Physicians’ perceived mastery of work: predictors and clinical consequences: a 20-year longitudinal study of a nationwide cohort

Anna Belfrage, 2020. Docotrs represent a group that is expected to master demanding situations. When doctors doubt their capability in difficult situations, it may have consequences for their mental health and for patient care. This thesis investigated predictors and factors associated with perceived mastery among doctors.

Medical students and physicians are exposed to a high number of stressful and demanding 
situations in their everyday academic and working life. Furthermore, they represent a group 
that is supposed or expected to master demanding situations. When doctors doubt their 
capability in difficult situations, it may have consequences for their mental health and for 
patient care. Therefore, knowledge about predictors and factors associated with perceived 
mastery is important for improving both the education of doctors and the quality of their work 
situation. If we can find predictors as early as in the final year of medical school, we can help 
individuals at risk of developing low perceived mastery for as long as 20 years of their career.
However, there is a lack of studies on risk factors for low perceived mastery or factors 
associated with increased perceived mastery, and how these factors influence patient 
counselling. 

This thesis consists of three papers from a large prospective study, the Longitudinal 
Study of Norwegian Medical Students and Doctors (NORDOC). This is the most 
comprehensive nationwide study in the field with the longest follow-up period in Norway and 
internationally. Two cohorts of medical students, those in their first year (the Student Cohort) 
and those in their final year (the Young Doctor Cohort) of all medical schools in Norway, 
have been followed up with postal questionnaires at six measurement points since 1993 (the 
last survey was launched in 2014). In the first paper, long-term predictors of perceived 
mastery of clinical work ten and twenty years after medical school were identified. In the 
second paper, two subgroups with low vs. increased perceived mastery over a ten-year period 
were compared. The third paper examines the influence of physicians’ own lifestyle habits 
(use of alcohol and physical activity) on their preventive counselling on similar lifestyle 
habits among their patients. In addition, this paper examines the possible impact of 
physicians’ perceived mastery of clinical work and the personality trait of vulnerability on 
their patient counselling.

Important findings are 1) the risky avoidant coping behavior of using alcohol to cope 
with stress during medical school predicted physicians’ low perceived mastery of clinical 
work both early in their career (Paper I), and as long as 20 years after medical school (Paper 
II). Another important finding is 2) that vulnerable personality traits, measured during 
medical school, had a negative impact on both physician’s perceived mastery of their clinical 
work (Paper II) and on their patient counselling (Paper III), as long as 20 years after 
graduation. Vulnerable personality traits consist of e.g. fear of being criticized or a belief that others do things better than oneself. These two findings therefore indicate the importance of 
giving medical students and young doctors support in how to handle stressful situations, such 
as being criticized, and how to develop healthy coping strategies to better handle stress and 
high demands.

In the first paper, we found medical recording skills and identification with the role of 
being a doctor to be predictors of high perceived mastery, while in paper two we found taking 
up leading positions to be associated with increased perceived mastery. This indicates a 
further finding, namely 3) that learning skills, developing and taking up new positions at work 
could be causes or consequences of approaching behavior. We also found that doctors with a 
high level of vulnerable personality traits counselled less frequently about physical activity 
(Paper III). However, when they themselves were physically active, they counselled more 
often on exercise. This indicates that vulnerable personality traits can be compensated by 
other factors, and perhaps then be an asset. Interventions that promote learning of new skills, 
challenging oneself in new demanding situations via guidance or group meetings, or 
practicing early in practical settings could help medical students and young doctors to develop 
higher levels of perceived mastery in stressful situations.

 

Du kan lese hele avhandlingen til Belfrage her.