Promoting a sense of belonging, engagement, and collegiality to reduce burnout: a mixed methods study among undergraduate medical students in a non-Western, Asian context

Abstract

Background Burnout is a psychological condition induced by work-related chronic interpersonal stressors. Interventions creating a sense of belonging and collegiality have been proposed as approaches for alleviating burnout. The current study aimed to: (1) explore the relationships between burnout, sense of belonging (relatedness with others), and work engagement; and (2) identify the key elements perceived by undergraduate medical students as positively contributing to collegiality, engagement, and a sense of belonging, in an undergraduate medical training setting. Methods An exploratory sequential mixed-methods design using questionnaires and semi-structured individual interviews collected quantitative and qualitative data among undergraduate medical students at Mahidol University, Thailand. The Maslach Burnout Inventory-Student Survey questionnaire was used to measure burnout. The Basic Psychological Need Satisfaction at Work Scale (BPNSS-21) and the Utrecht Work Engagement Scale-Student Version (UWESS-9) measured students’ basic psychological needs satisfaction at work and work engagement, respectively. Descriptive statistical analysis and confirmatory factor analysis were performed on BPNSS-21 and UWESS-9 data. Spearman’s correlation coefficient was used to identify the correlation between burnout and other factors. Twenty undergraduate medical students participated in the qualitative study. Qualitative analysis was conducted iteratively using constant comparison and the standard principles of primary, secondary, and tertiary coding for thematic analysis. Results Thai versions of the BPNSS-21 and UWESS-9 showed an acceptable fit for the Thai cultural context. Burnout had significant weak inverse associations with engagement (r = − 0.39, p < 0.005) and basic psychological needs satisfaction (r = − 0.37, p < 0.005). Sense of belonging had a significant weak inverse relationship with burnout (r = − 0.25, p < 0.005). The main themes emerging from qualitative analysis were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills. Conclusions Sense of belonging, engagement, and collegiality were related to burnout. The key features for promoting collegiality, the sense of belonging, and engagement were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills.

Let’s get real: Identity concealment, burnout, and therapeutic relationship quality among psychology trainees with concealable stigmatized identities.

“…The current findings provide preliminary empirical evidence for the importance of authenticity and belonging in the associations between identity concealment, burnout, and therapeutic relationship quality among psychology trainees with concealable stigmatized identities. Coupled with prior research showing that burnout is associated with lower levels of authenticity and belonging (Grandey et al, 2012; Öztürk et al, 2022; Puranitee et al, 2022; van den Bosch & Taris, 2018) and poorer psychotherapy outcomes (e.g., higher levels of depression and anxiety in clients; Delgadillo et al, 2018), these findings can support the development of nondiscrimination policies, trainings, and other environmental changes (e.g., displaying a rainbow symbol) aimed at creating safer, more welcoming work and education environments for psychology trainees with concealable stigmatized identities (e.g., LGBT+ identity; Burke, 2021; Wolfe, 2023). In clinical training sites and other mental health care facilities, these changes would also facilitate affirmative therapy practices and benefit clients with concealable stigmatized identities (Alessi et al, 2019; Kelley, 2015).…”

“…In these cases, thoughtful consideration of the risks and benefits associated with self-disclosing identities to different people may also help trainees with concealable stigmatized identities be more strategic in their efforts to increase social support and minimize the negative effects of discrimination experienced at clinical training sites. Clinically, it may also be beneficial for clinicians to be strategically open and honest about their own concealable stigmatized identities with clients to increase the likelihood of establishing a genuine and real relationship, minimizing the risk of burnout, and improving treatment outcomes (Grandey et al, 2012; Hill et al, 2018; Puranitee et al, 2022). Overall, the ethical aspects of self-disclosure should guide clinicians’ decisions to reveal their stigmatized identities to clients, particularly the need for beneficence, nonmaleficence, and fiduciary professional relationships in which the client trusts that their interests and welfare are prioritized by the therapist (Barnett, 2011; Gibson, 2012).…”

The importance of creating the right conditions for group intervision sessions among medical residents– a qualitative study

“…As a consequence, intervision sessions can help to better identify individual work-related and personal resources, and preferences for essential recovery and recharge [12][13][14]32]. Moreover, this study revealed that intervision sessions can contribute to collegiality and a sense of belonging, an important job resource to alleviate burnout [33]. This is in line with previous studies reporting that peer re ection sessions can improve group dynamics regarding respect and trust between residents, thereby stimulating a safer daily learning environment in the long term [18][19][20][21]34].…”

Spotlighting ‘Medical Collegiality’

“…26 On the flipside, in a 2022 study of Thai medical students, the authors found that an improved perception of collegiality, achieved through instilling a greater sense of belonging to the clinical team, promoting psychological safety of the learning environment, good teamwork and peer support, was helpful to alleviate risk of burnout. 27 Secondly, healthcare collegiality leads to better clinical outcomes, work efficiency, patient safety and quality improvement by improving teamwork, care coordination, knowledge and skills sharing and collaborative decision-making. 22,28 On the contrary, excessive professional hierarchy leads to fear in speaking up even in dangerous clinical situations, such as in operations, which can lead to patient harm.…”

“…26 On the flipside, in a 2022 study of Thai medical students, the authors found that an improved perception of collegiality, achieved through instilling a greater sense of belonging to the clinical team, promoting psychological safety of the learning environment, good teamwork and peer support, was helpful to alleviate risk of burnout. 27…”