Evolving Health Professions Educators’ Work Engagement in Teaching While Combining Roles in an Academic Medical Center

Evolving Health Professions Educators’ Work Engagement in Teaching While Combining Roles in an Academic Medical Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evolving Health Professions Educators’ Work Engagement in Teaching While Combining Roles in an Academic Medical Center JME Bruggen, HC Chen, MF Schaaf, HJM Pennings This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5043114/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted 7 You are reading this latest preprint version Abstract Background High quality professional education requires good educators who show engagement with teaching in addition to content knowledge and didactic skills. In health professions education it is common that teaching faculty combine their teaching role with roles in patient care and/or research. However, previous studies on work engagement have mainly focused on jobs as a whole and not considered people who combine roles or tasks that could have different demands. This study aims to describe how health professions educators’ work engagement in teaching , in combination with research and patient care , evolved over time at an academic medical center in the Netherlands. Methods All teaching faculty at the center were invited to complete the same online questionnaire in 2011, 2016, and 2022, where their work engagement was measured using the Utrecht Work Engagement Scale (UWES-9) and they rated 22 items affecting their engagement in teaching . We calculated descriptive statistics; computed engagement score means for overall work and individual task areas ( teaching , research , and patient care ); and compared means across groups with various task area combinations and across years. We also performed content analysis of responses to the open-ended questions in the questionnaire. Results Work engagement scores overall and for each task area ( teaching , research , and patient care ) fluctuated over time. Job-related aspects enhancing engagement in teaching included ‘autonomy’ and ‘appreciation.’ ‘Teaching about my own specialty’ consistently scored high. Conclusion Teaching faculty in our center are engaged with teaching tasks and their work engagement is consistently high over time. Combining roles might be positively related to teaching engagement by maintaining balance when job demands in other tasks increase. To maintain and increase teaching engagement, organizations should focus on the provision of time, autonomy, and support to health professions educators. Teaching engagement may increase more through content knowledge and autonomy in teaching than by facilitating educational research and dissemination opportunities. Health Profession Educators Faculty Development Work Engagement Job Roles Teaching Background Competent educators are indispensable for high quality health professions education. Good teaching requires knowledge, attitudes, and skills, but it starts with educators’ willingness, energy, and drive to learn, to work effectively, and to achieve their potential 1 , 2 . Becoming a good educator requires sustained engagement with teaching tasks 3 , 4 , 5 . Work engagement is defined as an active, energetic state of mind that is characterized by vigor, dedication, and absorption 6 . Vigor is characterized by high levels of energy and mental resilience while working, the willingness to invest effort in one’s work, and persistence even in the face of difficulties. Dedication means being strongly involved in one’s work and experiencing a sense of significance, enthusiasm, inspiration, and challenge. Absorption is characterized by being fully concentrated and happily engrossed in one’s work, whereby time passes quickly, and one has difficulty detaching from work 6 . Employees feel more engaged in their work when their jobs are resourceful 7 . All jobs entail tasks that provide energy (i.e., job resources) or drain energy (i.e., job demands) from employees 8 . How such tasks affect employees’ work engagement is often studied using the job demands–resources (JD-R) model 8 . At the heart of this model lies the assumption that all aspects of work environments can be categorized as job demands or job resources that either positively or negatively affect work engagement 8 . The presence of job demands, and the absence of job resources are associated with reduced work engagement and could lead to burnout 8 . The presence of sufficient job resources can increase work engagement 9 , 8 and may lead to employees taking initiative in their work that goes beyond what is formally required of them 10 . Thus, ensuring a balance between job demands and resources is essential to improving or maintaining work engagement. However, these studies have primarily looked at jobs as a whole and not considered people whose jobs combine roles/tasks where there are different demands and/or resources for those tasks and how one task can have a great impact on another. To develop as good educators, engagement in teaching is vital, and