Out of a total of 170 participants, 69 MHAs (14 professors, 20 associate professors, 35 assistant professors) and 101 HCPs (35 consultants, 41 specialists and 25 residents) were interviewed.
To maintain the goodness of research, a continuous check for consistency and interpretation throughout the coding scheme was maintained. In an iterative manner, a thorough search and revision of the descriptive themes was performed which led to the rearrangement of codes into newly emerging thematic categories, resulting in the identification of five distinct themes. Engaged in researchers’ discussions involving a thorough comparison and refinement of themes, we ultimately condensed the initial five themes into three overarching themes accompanied by two sub-themes in each category. The restructuring of codes to align with the newly defined thematic categories were carried out to ensure accurate representation of contents. Another key finding which was highlighted in this study were the contrasting statements put forward by HCPs and MHAs in terms of realistic expectations, personal well-beign and work-life balance with different meanings for both groups of participants. The schema of this iterative approach is summarised in Table 1.
Stage
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Description of analysis process
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Authors involved
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Initial coding
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line-by-line inductive coding approach to grasp the essence and substance of the data.
- Generated a total of 95 codes by SSG and SYG.
- Organized codes into eight preliminary themes for structured representation of the data.
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AMR, FAS, and YAM
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Initial theme development
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- Continuous check for consistency and interpretation throughout the coding scheme.
- Iterative search and review of descriptive themes.
- Rearrangement of codes into newly emerging thematic categories.
- Identification of five distinct themes.
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SSG, SYG, AMR, FAS, and YAM
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Theme refinement
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- Constant contrast and compare process.
- Refined list of three themes with two sub-themes in each category.
- Engaged in author discussions involving thorough comparison and refinement of themes.
- Condensing the initial five themes into three overarching themes accompanied by two sub-themes in each.
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SSG, SYG, AMR, FAS, and YAM
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Code restructuring
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- Codes restructuring to align with newly defined thematic categories.
- Ensuring accurate representation of the content through iterative refinement and alignment of codes with themes.
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SSG
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Validation
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- Validation of themes through peer review or other methods to ensure reliability and credibility.
- Verification of thematic interpretations by cross-referencing with original data.
- Addressing any discrepancies or inconsistencies through further discussion and refinement.
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SSG, SYG
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Reporting
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- Documentation of the final thematic structure and interpretations in the research report or publication.
- Explanation of the rationale behind theme selection and development process.
- Clear presentation of findings supported by illustrative examples or quotes from the data.
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SSG
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Table 1: The 6-step approach used in this study for the inductive qualitative themnatic analysis.
Through a comprehensive inductive thematic analysis of responses to seven key questions, three overarching themes emerged, reflecting the intricate interplay between cognitive mastery, affective well-being, and conative efficiency (Figure 1).
The theme of ‘cognitive mastery’ underscores the significance of continuous learning, adaptation, and problem-solving skills. ‘affective well-being’ highlights the role of a positive outlook and social support in fostering emotional strength. ‘conative efficiency’ emphasizes practical strategies such as effective time management and proactive approaches. Illustrating these themes as interconnected and cyclical components provides valuable insights into the dynamic nature of resilience in the medical profession, where a harmonious integration of cognitive, affective, and conative elements plays a pivotal role in navigating the challenges posed by workplace stressors.
Theme I – Cognitive mastery
In the context of resilience, cognitive mastery surfaced as mental agility, continuous learning, and flexibility which HCPs and academics used to overcome challenges.
Two sub-themes were identified in this theme.
- Cognitive appraisal and adaptation
Multiple respondents stressed the ongoing need for learning and adaptation in the medical field especially continuous professional development with an embracing attitude to evolving challenges in the medical and academic filed, especially in the context of recent COVID-19 pandemic. Most respondents identified resilience as a cognitive ability keeping the dynamic nature of the field requiring a lifelong and continuous pursuit of knowledge.
"Stress in medical field comes a lot from being short staffed, extra working hours with no pay or compensation, workload, exams (residency fellowship), difficult patients and over-demanding families, difficult and abusive managers resistant to flexibility and positive change etc. All these difficulties wears a physician down and can lead to depression and burnout.”
1.2 Problem-solving abilities – role of emotional regulation
A significant portion of data highlighted resilience as an ability to approach challenges with a problem-solving mindset. They identified problem-solving skills as an enabler of HCPs to navigate through complex situations, by making informed choices in a particular context. To enhance problem-solving abilities, cognitive flexibility and adaptability were the desired attributes.
“Learn your limits, workout ways that work out best for you”.
“They fail to consider the root of their issues in order to resolve it which will only lead them to more frustration and stress”.
“They build good control of their emotions and don’t overreact to every problem they face”
“They are good at dissecting the problems they face and logically solving them without investing too many emotions in there, so that way it won’t affect them mentally as much. also, they are great at communication, this helps let their doubts out of the way”.
