To stay or go? A mixed methods study of psychiatry trainees’ intentions to leave training

Figures & data

Figure 1. Presentation of the tailored JD-R model that will be tested quantitatively (Aim 1) and qualitatively (Aim 2). Note. Descriptions of constructs are presented in Table 1.

Table 1. Description of measures.

Construct	Content	Origin	Items	Likert scale	Cronbach’s alpha	Mean (SD)
Sociodemographic characteristics	Personal (e.g., gender, age); training context (e.g., work pattern)	Self-developed	9	—	—	—
Intentions to leave psychiatry	Thinking about leaving occupation and/or looking for another job	Intentions to leave (Cohen, 1998)	3	5-point (strongly disagree–strongly agree)	.9	1.86 (0.95)
Affective occupational commitment	Positive emotional attachment to the profession	Three-component Model of Commitment Subscale (Meyer et al., 1993)	6	7-point (strongly disagree–strongly agree)	.8	5.81 (0.89)
Work engagement^a	Vigor (mental resilience), absorption (happily engrossed in one’s work), dedication (proud of one’s work)	Utrecht Work Engagement scale (Schaufeli & Bakker, 2003)	9	7-point (never–always/every day)	.9	3.54 (0.86)
Burnout^b	Exhaustion (loss of energy), mental distancing (cynicism), emotional impairment (feeling overwhelmed), cognitive impairment (attention/concentration deficits)	Burnout Assessment Tool (Schaufeli et al., 2019)	23	5-point (never–always)	.9	2.14 (0.45)
Job demands^b	Emotional demands (e.g., high emotional labor, dealing with people whose problems touch one emotionally)	Demand-Induced Strain Compensation Questionnaire Short Version Subscale (Jonge et al., 2009)	6	5-point (never or very rarely–very often or always)	.8	3.38 (0.73)
	Job effort (time pressure, disruptions)	Effort–Reward Imbalance Questionnaire Short Version Subscale (Siegrist et al., 2014)	3	4-point (strongly disagree–strongly agree)	.8	2.67 (0.60)
	Aggression from patients (e.g., violence, suicide)	Selected items from the Perception of Prevalence of Aggression questionnaire (Oud & Adm, 2000)	5	5-point (never–frequently)	.7	2.25 (0.69)
Job resources^b	Support from the supervisor (e.g., advice, feedback)	Social Support Questionnaire (O’Driscoll et al., 2004)	4	5-point (never–all the time)	.9	3.81 (0.99)
	Autonomy (e.g., choosing how work is carried out)	Autonomy and control (Haynes et al., 1999)	6	5-point (not at all–a great deal)	.9	3.21 (0.84)
	Task significance (e.g., work influences the lives of others)	The Work Design Questionnaire Subscale (Morgeson & Humphrey, 2006)	4	5-point (strongly disagree–strongly agree)	.8	3.80 (0.62)
Psychological detachment from work	Mental disengagement from work, not thinking about work after work hours	Recovery Experience Measure Subscale (Sonnentag & Fritz, 2007)	4	5-point (do not agree at all–fully agree)	.8	2.94 (0.81)

Notes. Satisfactory internal consistency (Cronbach’s alphas >.7).

^a Subconstructs were combined into one overarching score because subconstructs were part of one measurement scoring the same overall construct (approach supported by authors who developed these questionnaires).

^b Subconstructs were assessed as individual subconstructs because each subconstruct was measured using a different tool.

Table 2. Sociodemographic characteristics of the study sample.

Variables	Quantitative, % (N)	Qualitative, % (N)
Gender (female)	62.9 (100)^a	88.9 (8)
Ethnicity
White	64.8 (103)^b	66.6 (6)^c
Asian/Asian British	22 (35)	22.2 (2)
Black/African/Caribbean/Black British	3.1 (5)	0 (0)
Arab/Arab British	2.5 (4)	0 (0)
Mixed/Multiple ethic groups	5 (8)	0 (0)
Dependents (no)	69.8 (111)^d	66.7 (6)
Region of primary medical qualification (UK)	79.9 (127)^e	66.7 (6)^d
Training level^f
Core	56.6 (90)	66.6 (6)^g
Specialty	41.5 (66)	33.3 (3)
Training region: London
South West	10.7 (17)	n/a
South East	36.5 (58)	n/a
North East	15.7 (25)	n/a
North West	12.6 (20)	n/a
North Central	24.5 (39)	n/a
Work pattern (full-time)^e	82.4 (131)	n/a
Trainees’ intentions to leave training (agree/strongly agree)
Thinking a lot about leaving	22.1 (35)	n/a
Thinking to leave as soon as possible	4.4 (7)	n/a
Actively looking for a job outside psychiatry	8.2 (13)	n/a
Burnout level^h
Low	11.9 (19)	n/a
Average	63.5 (101)	n/a
High	23.9 (38)	n/a
Very high burnout levels	0.6 (1)	n/a

Notes. ^a2.5% (4) missing/other.

^b 1.3% (2) missing.

^c 11.1% (1) missing.

^d 2.5% (4) missing.

^e 0.6% (1) missing.

^f 1.9% (3) missing.

^g These trainees had completed their core training but not progressed to specialty.

^h Cutoff values for burnout were provided by Schaufeli et al. (2019).

Figure 2. Visual representation of the SEM model testing the tailored JD-R theoretical model and the relationships between the constructs. Note. The dotted constructs indicate the latent variables job demands and resource.

Table 3. Regression coefficients and test statistics for the relationships between the constructs used in the structural equation modeling.

Outcome	Predictor	Unstandardized coefficient (b)	Standardized coefficient (β)^a	Z value	p
Intentions to leave	Affective commitment	−0.49	−0.46	−5.9	<.001
	Engagement	−0.30	−0.18	−2.4	.017
	Burnout	0.22	0.10	1.5	.135
Affective commitment	Engagement	0.48	0.47	7.0	<.001
	Burnout	−0.50	−0.25	−3.8	<.001
Engagement	Job resources	1.52	0.62	3.4	.001
Burnout	Job resources	−0.42	−0.33	−2.7	.007
	Job demands	0.34	0.42	3.8	<.001
	Psychological detachment	−0.10	−0.17	−2.4	.017
Psychological detachment	Job demands	−0.61	−0.41	−4.2	<.001

Note. ^aCompletely standardized solution in which both the observed and latent variables are standardized. Bold numbers indicate significant effects.

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