A Positive Approach to Professional Development Vicki Flynn, M.D. - - PowerPoint PPT Presentation

Vicki Flynn, M.D. Department of Psychiatry University of Arkansas for Medical Sciences

A Positive Approach to Professional Development

Peer reviewed and accepted for an

• ral

presentation at American Psychiatric Association (APA) Annual Meeting, April 27 2020. Cancelled due to COVID-19 pandemic

Objectives

• Recognize challenges and opportunities at different stages of development
• Identify virtues and character traits to enhance throughout career
• Gain an understanding of professional burnout – potential causes, consequences,

and solutions

Background

• Most people spend a third of their adult lives at work, making wellbeing at work a

key component of their overall wellbeing (1)

• Transitions in training, job search, and a career can be both exciting and

challenging, with the potential for self-doubt, imposter syndrome, burnout, turnover, and early career transition

• Positive psychology and psychiatry are approaches to mental health, rather than

mental illness, with an emphasis on enhancement of positive psychosocial traits, promotion of positive change, and development of wellbeing(2–5)

Positive Psychological Traits

• Positive psychosocial factors (PPSF) include positive social and environmental

influences and internal positive psychological traits (PPT)

• PPTs originate from the positive psychology movement which focuses on

circumstances and processes that yield successful and optimal functioning in individuals, groups, and institutions

• Enhancement of PPTs is helpful for both personal and professional development

Challenges and Opportunities

• Individuals face unique challenges and opportunities as they progress through

various stages of their profession

• These challenges can be viewed through a developmental lens, similar to Erikson’s

psychosocial development model, and traversed by enhancement of various character strengths and virtues

Challenges and Opportunities

Professional Development: Opportunities, Challenges, and Character Traits

Stage of Career Opportunities and Challenges Erikson developmental phase Associated Virtue Student Knowledge acquisition; Test based performance evaluation Autonomy vs. Shame and doubt Curiosity and Optimism Apprenticeship Learning to apply acquired knowledge; Supervised application of acquired knowledge; Skill based performance evaluation Industry vs. Inferiority Love of Learning Early Career Transition to young professional; Independent application of knowledge; Skill based performance evaluation Professional Identity vs. Role Confusion Vitality and Zest Mid-Career Professional mastery and wisdom; Leadership and mentorship development Intimacy vs. Isolation Social and Emotional Intelligence Late Career Expert professional mastery; Knowledge and skill transfer to trainees Generativity vs. Stagnation Perspective, Kindness, and Gratitude Retirement Transition from professional life; Evaluation of personal and professional life accomplishments Integrity vs. Ego Despair Appreciation of Beauty and Excellence

Important Character Traits

• Curiosity and Optimism

▫ Curiosity accounts for 10% of the variance of learning and performance (19) with greater curiosity associated with greater learning, engagement, and performance (20) ▫ Individuals with high levels of optimism tend to attribute positive outcomes to internal, stable factors and negative outcomes to external, temporary factors (2)

Point in Career Developmental stage Character Trait or Virtue Student and Trainee Autonomy vs. Shame and Doubt Curiosity and Optimism

Important Character Traits

• Love of Learning

▫ Enjoy learning for the sake of learning and are able to self-regulate efforts to persevere, despite challenge and frustration (18) ▫ Beneficial for life-long learners in nearly every field – healthcare, business, education, finance – as advancements in technology rapidly change daily operations and communication avenues to exchange information ▫ Developing love of learning as a strength leads to increased opportunities for skill development and gaining value from learning by increased confidence, competence and an optimistic sense of possibility

Point in Career Developmental stage Character Trait or Virtue Apprenticeship Industry vs. Inferiority Love of Learning

Important Character Traits

• Vitality or Zest

▫ Vitality is a positive energy from within that energizes and motivates the self and others ▫ Vigor, enthusiasm, spirit ▫ Vitality is increased by

 Self-motivated activities with a perceived internal locus of causality(24)  Exercise and a healthy lifestyle (25-27)  Coaching and training workshops (28)  Environmental (nature) and social contacts (29-31)

Point in Career Developmental stage Character Trait or Virtue Early-Career Professional Identity vs. Role Confusion Vitality

Important Character Traits

• Social and Emotional Intelligence (SEI)

▫ Skills of self-awareness, self-regulation, motivation, empathy, and social skill

 Identify emotion in faces, voices, and designs; use this information to facilitate cognitive activities; understand what this means in relationships; manage and regulate emotions of the self and others; use social information to facilitate cooperation; and identify social relationships and hierarchies among groups(18)

