BackgroundFor the purpose of continuous performance improvement, physicians are expected to reflect on their practice. While many reflection studies are theoretically oriented and often prescriptive in the sense that they conceptualize what reflection should look like, the current study starts with practicing physicians themselves and maps how these physicians conceptualize and experience reflection in daily professional practice.MethodsWe conducted a qualitative study using in-depth interviews with 13 hospital-based physicians from various specialties and institutions. The interviews were transcribed verbatim and were analyzed iteratively, following the interpretative phenomenological analysis approach.ResultsData analysis resulted in the identification of three main topics: fuzziness, domain specificity and dialogical dynamics of reflection in professional practice. Reflection was conceptualized as a fuzzy process of contemplation and action, leading to change and hopefully improvement of personal performance and health care in general. Physicians’ experiences with reflection were different for the patient domain and the team domain. Whereas experiences in the patient domain were recalled first and discussed in relatively clear terms, those in the team domain came second and were discussed in more ambiguous terms. In order to achieve improvement in daily practice, honest and open dialogues were perceived as necessary. These dialogues were regarded as the result of an interplay between an internal and an external dialogue. The internal dialogue required sensitivity and courage of the individual; the external dialogue required psychological safety and encouragement of the environment. Within the team domain however, handling the external dialogue effectively was not self-evident, underlining the importance of psychological safety.ConclusionsThis study draws attention to the interdependence between the individual and the collective contributions to reflective activity in professional practice. Apart from its importance to physicians’ individual medical performance, reflective activity is also important to the functioning of a team of physicians. To allow reflection to rise from an individual activity to a team activity, it is necessary to invest in a safe environment in which people are encouraged to think, act, and be engaged.

BackgroundAttention for the well-being of medical school faculty is not only important for the prevention of attrition and burnout, but may also boost performance in their tasks in medical education. Positive well-being can be conceptualized as work engagement and this is associated with increased performance. In this study we explore how demands and resources from different tasks affect work engagement specifically for education.MethodsBetween June and September 2013, we conducted a multisite semi-structured interview study with a diverse group of medical school faculty and used an open-coding strategy within the Work Engagement Model on the transcribed interviews.ResultsWe interviewed 16 faculty members whose teaching experience ranged from 7 to 38 years and whose professional tasks ranged from being solely an educator to being a physician, researcher, educator and administrator simultaneously. All participants were clear on the perceived demands and resources, although similar aspects of the work environment could be perceived oppositely between participants. Overarching themes were perceptions related to the organization or department, often described as a general and long-term effect and perceptions directly related to a task, often described as a direct and short-term effect on well-being. Furthermore, the demands and resources as resultant of fulfilling multiple tasks were described clearly by participants.ConclusionsThe ambiguous nature of the work environment in terms of demands and resources requires an individualized approach to supporting work engagement. Furthermore, faculty members perceive many resources from fulfilling multiple tasks in relation to their tasks in education. Faculty developers and administrators alike could use these findings to apply the concept of work engagement to their daily support of faculty in medical education.

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Support for education comes from a wide range of sources because it is both sought and offered beyond the boundaries of the educational role. The resulting differences in support provided necessitate that educational leaders and policymakers consider the sources available to each educator, connecting educators where necessary. When facilitating or designing social support it is important that the need to feel reassured, encouraged or related is met.