions, and make decisions regarding patient care without criticism. Examples were provided to emphasize the positive impact of a supportive learning environment.

“Compared to institutions that had previously graduated, Ramathibodi Hospital’s teachers were very open-minded to residents’ voices and thoughts. There was no consult protocol based on seniority of the residents and teachers. I felt more confident and have freedom to voice my own opinion. No concern or overstress about being blamed when there were some mistakes.” (ID24, female resident, year 3)

“I appreciated the teachers for allowing me to discuss about as I wanted…Being a resident here, I truly like it. Instead of criticizing my mistakes, the teacher suggests an alternate decision making, and better options for patient care.” (ID07, female resident, year 1)

A great work atmosphere resulted from everyone respecting one another and refraining from using derogatory words or displaying anger against one another.” (ID30, male resident, year 2)

Patient reactions and acts of disrespect could compromise the learning environment and negatively impact residents’ autonomy.

“During [the] COVID-19 situation, when I was assigned to postpone patients’ appointments to elective surgery, that had been canceled multiple time and postponed indefinitely. [A] Patient who had their appointment canceled was suddenly angry with me and used harsh words to me, then he threatened to sue me and request the sound recording accompanying the lawsuit…made me feel bad that no one can protect me. Although, I understood the feeling of [the] patient, but I felt insecure in work.” (ID26, male resident, year 1)

Acts of disrespect between senior doctors and residents could negatively impact teamwork and relationships.

“I felt bad when a fellow doctor (sub-specialty trainee) used strong reprimands, including throwing used gloves. Even though I realized I made a mistake by delaying consulting him in an emergency situation, I also believed the senior action was inappropriate. This makes me reluctant to interact with this fellow doctor again.” (ID22, male resident, year 2)

Residents valued challenging tasks, positive feedback, and well-deserved rewards, as they encouraged self-improvement and had a positive effect on their grit.

“I had received compliments on my earlier research presentations. It inspired me to finish this research.” (ID25, female resident, year 3)

“When I presented case report, I assumed that no one would be interested in listening too much. But the teacher still listened attentively and commented positively. Keep giving advice and encouragement.” (ID05, female resident, year 1)

“I felt good doing challenging work. Even though I would feel discouraged while working, everyone around me, especially the teacher, offered suggestions and support until the project was successful.” (ID17, resident, year 2)

Faculty Member Characters and Action in Teaching

Faculty members’ ability to provide feedback, act as role models, demonstrate respect, and be approachable and open-minded influenced residents’ internal motivation, grit, and well-being. Longitudinal support from faculty members and good relationships also enhanced residents’ grit in achieving long-term goals.

“I was grateful for the time I had set up for student feedback without restriction. Having teachers’ pay attention was a positive thing. Can assist in problem resolution.” (ID10, female resident, year 2)

“When people praised me, I felt accomplished. The award was more proof of my success. Encouraged me in maximizing my possibilities for profession. Teachers who are accessible could be able to talk through difficult issues until they are resolved. Additionally, friends and elders provide helpful examples of how to handle issues increasing work experience.” (ID06, female resident, year 3)

“I appreciated always having a teacher consultant. The teacher made suggestions and assisted with problem-solving, this could help to keep up my task until it was completed.” (ID27, female resident, year 1)

Curriculum Design

A well-designed curriculum with clear learning goals and objectives, meaningful tasks, clear role assignments, challenging tasks, and a learning timetable that aligns with the flow of healthcare services positively influenced residents’ motivation, grit, and well-being. Autonomy was emphasized in the curriculum design to allow residents to catch up and adapt to new information, enabling them to apply it in practical situations.

“During the residency training program that [a] senior resident [should] supervise [the] novice first year resident, making decisions only [on] uncomplicated issues, then a second-year resident will have an opportunity to approach and manage more complex cases under [their] teacher’s supervision. This systematic role arrangement which match with the level of difficulty or complexity made me feel more confident to make decision.” (ID17, female resident, year 2)

Relatedness was impacted by the competitive learning and assessment system, which affected relationships among residents.

“A poor educational system, in my opinion, that prioritized grades and performance. Teachers would pay special attention to residents who scored highly or had exceptional abilities. Ignoring the importance of acting morally uprightly but this isn’t like that. It’s great not to be in a hostile environment.” (ID16, male resident, year 1)

The allocation of time between practice and learning activities affected the residents’ autonomy, especially when inadequate time was provided for learning, limiting their capacity for autonomous decision-making.

“I had no time for class when I was on the emergency rotation since there were so many patients. Due to my inexperience of the proper order and the fact that my directions appeared odd to my peers, the nurse refused to follow my instructions. All of which made me reduced autonomy to make a decision from insecure perception of knowledge.” (ID08, female resident, year 1)

Personal Factors Outside the Workplace

Residents’ perceptions of their ability to manage their personal lives effectively, including having adequate personal time, financial stability, and support from friends and family, influenced their grit, well-being, and internal motivation. Adequate relaxation time was considered essential for job satisfaction and well-being.

“I really believed that having free time so you may take charge of your own life was essential for being able to work happily. How much fun will the course be? It’s undoubtedly not enjoyable if you did have no time for yourself.” (ID19, male resident, year 3)

“In 3 weeks, I had to work 10 shifts, I felt depressed every time when I was on duty.” (ID08, female resident, year 1)

Residents’ clear goals and determination to achieve those goals, along with strong support from family and friends, were crucial factors affecting their grit and ability to pursue their goals.

“One of the hardest things in my life was completing a research study. I had given up on three research projects, which left me dejected. I don’t want to do the research anymore, but I was unable to stop. Because I wouldn’t graduate if I couldn’t complete it. To get over this, I tried to soothe myself and ask my professors, friends, and family for guidance.” (ID02, female resident, year 3)

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