ArticleBMJ quality & safety2026
Optimising professional support for doctors who experience work performance issues: a realist evaluation.
Article in BMJ quality & safety, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal performance of doctors is critical to delivering high-quality, safe healthcare. However, 6-12% of doctors may experience challenges that impact their work performance. In many countries, including the UK, there is variation in the practice and quality of professional support services between different types of organisations. The aims of our study were (1) to identify why, how, in what contexts and for whom professional support works, (2) to develop a guide for healthcare organisations to use to optimise professional support.
methodsWe carried out a realist evaluation consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) II standards. 45 interviews were conducted with professional support staff and doctors who had undertaken professional support across seven sites in England. Interviews were analysed using a realist logic. To develop the guide, six workshops were held with the same groups plus a patient and public involvement group.
resultsWe identified six principles of effective professional support, based on 47 context-mechanism-outcome configurations. (1) Work-place culture influences support-seeking behaviour. (2) Trust and psychological safety are central to enable candid conversations and engagement. (3) Doctors can then develop self-awareness and situational awareness, reframe challenges, accept responsibility where appropriate and recognise structural factors underpinning their difficulties. (4) Doctors are more likely to feel motivated to engage through positive framing. (5) Personal and professional growth occurs when doctors are empowered to make changes to their practice. (6) Cultures that stigmatise help-seeking undermine support, while those that model vulnerability and normalise support enhance the likelihood of positive outcomes.
conclusionsOur guide provides step-by-step advice to identify key actions for those delivering professional support . Since the realist approach identifies principles and causal explanations, the findings are likely transferable to other settings/countries.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.