▫ Goleman argues this may be more important than IQ for successful leadership(32) ▫ Acceptance and Commitment Therapy (ACT) practices to build skills

 Recognize thought and emotion patterns, label thoughts and emotions, accept ideas and emotions with an open attitude, and act based on values(32)

▫ Strengthening emotional agility and social-emotional intelligence can alleviate stress, reduce errors, increase innovation, and improve performance(32)

Point in Career Developmental stage Character Trait or Virtue Mid-Career Intimacy vs. Isolation Social and Emotional Intelligence

Important Character Traits

• Perspective and Gratitude

▫ Gratitude arises from belief that one benefitted from actions of another; it is acknowledgement

• f this gift, appreciation and recognition of the value of that gift(18)

▫ Late career individuals who benefitted from assistance of another often give back to trainees and early career individuals. Their generativity and inclusion positively affects the development of trainees and early career professionals ▫ Two work-related gratitude diary entries per week decrease perceived stress at work(33) ▫ Generating gratitude in the workplace through various gratitude interventions increases job satisfaction(34)

Point in Career Developmental stage Character Trait or Virtue Late-Career Generativity vs. Stagnation Perspective, Kindness, Gratitude

Important Character Traits

• Appreciation of Beauty in Excellence

▫ Individuals who have reached later phases of their career and retirement theoretically reach what Maslow would describe as the “peak experience” of one’s career ▫ Peak experiences capitalize on a gained appreciation and include a selfless attitude, receptive and humble cognition, enhanced ability to see, hear, and connect with others, and a view of the world as good and beautiful despite conflicts and suffering(35) ▫ Appreciative inquiry has been studied to celebrate excellence in a community, with the goal of further increasing positivity and excellence(36)

Point in Career Developmental stage Character Trait or Virtue Retirement Integrity vs. Ego Despair Appreciation of Beauty and Excellence

Professional Burnout

• Emotional exhaustion, depersonalization, low sense of personal accomplishment
• Of concern for healthcare, as rates exceed 50% in students, trainees, and early

career professionals(7–13)

• Affects ability to successfully navigate challenges throughout professional

development, especially during role transition where burnout rates are higher

• Professional and personal consequences

▫ Depression, maladaptive coping (alcohol or drug use), broken relationships, work errors, decreased satisfaction, and intent to leave one’s job

Potential Solutions

Organizational Leadership Individual

Potential Solutions

• Individual

▫ Interventions of mindfulness training, meditation, gratitude exercises or reengagement with hobbies(33,34,49–52,60,61)

• Organization / Leadership

▫ Specific interventions to target proposed drivers for engagement or burnout – values and culture, meaning, flexibility, community, resources, workload, and work-life integration (11) ▫ Address the psychological needs of employees, cultivate organization-employee relationships, and sponsor leadership development in order to develop comradery and excellence (63)

Potential Solutions

• Professional coaching

▫ A results-oriented method of enhancing self-awareness, drawing on individual strengths, questioning self-defeating thoughts and beliefs, examining new perspectives, and aligning personal values with professional duties (64) ▫ International Coaching Federation (ICF) defines the goal of coaching as a partnership with a client to inspire them to reach their full potential through a thought provoking, question driven, creative process (16)

Summary

• Individuals face unique challenges and opportunities as they progress through various

stages of their profession

• Challenges seen through a developmental lens, like Erikson’s psychosocial development

model, are traversed by enhancement of strengths and virtues

• Professional burnout is associated with personal and professional consequences
• Interventions to improve satisfaction and reduce burnout at individual, organization, or

leadership levels should be specific, not universal

• A professional coach or mentor guides in professional developmental challenges

Thank you!

• Please contact me with follow up questions, comments, or thoughts.
• Vicki Flynn, MD

▫ vflynn@uams.edu

References

• 1. World Health Organization. Global strategy on occupational health for all: the way to health at work, recommendation of the Second Meeting of

the WHO Collaborating Centres in Occupational Health, 11-14 October 1994, Beijing, China.

• 2. Jeste DV, Palmer BW, American Psychiatric Publishing, editors. Positive psychiatry: a clinical handbook. First edition. Washington, DC: American

Psychiatric Publishing, a division of American Psychiatric Association; 2015. 363 p.