to engage in teaching, the characteristics of the teaching job need to be resourceful 11 . Yet being a health professions (HP) educator in an academic medical center means juggling and combining a variety of tasks and obligations 12 , 13 , 14 . Medical specialists also have patients to care for and both clinical and basic science faculty are often also involved in research. The current pressures in health care, to cut costs by increasing efficiency combined with staff shortages, result in increased demands on the job. Teaching is a third core task of an academic medical center that can suffer from the competing tasks in patient care and/or research. For some faculty, teaching is seen as an auxiliary task to patient care, and sometimes as forced labor, which comes with being a health professional in an academic medical center 13 . Thus, to understand the teaching engagement of health professions educators, it is important to consider not just the demands and resources present for their teaching task, but also the impact of their other tasks in patient care and/or research. Van den Berg and colleagues conducted a study to investigate the relationship between work engagement and job crafting 15 . Job crafting is the process of taking proactive steps to shape one’s own job to better align with personal needs, goals, and skills 15 . They compared groups of medical faculty that combined patient care and teaching tasks and found that increased engagement for a specific task was related to being able to job craft or modify one’s role for that task. The ability to job craft or modify one’s role for tasks may be particularly important and potentially more difficult for those whose jobs combine tasks, especially if one of the tasks is experienced as auxiliary (as teaching is sometimes considered within an academic medical center). As academic medical centers consider increasing resources for teaching to alter the demands/resources balance for teaching in efforts to improve faculty teaching engagement, it is important to consider whether the impact will be the same for faculty who combine patient care and/or research tasks with their teaching. The context of this study is a university medical center in the Netherlands that has made deliberate investments in faculty development. In the Netherlands, all faculty members who teach are required to obtain a University Teaching Qualification (UTQ). This institution had implemented mandatory Teaching Qualifications for all faculty members in 1995, including didactic training and reflection on one’s own teaching based on feedback from students and observing colleagues, prior to the national UTQ implementation in 2008 16 . It also established teaching awards, educational innovation grants, and an educational leadership program. In 2011, the center surveyed HP educators to assess their work engagement, revealing lower work engagement in teaching tasks than for research and patient care tasks 13 . In response, the center further implemented individualized faculty development programs at different levels to increase job resources for HP educators. This included a longitudinal two-year program focused on developing scholarly approaches to teaching (Teaching Scholars Program). A follow-up survey among HP educators, conducted in 2016, showed increased work engagement in teaching 17 . Given the center’s continued attention to faculty development, recognition and appreciation of HP educators, and the context of increased job demands during the COVID-19 pandemic, we again examined our HP educators’ work engagement for their combined task areas (i.e., patient care, research, teaching) in 2022. We conducted a descriptive survey study on measurements of HP educators’ current work engagement and made comparisons to the data gathered in 2011 and 2016. We formulated the following research questions: (1) How engaged are HP educators in their teaching task and has that changed over time? (2) How does the engagement of HP educators in teaching compare to engagement in their patient care and research tasks when combining roles, and has that changed over time? (3) Which job-related aspects stimulate, and which job-related aspects hamper engagement in teaching and has that changed over time? Methods Design This study examines measures of the teaching faculty over time, with online anonymous questionnaire measurements among faculty members conducted in 2011, 2016, and 2022. The 2022 measurement was delayed one year due to the COVID-19 pandemic. The content of the questionnaires remained the same for all measurements and included both closed and open-ended questions. In 2011 and 2016, the online questionnaire was conducted only in Dutch; the 2022 questionnaire was conducted both in English and in Dutch to be more inclusive for all educators. Translating to English was done via forward and backward translation and checked by a native speaker. The 2022 questionnaire was piloted with eleven participants, resulting in layout refinement, allowing for computer as well as smartphone completion. To decrease the potential