Risk and protective factors associated with psychological distress and the mediating role of resilience among physician educators in Hong Kong: a cross-sectional survey

Background Academic and clinical medicine place different, but equivalently exacting demands on their practitioners. Physician educators in Hong Kong (HK) must straddle both of these environments simultaneously, and also negotiate unspoken culturally nuanced workplace expectations, contributing to the high stress and turnover rate within this population. Limited literature exists regarding psychological distress among physician educators in an Asian context more broadly, and HK more specifically, making it difficult to design culturally appropriate interventions to mitigate their distress. Objectives To examine the risk and protective factors associated with psychological distress among physician educators affiliated with one of two medical schools in HK, and to investigate the mediating role of resilience in relation to these factors. Design A cross-sectional survey study. Setting One medical school in HK. Participants 333 physician educators who were full-time, part-time or honorary clinical academic staff at one HK medical school and who were involved in teaching medical learners, trainees and/or physicians. Most participants were male (71.5%), married (76.3%), Chinese (94.6%) and aged 40–49 (34.5%). Primary and secondary outcome measures Well-being, resilience and psychological distress were measured using three validated instruments: the 5-item WHO Well-Being Index (WHO-5), the 2-item Connor-Davidson Resilience Scale (CD-RISC2) and the 9-item Physician Well-Being Index-Expanded (ePWBI-9), respectively. Results A path analysis for physician educators’ psychological distress (Tucker-Lewis Index=0.99; Normed-Fit Index=0.99; Comparative Fit Index=1.00; root mean square error of approximation=0.03; standardised root mean-square residual=0.02) indicated that resilience partially mediated the relationship of well-being with psychological distress ( β W e l l b e i n g - r e s i l i e n c e - d i s t r e s s =−0.50, 95% CI −0.57 to −0.41, p=0.002). Average working hours had a positive direct effect on distress ( β A v e r . w o r k i n g h r - d i s t r e s s =0.29, 95% CI 0.20 to 0.37, p=0.001). However, age, relationship status and years as an educator were not significantly associated with either resilience or psychological distress among HK physician educators. Conclusions The risk and protective factors identified in this study, including the partial mediating role of resilience, provide preliminary insights into factors associated with psychological distress among clinical physician educators in this HK setting. The findings suggest the importance of well-being interventions, coupled with strategies to address prolonged working hours, as potential mechanisms to mitigate psychological distress in similar contexts.