• 3. Rashid T, Seligman MEP. Positive psychotherapy: clinician manual [Internet]. 2018 [cited 2019 Jan 13]. Available from:

http://dx.doi.org/10.1093/med-psych/9780195325386.001.0001

• 4. Seligman MEP, Steen TA, Park N, Peterson C. Positive Psychology Progress: Empirical Validation of Interventions. Am Psychol. 2005;60(5):410–21.
• 5. Summers RF, Jeste DV, American Psychiatric Association Publishing, editors. Positive psychiatry: a casebook. Washington, D.C: American

Psychiatric Association Publishing; 2019. 235 p.

• 6. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory.
• 7. Sablik Z, Samborska-Sablik A, Drożdż J. Systematic review/Meta-analysis Universality of physicians’ burnout syndrome as a result of experiencing

difficulty in relationship with patients. Arch Med Sci. 2013;3:398–403.

• 8. Dyrbye L, ShanafeltT. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016 Jan;50(1):132–49.
• 9. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative

to the General U.S. Population: Acad Med. 2014 Mar;89(3):443–51.

• 10. Messias E, Gathright MM, Freeman ES, Flynn V, Atkinson T, Thrush CR, et al. Differences in burnout prevalence between clinical professionals and

biomedical scientists in an academic medical centre: a cross-sectional survey. BMJ Open. 2019 Feb;9(2):bmjopen-2018-023506.

• 11. ShanafeltTD, Noseworthy JH. Executive Leadership and Physician Well-being. Mayo Clin Proc. 2017 Jan;92(1):129–46.
• 12. ShanafeltT, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017 Dec 1;177(12):1826.
• 13. West CP, Dyrbye LN, Erwin PJ, ShanafeltTD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The
• Lancet. 2016 Nov;388(10057):2272–81.

• 14. Palamara K, Kauffman C, Stone VE, Bazari H, Donelan K. Promoting Success: A Professional Development Coaching Program for Interns in
• Medicine. J Grad Med Educ. 2015 Dec;7(4):630–7.
• 15. Ammentorp J, Jensen HI, Uhrenfeldt L. Danish Health Professionalsʼ Experiences of Being Coached: A Pilot Study: J Contin Educ Health Prof.

2013;33(1):41–7.

• 16. International Coach Federation. (n.d.). Core Competencies. [online] Available at: https://coachfederation.org/core-competencies [Accessed 1 Jan.

2019]. In.

• 17. Knight ZG. A proposed model of psychodynamic psychotherapy linked to Erik Erikson’s eight stages of psychosocial development. Clin Psychol
• Psychother. 2017 Sep;24(5):1047–58.
• 18. Peterson C, Seligman MEP. Character strengths and virtues: a handbook and classification. Washington, DC : New York: American Psychological

Association ; Oxford University Press; 2004. 800 p.

• 19. Schiefele U, KrappA, Winteler A. Interest as a predictor of academic achievement: A meta-analysis of research.
• 20. Harackiewicz JM, Barron KE, Tauer JM, Elliot AJ. Predicting success in college: A longitudinal study of achievement goals and ability measures as

predictors of interest and performance from freshman year through graduation. Journal of Educational Psychology. 2002 Sep;94(3):562.

• 21. Jones-Schenk J. Character: We Are All Works in Progress. Bleich MR, Jones-Schenk J, editors. J Contin Educ Nurs. 2018 Aug 1;49(8):343–4.
• 22. Renninger KA, Hidi S, KrappA. The development and function of interests during the critical transition from home to preschool. In: The role of

interest in learning and development. Lawrence Erlbaum Associates; 2015. p. 397–429.

• 23. Ryan RM, Frederick C. On Energy, Personality, and Health: Subjective Vitality as a Dynamic Reflection of Well-Being. Duke Univ Press. 1997

Sep;65(3):529–65.

• 24. Nix GA, Ryan RM, Manly JB, Deci EL. Revitalization through self-regulation: The effects of autonomous and controlled motivation on happiness

and vitality. Journal of Experimental Social Psychology. 1999 May 1;35(3):266-84.

• 25. van ScheppingenAR, de Vroome EMM, ten Have KCJM, Zwetsloot GIJM, Wiezer N, van MechelenW. Vitality at work and its associations with

lifestyle, self-determination, organizational culture, and with employees’ performance and sustainable employability. Work. 2015 Aug 19;52(1):45–55.