risk to faculty of having work engagement information linked to specific individuals, participants completed the questionnaire anonymously. For privacy purposes, individual participation was not tracked, and questionnaire responses were therefore not linked over the three timepoints. Participants received information on the study via an email invitation, and the questionnaire was opened only after consent was given. The study was approved by the Netherlands Association of Medical Education (NVMO) Ethical Review Board application number 2022.6.6 in October 2022. Participants and Procedures For all three survey rounds, all HP educators teaching in the curricula of the Faculty of Medicine at the University Medical Center Utrecht were invited to participate. This group included basic scientists and clinicians from all divisions. In 2011 and 2016, the questionnaire was distributed using snowball-sampling via the medical center’s directors of educational programs and courses. They were asked to forward an e-mail request to all educators in their programs to fill out the electronic questionnaire. We assume most of the teaching faculty were captured using this approach but acknowledge that some educators may have been missed. The exact number of invited participants is not specified due to snowball-sampling and is estimated to be 600 in 2011 and 750 in 2016 based on the UTQ administration. For the 2022 measurement, based on an updated UTQ-administration, faculty were invited via direct email if they were registered: (1) as requiring the UTQ, (2) to have started the UTQ trajectory, or (3) to have obtained the UTQ (both mandatory and voluntarily). A total of 1044 HP educators were invited. Questionnaire The questionnaire was comprised of two sections to answer our specific research questions. For a full English version of the questionnaire see supplementary file A. Work Engagement . To answer research questions 1 and 2, work engagement was measured using the validated 9-item Utrecht Work Engagement Scale (UWES-9) 6 . Items such as ‘At my work, I feel bursting with energy’, ‘When I get up in the morning, I feel like going to work’, ‘I am proud of the work that I do’ were rated from 1 (never) to 7 (always) 6 , 13 . Participants completed this scale multiple times: first, for their job as a whole ( work in general ). Then, they were asked to complete the scale for the different task areas ( teaching , research , and patient care ) relevant to their job. The estimated reliability of the UWES was good: Cronbach’s alpha = .76 in 2011, alpha = .92 (2016); alpha = .93 (2022). Demands and Resources . To answer question 3 and assess which job-related aspects of teaching represent job demands or resources, participants were asked to rate how 22 teaching experiences affected their willingness to teach. Each task was rated using a 5-point Likert scale (1 = very negative, 5 = very positive). These 22 items were selected through thematic analysis of semi-structured interviews with faculty members in 2010 13 . Examples of items are: ‘Teaching large groups (for example, in the lecture hall)’, ‘Feedback on my teaching performance’, and ‘The possibility of a teaching career.’ These items could be perceived as either a job demand or resource. Text boxes were added to the questionnaire to allow participants to provide additional aspects that positively or negatively impacted their engagement with teaching and provide suggestions on how the medical center could support work engagement in teaching. Data analyses For work engagement, means and standard deviations (SD) were calculated for the participants’ work engagement in general and separately for teaching, for research, and for patient care. Based on the combination of their indicated tasks, respondents were grouped into four different subgroups: (1) teaching + research + patient care, (2) teaching + research, (3) teaching + patient care, and (4) teaching-only. After an assumption check, two-way ANOVA was used to determine how work engagement (dependent variable) differed between these groups (independent factor 1) and over time (independent factor 2). To test differences between the 2011, 2016, and 2022 survey rounds, we used a one-way ANOVA and Games-Howell post hoc test. Descriptive statistics (means and SD) were calculated to rank the job-related aspects as demands or resources. The data was analyzed using SPSS (version 28). Comments provided in the open-ended questions in the 2022 survey round were analyzed using content analysis. The first and second author first met to review content categories inductively identified in 2011 and 2016 and updated their definitions and understanding of these categories. Then, the first and second author, using a deductive approach, independently coded the 388 comments from the participants in 2022 into these categories and compared their results, discussed differences, and reached consensus. The first author calculated the frequency of comments in each category and compared them to those of previous years. Results The response rate was lower in 2022 (~ 