Based on a transactional model of stressors, mediators/moderators and strains, this large scale study investigated occupational stress, job satisfaction and role conflict in doctors in Scotland using a self-report questionnaire methodology. The sample of 986 doctors included male and female general practitioners (GPs) and specialist consultants. The relationship between sources and levels of occupational stress and job satisfaction was investigated using scales from the Occupational Stress Indicator (OSI) (Cooper et al 1988), considering the role of intervening variables mcludmg age, gender, marital/parental status, medical speciality, coping and attitudes. The relationship between occupational and domestic stressors and satisfactions was examined using theoretically denved models of additivity and asymmetric permeability of roles. A range of analytic procedures mcluding multivanate analysis of variance, hierarchical regression, factor analysis and qualitative content analysis methods were employed. Results mdicated that GPs recorded greater stress and lower job satisfaction than consultants on the OSI scales Managenal or structural occupational factors, and factors intrinsic to medical work were major stressors. Patient care was both a main source of stress and job satisfaction. The rather small magnitude of differences in stress and satisfaction between subject groups, and between subject groups and norms for the OSI scales was offset by clear evidence of stress related to doctors occupational roles, domestic roles, and gender roles elucidated using more qualitative methodologies. Subjects' age, gender and medical speciality were shown to affect the relationship between occupational stress and job satisfaction. Younger doctors, male GPs and female consultants experienced greater stress and less job satisfaction. Coping efficacy was negatively related to occupational stress and positively related to job satisfaction for GPs, and male and female GPs employed different styles of coping with stressors. Comparison of consultant specialities revealed differences in sources and levels of occupational stress and job satisfaction with Public Health Consultants recording most stress. Both male and female doctors with multiple occupational and domestic role demands reported higher levels of stress. Stress from work to home was found to be greater than stress from home to work for both male and female doctors. Recommendations and implications of the research for doctors, patients, and the National Health Service are discussed.

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1977.

Thesis (Ph.D.) - University of Queensland, 2003. / Includes bibliography.

Thesis (MEdPsych)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.

This research study explores in general the nature of a private general medical practice [PGMP] and whether analysis of the PGMP as a social system can lead the Group Dynamics Practitioner towards developing interventions that will enhance group effectiveness in the PGMP support staff group. The main assumption is that, through the application of a framework of analysis based on that of G. C. Homans and the AGIL functional prerequisites developed by T. Parsons, a structured analysis of the external and internal variables that impact on the PGMP as a social system can be undertaken. The findings of the analysis would lead to the formulation of interventions that would improve the performance effectiveness of the PGMP as a social system. Following a two-questionnaire survey of 17 practices that provided demographic information as well as soft skills training needs, a single PGMP was identified for the case study. Data pertaining to the group as a social system were collected, and by using direct observation, content analysis and a sociometric test, the practice support staff sub-system, being the main focus of this research, could be analysed. By linking the findings to the elements of the framework of analysis, areas of ineffective group functioning could be identified and interventions suggested. This research indicates that the choice of soft skills is associated with the nature and size of the practice, as well as the dynamics of the sociometric patterns characteristic of the relations within the practice support staff subsystem; that while some practice support staff have preferences for sociometric task and socio-emotional relations outside their work clusters, these seem to serve as a buffer against clique forming, thus enhancing the function of integration within the social system as a whole; and that the physical practice layout, and the interaction dynamics that it creates, tend to hinder integration between the members of the practice support staff group, as a social subsystem.

The practice of midwifery by those other than physicians is illegal in Canada and despite recommendations of nursing, medical and consumer groups, no trials evaluating the effectiveness of the nurse-midwife as a member of the modern obstetrical team have occurred here. To demonstrate a nurse-midwifery model, four nurse-midwives provided primary care to forty-seven childbearing women and their families over a twenty-two month period in a maternity teaching hospital. This clinic presented a unique opportunity for comparing the prenatal care provided by nurse-midwives with that of general practitioners who attended deliveries in the same setting. Utilizing a retrospective chart audit, case control study design, the nurse-midwife cases (NM cases) were each matched to two general practitioner controls (GP controls) through the use of the hospital's prenatal data base. The matching characteristics included low risk status, date of delivery, age, parity, gravidity, previous pregnancy losses and census tract income. Prenatal criteria that had been developed and tested in "The Burlington Randomized Clinical Trial of the Nurse Practitioner" for assessing the quality of care were reviewed and updated for this study. With these criteria two blinded abstractors audited the prenatal record forms of all the subjects and scored them as either "superior", "adequate" or "inadequate". Seventy-seven percent of the records of the NM cases received a "superior" score, where as 60% of the GP controls' records received an "inadequate" score [mathematical formula omitted] Overall, the general practitioners' records indicated more erratic care than those of the nurse-midwives. Although the physicians met most of the initial assessment criteria, they failed to meet the criteria that evaluated the ongoing routine assessment process by recording an inadequate number of prenatal visits (36%), or by omitting urine test results (38$) and blood pressure readings (21%). No differences were found in variables relating to labour and delivery with the exception of the incidence of episiotomies. The results indicate that nurse-midwives as part of an obstetrical team are able to provide safe prenatal care to a low risk population in a Canadian urban context, and that their records are thorough and more consistent than those of general practitioners. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The sequence of events leading to the implementation of a change in emergency physicians' practice and the learning activities and processes undertaken are examined and described in this study. A qualitative case study design was utilized and semi-structured interviews were employed as the primary means of data collection. Thirty emergency physicians were interviewed in face-to-face or telephone interviews. One change that required learning was selected per physician for an in-depth interview. The following factors were examined: motivation to change a practice behavior, time to implementation of changes, source of awareness, barriers to change, use of learning resources, stages in the change process, and method of learning.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.D.)--Guatemala, 1902. / Includes index.