• 26. Jakobsen MD, Sundstrup E, Brandt M, Andersen LL. Psychosocial benefits of workplace physical exercise: cluster randomized controlled trial. BMC

Public Health [Internet]. 2017 Dec [cited 2019 Feb 13];17(1). Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017- 4728-3

• 27. Hendriksen IJM, Bernaards CM, SteijnWMP, Hildebrandt VH. Longitudinal Relationship Between Sitting Time on a Working Day and Vitality, Work

Performance, Presenteeism, and Sickness Absence: J Occup Environ Med. 2016 Aug;58(8):784–9.

• 28. Hendriksen IJM, Snoijer M, de Kok BPH, van Vilsteren J, Hofstetter H. Effectiveness of a Multilevel Workplace Health Promotion Program on

Vitality, Health, and Work-Related Outcomes: J Occup Environ Med. 2016 Jun;58(6):575–83.

• 29. Ryan RM, Weinstein N, Bernstein J, Brown KW, Mistretta L, Gagné M. Vitalizing effects of being outdoors and in nature. J Environ Psychol. 2010

Jun;30(2):159–68.

• 30. Irby DM. Faculty development and academic vitality. Academic Medicine. 1993 Oct 1;68(10):760-3.
• 31. KasserVG, Ryan RM. The Relation of Psychological Needs for Autonomy and Relatedness to Vitality, Well-Being, and Mortality in a Nursing
• Home1. J Appl Soc Psychol. 1999 May;29(5):935–54.
• 32. Harvard Business Review Press, editor. HBR’s 10 must reads on emotional intelligence. Boston, Massachusetts: Harvard Business Review Press;
• 2015. 166 p. (HBR’s 10 must reads series).
• 33. Cheng S-T, Tsui PK, Lam JHM. Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention. J

Consult Clin Psychol. 2015;83(1):177–86.

• 34. StegenA, Wankier J. Generating Gratitude in the Workplace to Improve Faculty Job Satisfaction. J Nurs Educ. 2018 Jun 1;57(6):375–8.
• 35. Maslow AH. Religions, values and peak experiences. New York, NY: Penguin Books; 1994. 123 p. (Penguin compass).
• 36. Fryer-Edwards K, Van Eaton E, Goldstein EA, Kimball HR, Veith RC, Pellegrini CA, et al. Overcoming Institutional Challenges through

Continuous Professionalism Improvement: The University of Washington Experience: Acad Med. 2007 Nov;82(11):1073–8.

• 37. Wilkinson H, Whittington R, Perry L, Eames C. Examining the relationship between burnout and empathy in healthcare professionals: A

systematic review. Burn Res. 2017 Sep;6:18–29.

• 38. Maslach C, Leiter MP. Early predictors of job burnout and engagement. J Appl Psychol. 2008;93(3):498–512.
• 39. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016

Jun;15(2):103–11.

• 40. SchaufeliWB, Leiter MP, Maslach C. Burnout: 35 years of research and practice. Career Dev Int. 2009 Jun 19;14(3):204–20.
• 41. Demerouti E, Bakker AB, Leiter M. Burnout and job performance: The moderating role of selection, optimization, and compensation
• strategies. J Occup Health Psychol. 2014;19(1):96–107.
• 42. Cherniss C. Staff burnout: Job stress in the human services. Beverly Hills, CA: Sage Publications; 1980 Nov.
• 43. Bakker AB, Demerouti E. The Job Demands‐Resources model: state of the art. J Manag Psychol. 2007 Apr 3;22(3):309–28.
• 44. Freedy J, Hobfoll SE. Conservation of resources: A general stress theory applied to burnout. InProfessional burnout 2017 Jun 26 (pp. 115-129).

Routledge.

• 45. Leiter MP, Maslach C. AREAS OF WORKLIFE: A STRUCTURED APPROACH TO ORGANIZATIONAL PREDICTORS OF JOB BURNOUT. In:

Research in Occupational Stress and Well-being [Internet]. Bingley: Emerald (MCB UP ); 2003 [cited 2019 Jan 22]. p. 91–134. Available from: https://www.emeraldinsight.com/10.1016/S1479-3555(03)03003-8

• 46. Messias E, Flynn V. The Tired, Retired, and Recovered Physician: Professional Burnout Versus Major Depressive Disorder. Am J Psychiatry. 2018

Aug;175(8):716–9.

• 47. Bianchi R, Schonfeld IS, Laurent E. Burnout–depression overlap: A review. Clin Psychol Rev. 2015 Mar;36:28–41.
• 48. Creedy DK, Sidebotham M, Gamble J, Pallant J, Fenwick J. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a

cross-sectional survey. BMC Pregnancy Childbirth [Internet]. 2017 Dec [cited 2018 Jul 31];17(1). Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1212-5

• 49. Goldhagen BE, Kingsolver K, Stinnett SS, Rosdahl JA. Stress and burnout in residents: impact of mindfulness-based resilience training. Adv

Med Educ Pract. 2015;6:525–32.