14%) compared with 2011 (~ 50%) and 2016 (~ 20%). Demographics for all groups of participants in the survey rounds were similar. Across the three survey rounds, most respondents were between 30 and 50 years of age, and 20–30% reported having > 20 years of teaching experience. About 30% reported spending on average more than 2 days a week on teaching activities. The majority of participants indicated that their teaching duties consisted primarily of teaching medical students in a classroom. Work engagement among participants overall Work engagement among all participants as a group generally increased between 2011 and 2022. This included work engagement for the job as a whole ( work in general ) and for the task areas of teaching and research. The one-way ANOVA for work in general showed a significant difference in work engagement among the three survey rounds. Post-hoc analysis showed that engagement scores were higher in 2016 and 2022 compared to 2011 ( p < 0.001), but the difference between 2016 and 2022 was not statistically significant. See Table 1 for the means and SDs of the UWES-9 for all three survey rounds, broken down by participant subgroups based on their task combinations and for all participants overall (last row). Table 1 – Work engagement in general and on (combinations of) subtasks Task combination n Work in general Teaching Research Patient Care 2022 2016 2011 2022 2016 2011 2022 2016 2011 2022 2016 2011 2022 2016 2011 Teaching + research + patient care 45 61 157 5.58 5.22 4.22 ⁎ 5.31 4.97 4.59 † 5.31 § 4.45 4.69 5.60 ‡ 4.95 ‡ 5.43 (0.77) (0.84) (0.82) (1.06) (0.80) (1.11) (1.04) (1.59) (1.29) (0.89) (1.54) (0.91) Teaching + patient care 12 7 20 5.27 ¶ 4.87 4.13 ¶ 4.83 4.52 4.89 - - - 4.91 4.80 5.23 (0.59) (1.00) (0.88) (1.12) (1.16) (0.94) (0.72) (0.67) (1.07) Teaching + research 60 39 64 5.52 ‡ 5.17 ‡ 4.36 ⁎ 5.14 5.03 4.86 5.22 5.13 5.31 - - - (0.81) (0.57) (0.90) (1.12) (0.77) (1.12) (1.09) (0.75) (1.04) Teaching 21 24 34 5.10 5.45 4.36 ¿ 4.84 5.42 5.46 - - - - - - (1.01) (0.81) (0.85) (1.05) (0.81) (0.84) Overall average (SD) 138 131 275 5.45 5.23 4.26 5.12 5.05 4.78 5.26 4.72 4.87 5.46 4.93 5.41 (0.82) (0.77) (0.85) (1.09) (0.82) (1.10) (1.06) (1.36) (1.25) (0.90) (1.40) (0.93) ⁎ 2011 lower than 2016 and 2022 (p < 0.001) † 2011 lower than 2016 and 2022 (p < 0.05) § 2 022 higher than 2011 and 2016 (p < 0.05) ‡ 2022 higher than 2016 (p < 0.05) ¶ 2011 lower than 2022 (p < 0.001) ¿ 2011 lower than 2016 and 2022 (p < 0.05) <insert Table – separate document in landscape) Schaufeli and Bakker 18 interpret UWES-9 scores 5.51 as very high. With this interpretation, work engagement of the HP educators surveyed was generally high across all survey rounds with 77% of mean work engagement scores falling in the high range and 17% in the average range. In 2011, work engagement was measured in the average range for work in general among all participants and within each subgroup. By 2022, very high work engagement was found for work in general in the subgroup of participants who conducted teaching and research and patient care (teaching + research + patient care) and in the subgroup of participants doing teaching and research (teaching + research). Work engagement among participant subgroups with different task combinations Comparing groups of HP educators with jobs involving different combinations of task areas revealed differences in engagement scores between and within the groups for their different task areas (see Table 1 for details). First, for the subgroup ‘teaching + research + patient care’, engagement scores for work in general and for teaching increased from 2011 to 2016 ( p < .001 and p = .017) and 2022 ( p < .001 and p < .001). Yet, work engagement was not significantly different between 2016 and 2022 ( p = .062 and p = .171). Work engagement scores for research and patient care did not change from 2011 to 2016 ( p = .534 and p = .059) but increased in 2022 ( p = .003 and p = .018). Second, the subgroup ‘teaching + patient care’ showed an increase of work engagement scores for their work in general from 2011 to 2022 ( p < .001) but neither the 2011 nor 2022 scores were significantly different from the 2016 scores ( p = .291 and p = .658). The work engagement scores for the separate task areas of teaching and patient care did not change over the years (p = 0.743 and p = 0.485). Third, the subgroup ‘teaching + research’ also shows a statistically significant increase of work engagement for their work in general between 2011 and 2016 and 2022 ( p < .001 and p < .001) and between 2016 and 2022 ( p < .029). Yet, the work engagement for their separate task areas of teaching and research did not change ( p = .354 and p = .896). Finally, the subgroup ‘teaching-only’ increased their work engagement scores for work in general between 2011 and 2016 ( p < .001) and 2022 ( p < .022). There was no significant difference between 2016 and 2022 ( p = .403). When looking at work engagement scores for the task area teaching , this subgroup differs from the other subgroups in that their work engagement scores for teaching