Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis.

BACKGROUND: At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. METHODS: This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. RESULTS: The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors. CONCLUSION: Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.

The Dimensionality of the Brief COPE Before and During the COVID-19 Pandemic.

The Brief COPE (Coping Orientation to Problems Experienced) is a frequently used questionnaire assessing 14 theoretically derived coping mechanisms, but psychometric research has suggested inconsistent results concerning its factor structure. The aim of this study was to investigate primary and secondary order factor structures of the Brief COPE during the COVID-19 pandemic by testing 11 different models by confirmatory factor analyses and to assess differences between sex, age groups, and relationship status. Altogether, 529 respondents from Austria and Germany participated in a web-based survey. Results supported the originally hypothesized 14-factor structure but did not support previously described higher-order structures. However, bass-ackwards analyses suggested systematic overlap between different factors, which might have contributed to different factor solutions in previous research. Measurement invariance across sex, age groups, and relationship status could be confirmed. Findings suggest that cultural and situational aspects as well as the functional level should be considered in research on theoretical framing of coping behavior.

Future Objectivity Requires Perspective and Forward Combinatorial Meta-Analyses.

This manuscript contributes to a future definition of objectivity by bringing together recent statements in epistemology and methodology. It outlines how improved objectivity can be achieved by systematically incorporating multiple perspectives, thereby improving the validity of science. The more result-biasing perspectives are known, the more a phenomenon of interest can be disentangled from these perspectives. Approaches that call for the integration of perspective into objectivity at the epistemological level or that systematically incorporate different perspectives at the statistical level already exist and are brought together in the manuscript. Recent developments in research methodology, such as transparency, reproducibility of research processes, pre-registration of studies, or free access to raw data, analysis strategies, and syntax, promote the explication of perspectives because they make the entire research process visible. How the explication of perspectives can be done practically is outlined in the manuscript. As a result, future research programs can be organized in such a way that meta-analyses and meta-meta-analyses can be conducted not only backward but forward and prospectively as a regular and thus well-prepared part of objectification and validation processes.

Interpreting physical sensations to guide health-related behavior : An introductory review on psychosomatic competence.

From a biopsychosocial perspective, maintaining health requires sufficient autoregulatory and self-regulatory capacity to both regulate somatic physiology and manage human-environment interactions. Increasing evidence from neuroscientific and psychological research suggests a functional link between so called interoceptive awareness and self-regulatory behavior. Self-regulation can, again, influence autoregulatory patterns as it is known from biofeedback training or meditation practices. In this review, we propose the psychosomatic competence model that provides a novel framework for the interrelation between interoceptive and self-regulatiory skills and health behavior. The term psychosomatic competence refers to a set of mind- and body-related abilities which foster an adequate interpretation of interoceptive signals to drive health-related behavior and physical well-being. Current related empirical findings and future directions of research on interoception and self-regulation are discussed.

Should We Say Goodbye to Latent Constructs to Overcome Replication Crisis or Should We Take Into Account Epistemological Considerations?

This paper discusses theoretical and epistemological problems concerning validity of psychological science in the context of latent constructs. I consider the use of latent constructs as one reason for the replicability crisis. At the moment, there exist different constructs describing the same psychological phenomena side by side, and different psychological phenomena that are reflected by the same latent construct. Hagger called them déjà-variables, which lead to a decreasing validity of measurements and inhibit a deeper understanding of psychological phenomena. To overcome this problem, I suggest a shift of theoretical and epistemological perspective on latent constructs. One main point is the explicit consideration of latent constructs as mental representations, which change objects and are changed by objects via assimilative and accommodative processes. The explicit orientation toward assimilation and accommodation allows the control of normally automatized processes that influence our understanding of psychological phenomena and their corresponding latent constructs. I argue that assimilation and accommodation are part of our research practice anyway and cause the mentioned problems. For example, taking a measurement is an assimilative process, and thus a high measurement error should lead to an increase of accommodative processes. Taking into account these considerations, I suggest consequences for research practices, for individual researchers and for the philosophy of science.

Ego and spiritual transcendence: relevance to psychological resilience and the role of age.

The paper investigates different approaches of transcendence in the sense of spiritual experience as predictors for general psychological resilience. This issue is based on the theoretical assumption that resilience does play a role for physical health. Furthermore, there is a lack of empirical evidence about the extent to which spirituality does play a role for resilience. As potential predictors for resilience, ego transcendence, spiritual transcendence, and meaning in life were measured in a sample of 265 people. The main result of a multiple regression analysis is that, in the subsample with people below 29 years, only one rather secular scale that is associated with ego transcendence predicts resilience, whereas for the older subsample of 29 years and above, spiritual transcendence gains both a positive (oneness and timelessness) and a negative (spiritual insight) relevance to psychological resilience. On the one hand, these results concur with previous studies that also found age-related differences. On the other hand, it is surprising that the MOS spiritual insight predicts psychological resilience negatively, the effect is increasing with age. One possible explanation concerns wisdom research. Here, an adaptive way of dealing with the age-related loss of control is assumed to be relevant to successful aging.