The Self-Promotion Boost: Positive consequences for observers of high-rank self-promoters.

This research examines how self-promotion conducted by relatively higher ranked individuals affects observers' affect and motivation. We developed and tested the idea of a Self-Promotion Boost-superior self-promoters inspire lower ranked observers by sharing achievement-related information that reflects opportunities to succeed in relevant domains, eliciting high-activation positive affect and greater motivation. Results from nine experimental studies (total N = 2,599) revealed that (1) interactions involving self-promotion by superiors (vs. peers or subordinates) lead observers to report greater experiences of high-activation positive affect (e.g., hope, inspiration), whereas peers and subordinates (vs. superiors) generate greater high-activation negative affect. (2) The positive effects of superiors' self-promotion go above and beyond effects elicited by superiors in interactions devoid of self-promotion. (3) Observers' inferences of self-promoters' earned success mediate the relationships between self-promoter rank and observer high-activation positive and negative affect. (4) High-activation positive affect elicited by superiors in turn leads to greater observer-reported motivation. Finally, (5) we found support for our theory that these effects are strengthened when observers view the self-promoting superiors as role models: Superiors elicit high-activation positive affect when they (a) are admired and respected by observers, (b) communicate what observers deem to be achievable successes, and (c) share accomplishments relevant to observers' own domain of success. Our findings illustrate the positive effects self-promotion can have on observers of this behavior, and how this behavior can consequently bolster observer motivation. We discuss implications for the literature on self-promotion, social comparison, and social motivation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Professions, honesty, and income.

Professional choices influence valued outcomes such as income, life satisfaction, and social status. However, public opinion polls consistently illustrate that an individual's profession also influences how honest one is perceived to be, and people are motivated to see themselves as honest for many reasons. Why would people choose professions that do not confer them with the benefits of honesty? Survey data reveals honesty perceptions to positively correlate with a profession's conferred prestige (i.e., perceived value to society) and negatively correlate with a profession's annual income. The tradeoff between income and honesty perceptions suggests a wage differential mechanism-employees may maintain a positive self-concept through increased income which compensates for costs incurred by working in a profession characterized by low honesty.

Physician-identified barriers to and facilitators of shared decision-making in the Emergency Department: an exploratory analysis.

OBJECTIVES: Shared decision-making (SDM) is receiving increasing attention in emergency medicine because of its potential to increase patient engagement and decrease unnecessary healthcare utilisation. This study sought to explore physician-identified barriers to and facilitators of SDM in the ED. METHODS: We conducted semistructured interviews with practising emergency physicians (EP) with the aim of understanding when and why EPs engage in SDM, and when and why they feel unable to engage in SDM. Interviews were transcribed verbatim and a three-member team coded all transcripts in an iterative fashion using a directed approach to qualitative content analysis. We identified emergent themes, and organised themes based on an integrative theoretical model that combined the theory of planned behaviour and social cognitive theory. RESULTS: Fifteen EPs practising in the New England region of the USA were interviewed. Physicians described the following barriers: time constraints, clinical uncertainty, fear of a bad outcome, certain patient characteristics, lack of follow-up and other emotional and logistical stressors. They noted that risk stratification methods, the perception that SDM decreased liability and their own improving clinical skills facilitated their use of SDM. They also noted that the culture of the institution could play a role in discouraging or promoting SDM, and that patients could encourage SDM by specifically asking about alternatives. CONCLUSIONS: EPs face many barriers to using SDM. Some, such as lack of follow-up, are unique to the ED; others, such as the challenges of communicating uncertainty, may affect other providers. Many of the barriers to SDM are amenable to intervention, but may be of variable importance in different EDs. Further research should attempt to identify which barriers are most prevalent and most amenable to intervention, as well as capitalise on the facilitators noted.

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education.

BACKGROUND: Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. OBJECTIVE: We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. METHODS: We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. RESULTS: Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. CONCLUSIONS: A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.

The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department.

BACKGROUND: Shared decision making (SDM) is increasingly recognized as an important facet of patient-centered care. Despite growing interest in SDM in the emergency department (ED), little is known about emergency physicians' (EPs') motivations for using SDM. Understanding current patterns of SDM use and EP's rationale for using SDM is essential for the development of interventions to increase use. OBJECTIVES: Recognizing the EP as an important stakeholder in SDM research, we sought to identify and explore factors that may motivate EPs' engagement in SDM. METHODS: In this qualitative study, informed by the Theory of Planned Behavior and Social Cognitive Theory, we conducted semistructured interviews with a purposeful sample of EPs. Interviews were recorded and transcribed verbatim. Using a directed qualitative content analysis approach, three members of the research team performed open coding of the transcripts in an iterative process, building a provisional code book as coding progressed. Respondent validation was employed to ensure methodologic rigor. RESULTS: Fifteen EPs, ages 31-65, from both academic and community practice settings, were interviewed. Several had not heard of the specific phrase "shared decision making," but all understood the concept and felt that they used SDM techniques to some degree. Most noted they had often had an agenda when they used SDM, which often motivated them to have the conversation. Agendas described included counteracting an algorithmic or defensive approach to diagnosis and treatment, avoiding harmful tests, or sharing uncertainty. All participants believed that patients benefited from SDM in terms of satisfaction, engagement, or education. Nearly all participants identified research outcomes that they felt would encourage their use of SDM (e.g., improvements in patient engagement, mitigation of risk) and many prioritized patient-centered outcomes over systems outcomes such as improved resource utilization. Little consensus was seen, however, regarding the importance of individual outcomes: of eight potential research outcomes participants endorsed, no single outcome was endorsed by even half of the physicians interviewed. CONCLUSION: Emergency physicians identified many factors that motivated them to use SDM. This study informs current research on SDM in the ED, particularly regarding the motivations of the physician-as-stakeholder.