The Interplay of Incivility, Person Factors and Organisation Factors in Medical Student and Junior Doctor Wellbeing

This thesis studied the effect of incivility on the physical, psychological and occupational wellbeing of medical students and junior doctors, and the role of person and organisation factors in mitigating/exacerbating any negative effects. A hypothesised moderated mediation model, theoretically underpinned by the Jobs Demands-Resources Model (Demerouti et al., 2001) informed the design of the studies. The research was conducted on first year postgraduate medical students, final year undergraduate medical students and junior doctors/Junior Medical Officers (JMOs) undertaking hospital-based postgraduate training. This thesis is a thesis by publication, encompassing a review paper and four studies. Following a systematic review of 113 peer-reviewed articles published over a period of 18 years, the review paper explains the factors related to burnout in the earlycareer stage of medicine. According to the principles of the JD-R model, identified factors were classified as demands or resources to explain the nature of the relationship with wellbeing. This review justified the use of the JD-R model as a theoretical framework to explain wellbeing in medical students and junior medical officers.

Focusing on first year postgraduate medical students, the first study demonstrates the moderating role of Emotional Intelligence (EI) and resilience. Good emotional management (EI facet 1) buffered the negative effects of incivility on wellbeing, whilst good emotional understanding worsened these negative effects. A strong ability to actively cope with uncivil behaviours, and treat the experience as a positive learning opportunity protected against the negative effects of incivility.

Extending on the above findings, the second study conducted on final year undergraduate medical students found experiences of incivility were related to a reduced sense of identification as a doctor, which in turn was associated with higher level of burnout. Resilience buffered the negative effects of incivility on professional identity, signifying a moderated mediation relationship to explain the effect of incivility on wellbeing. This study also looked at the moderating role of career entrapment, however no significant effects were found.  

Study 3 explains the role of resilience and fatigue in moderating the negative effects of incivility on JMO wellbeing. Consistent with the observations in Studies 1 and 2, junior medical officers with a strong perceived capacity for resilience presented with better wellbeing following experiences of uncivil behaviours. However, fatigued JMOs presented with poorer wellbeing compared to their less fatigued peers having experienced incivility. Whilst an attempt was made to assess the protective role of social support, no significant findings were found.

The fourth study looks at the within-person effects of incivility and the moderating role of organisation factors (hospital culture and supervisor recognition). Incivility returned shift-based effects on JMO wellbeing, with these effects varying relative to the source of incivility. Although no significant cross-level moderation effects were observed, both hospital culture and supervisor recognition were related to wellbeing across a single shift.

The final discussion chapter outlines the contributions, implications and limitations of my thesis, and highlights considerations for future studies based on the both the findings and learnings identified across this research project.