• 50. Barbosa P, Raymond G, Zlotnick C, Wilk J, Toomey III R, Mitchell III J. Mindfulness-based stress reduction training is associated with greater

empathy and reduced anxiety for graduate healthcare students. Educ Health. 2013;26(1):9.

• 51. Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and

Compassion in Primary Care Clinicians: A Pilot Study. Ann Fam Med. 2013 Sep 1;11(5):412–20.

• 52. Rosdahl J, Goldhagen B, Kingsolver K, Stinnett S. Stress and burnout in residents: impact of mindfulness-based resilience training. Adv Med

Educ Pract. 2015 Aug;525.

• 53. Dyrbye LN, Massie FS, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship Between Burnout and Professional Conduct and Attitudes

Among US Medical Students. JAMA. 2010 Sep 15;304(11):1173.

• 54. JagerAJ, Tutty MA, Kao AC. Association Between Physician Burnout and Identification With Medicine as a Calling. Mayo Clin Proc. 2017

Mar;92(3):415–22.

• 55. Kalani S, Azadfallah P, Oreyzi H, Adibi P. Interventions for physician burnout: A systematic review of systematic reviews. Int J Prev Med.

2018;9(1):81.

• 56. Linzer M, Poplau S, Grossman E, Varkey A, Yale S, Williams E, et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and

Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015 Aug;30(8):1105–11.

• 57. West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, et al. Intervention to Promote Physician Well-being, Job Satisfaction, and

Professionalism: A Randomized Clinical Trial. JAMA Intern Med. 2014 Apr 1;174(4):527.

• 58. Ahola K, HonkonenT, Virtanen M, Kivimki M, Isomets E, Aromaa A, et al. Interventions in Relation to Occupational Burnout: The Population-

Based Health 2000 Study: J Occup Environ Med. 2007 Sep;49(9):943–52.

• 59. Awa WL, Plaumann M, Walter U. Burnout prevention: A review of intervention programs. Patient EducCouns. 2010 Feb;78(2):184–90.
• 60. Kelly JD. Your Best Life: Breaking the Cycle: The Power of Gratitude. Clin Orthop Relat Res. 2016 Dec;474(12):2594–7.
• 61. Ghandeharioun A, Azaria A, Taylor S, Picard RW. “Kind and Grateful”: A Context-Sensitive Smartphone App Utilizing Inspirational Content to

Promote Gratitude. Psychol Well-Being [Internet]. 2016 Dec [cited 2019 Feb 15];6(1). Available from: http://psywb.springeropen.com/articles/10.1186/s13612-016-0046-2

• 62. Edgoose JYC, Regner CJ, Zakletskaia LI. BREATHE OUT: A Randomized Controlled Trial of a Structured Intervention to Improve Clinician

Satisfaction With “Difficult” Visits. J Am Board Fam Med. 2015 Jan 1;28(1):13–20.

• 63. Swensen S, Kabcenell A, ShanafeltT. Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo

Clinic Experience. J Healthc Manag. 2016 Apr;61(2):105–27.

• 64. Gazelle G, Liebschutz JM, Riess H. Physician Burnout: Coaching a Way Out. J Gen Intern Med. 2015 Apr;30(4):508–13.
• 65. Gardiner M, Kearns H, Tiggemann M. Effectiveness of cognitive behavioural coaching in improving the well-being and retention of rural

general practitioners: Cognitive Behavioural Coaching. Aust J Rural Health. 2013 Jun;21(3):183–9.

• 66. National Academy of Sciences (U.S.), National Academy of Engineering, Institute of Medicine (U.S.), editors. Adviser, teacher, role model,

friend: on being a mentor to students in science and engineering. Washington, D.C: National Academy Press; 1997. 84 p.

• 67. Rogers D. Which educational interventions improve healthcare professionals’ resilience? Med Teach. 2016 Dec;38(12):1236–41.
• 68. Novack D, SuchmanA, Clark W, Epstein R, Najberg E, Kaplan C. Calibrating the physician: personal awareness and effective patient care.
• JAMA. 1997 Aug 13;278(6):502–9.
• 69. Bickel J. Looking for mentor replacement therapy? A coach may be the answer. J Am Med Womens Assoc 1972. 2003;58(4):210–1.