Theme II – Affective wellbeing
Affective wellbeing comprises of emotional and psychological health. This determines the ability of an individual to manage and respond to emotions, stressors, and interpersonal relationships at the workplace.
Two sub-themes were identified in this theme.
2.1 Gratification from professional efficacy
To achieve professional efficacy, respondents stressed on maintaining a positive mindset by cultivating an optimistic attitude to manage stress and build resilience. Seeking gratification from the opportunity to relieve someone’s sufferings and finding self-validation after a successful complex surgery is unique to medical profession. The participants acknowledged the importance of maintaining a hopeful and constructive perspective in the face of challenges. In terms of emotional support, fair compensation, self-care, and the need for a balanced workload were the key highlights. In medical and healthcare field, the connection between financial satisfaction, quality personal time, and mental health indicates the intricate relationship between emotional support and overall well-being.
“In person, reminding them about their important lifetime choice, they made to follow the Medical field, and how this is a very important contribution, to the community, society and also to themselves”
"Proper distribution of workload, time management, managing employment prior to being short-staffed, and teamwork with a positive attitude and harmony can have a great impact on physician performance and mental health."
"Salaries play a very distinctive role in the field of Medicine if the doctor is satisfied financially."
2.2 Social support
Within the workplace and personal life, role of social support emerged as a crucial factor to build resilience. Respondents highlighted nurturing connections with family and friends while fostering relationships with colleagues and peers were crucial. This point became the highlight in the context of medical field which unlike other professions is very demanding and complex. To ensure optimal psychological wellbeing, social support plays a crucial role.
“Resilient colleagues often practice self-care, use effective time management, seek support from friends and family, and engage in activities they enjoy outside of work.”
"Healthcare professionals are not like any other employees. Enhance the social working environment hence develop a sense of togetherness."
Theme III – Conative efficiency
This theme describes the practical, goal-oriented actions and behaviours of academics and HCPs to enhance their productivity and effectiveness in the face of challenges. Two sub-themes were the highlight of this section.
3.1 Proactive approaches – discipline and time management
Discipline and time management are considered as an enabler of conative efficiency by reducing burnout and exhaustion. Respondents pointed out the importance of planning, commitment, and avoiding distractions to optimize productivity. Effective time management demands a crisp focus which in turn helps to achieve academic and professional success.
“Create a study schedule and develop a structured study routine that includes breaks, time for self-care, and social activities."
"Ensure you get enough rest to maintain focus and prevent burnout."
“Set realistic expectations according to your limit and work one small goal each day until you reach the ultimate goal ahead”.
“Your life is not your profession. Your profession is just a small part of your entire life and happiness.
“Proper distribution of workload, time management, managing employment prior to being short-staffed and teamwork with positive attitude and harmony can have a great impact on physician performance and mental health."
3.2 Introspection and reflection
This sub-theme talks about the metacognitive abilities in the form of taking initiatives to make conscious decisions to address challenges. Participants identified resilience building strategies in the form of self-delineation. Prioritizing family and health, compartmentalization, and considering alternative approaches like spirituality, could mitigate stressors. The promotion of introspection and self-awareness aligns with a proactive mindset toward personal and professional development.
“To follow ‘attach and detach approach’ by keeping free time for family and recreation.”
“Practice mindfulness meditation, deep breathing, or other relaxation techniques to reduce stress and anxiety.”
“First, take care of yourself physically and mentally. Second, build a strong support network and finally, set realistic expectations.”
“To remain dynamic and not be too fixed and practice internal reflection”.
4.0 Other key findings
This study identified contrasting statements by HCPs and MHAs for realistic expectations, personal well-being and work-life balance. Each of these statement they held different meanings for both groups.
4.1 Realistic expectations for productivity and achievement.
In terms of realistic expectations, productivity and achievement for the MHAs was captured in the following comment
“Setting clear achievable goals and regularly reviewing progress provides a sense of direction and accomplishment which can reduce stress”.
On the other hand the HCPs clarified that productivity and achievement meant;
“ communication is the key and asking for help when needed, try to talk to other colleagues when facing any problems in the field because colleagues can understand and help”.
4.2 Personal well being
Another striking contrast among both groups was related to personal well being. For MHAs personal well being and was viewed as;
“ high-quality publication, community service and attendance at conferences… time is not sufficient to do the required work”..
Whilst in the same vein the HCPs stated;
“Being a doctor is the main challenge to understand patients' physical and mental illness and bear the psychological stress of different types of patients”.
4.3 Work-life balance
Interestingly work-life balance was another area which was also viewed differently by both groups. This was captured in the following statement by the MHAs;
“ Multitasking multiple things at the same time could lead to setting wrong priorities including balancing work overload, high quality publications, community service and participating in conferences”.
For the HCPs, work-life balance was welcomed by opportunities to;
“Attend conferences and participate in workshops or other activities that hospitals provide to promote social interactions between member of staff”.