showed a downward trend, but no significant difference between 2011 and 2016 ( p = .987) and between 2016 and 2022 ( p = .109). Post hoc analysis showed the decrease from 2011 to 2022 was also not significant ( p = 0.71). Demands and resources related to teaching Table 2 shows the mean ratings and SDs of job-related aspects of teaching that can be considered demands (i.e., ‘hampering aspects’) or resources (i.e., ‘stimulating aspects’) impacting work engagement. They are ranked by decreasing ratings (in 2022) and compared across the survey rounds. Table 2 Aspects that stimulate or hamper teaching engagement Items 2022 n = 154 2016 n = 154 2011 n = 306 Mean SD Mean SD Mean SD Teaching about my own specialty 4.42 .67 4.38 .64 4.50 .56 Freedom to determine what I teach 4.27 .71 4.20 .62 4.03 .64 Freedom to determine how I teach 4.24 .72 4.16 .68 3.94 .65 Teaching to small groups (~ 12 students) 4.20 .75 4.11 .72 4.06 .80 Noticeable appreciation for teaching from my direct supervisor 4.12 .73 4.14 .66 4.10 .70 Noticeable appreciation for teaching from my immediate colleagues 4.08 .68 4.07 .65 3.99 .67 More secretarial support for my educational tasks 4.03 .80 3.92 .73 3.79 .72 Feedback on my teaching performance 3.95 .69 4.14 .63 4.03 .60 Teaching with an emphasis on the learning process 3.94 .85 3.90 .91 3.57 .96 Teaching with colleagues from other disciplines 3.88 .80 3.93 .69 3.75 .75 Teaching in which the transfer of content is paramount 3.75 .84 3.88 .77 3.98 .66 The possibility of a teaching career 3.60 1.02 3.64 .91 3.54 .82 Feedback from other teachers or teacher teams 3.58 .70 3.80 3.68 .67 Give more publicity to good teachers 3.56 .86 3.85 .73 3.72 .70 More educational assistance from the UMCU Education department 3.55 .73 3.69 .67 3.54 .69 Teaching to medium-sized groups (~ 40–60 students) 3.51 .87 3.42 .84 3.38 .86 Easing procedures of basic and senior teaching qualification 3.48 1.01 3.60 .92 3.63 .84 Wider range of teacher training courses 3.48 .79 3.65 .77 3.62 .71 Financial reward for obtaining a teaching qualification 3.40 1.06 3.65 .76 3.70 .81 Numerical rating/scores from student evaluations 3.38 .89 3.84 .75 3.73 .74 Teaching large groups (e.g., in the lecture hall) 3.37 .94 3.19 .95 3.30 .94 Conducting research and publishing about education 3.19 1.02 3.17 .86 3.03 .79 Note. Dark grey cells represent the 5 highest scoring aspects; light grey cells represent the 5 lowest scoring aspects. All 22 aspects had mean scores above 3.0 in all survey rounds. The five aspects with the highest scores (dark grey) remained nearly constant, but the five lowest scoring aspects (light grey) varied in 2022 compared to 2011 and 2016. The highest scoring aspect in all three survey rounds was ‘teaching about my own specialty.’ ‘Freedom to determine what…’ and ‘…how I teach’ were the top 2 and 3 in 2022 and 2016 and increased significantly compared to 2011. HP educators found ‘noticeable appreciation from direct supervisors’ important, and ‘teaching in small groups’ was rated higher in 2022, compared to 2016 and 2011. ‘Teaching in large groups’ and ‘conducting research and publishing on education’ scored lowest in all three survey rounds. Participants added other stimulating and hampering teaching aspects using two open-ended questions, providing 125 and 138 responses in 2022 which were fewer than in the previous survey rounds. These responses were categorized into 11 stimulating aspects, 8 hampering aspects, and 5 suggestions for improvement using the same categories that were defined and used previously for 2016 and 2011. See Table 3 . Table 3 Stimulating and hampering aspects in open-ended queries . Additional stimulating aspects listed 2022 n = 125 2016 n = 218 2011 n = 296 n % n % n % Having personal contact with students 32 25.6 13 6.0 17 5.7 Motivated students 19 15.2 55 25.2 62 20.9 Adequate time to plan teaching 19 15.2 21 9.6 32 10.8 Collaboration with colleagues 10 8.0 8 3.7 - - Acknowledgement and support for my teaching 7 5.6 18 8.3 33 11.1 Receiving feedback on my teaching 7 5.6 14 6.4 23 7.8 Adequate teaching facilities 3 2.4 8 3.7 27 9.1 Clear organization and expectations 3 2.4 22 10.1 32 10.8 Application of my content knowledge 2 1.6 40 18.3 24 8.1 Teaching fixed groups over time 1 0.8 2 0.9 17 5.7 Other 21 16.8 17 7.8 29 9.8 Additional hampering aspects listed 2022 n = 138 2016 n = 202 2011 n = 302 n % n % n % Bureaucracy and rules around teaching 30 21.7 57 28.2 51 16.9 Too little time provided to properly teach 21 15.2 29 14.4 50 16.6 Poor facilities 19 13.8 15 7.4 52 17.2 Lack of appreciation/support for teaching 15 10.9 21 10.4 - - Unmotivated students 13 9.4 29 14.4 52 17.2 Not sufficiently familiar with content 5 3.6 9 4.5 15 5.0 Monotonous repeated group teaching 1 0.7 5 2.5 8 2.6 Other 33 23.9 37 18.3 74 24.5 Suggestions for improvements* 2022 n = 125 2016 n = 49 2011 Not Applicable n % n % n % Providing resources (time/money) 52 41.6 10 20.4 - - Improving culture (importance/value of education) 40 32.0 17 34.7 - - Career support and development 9 7.2 5 10.2 - - Teacher skill development 4 3.2 9 18.4 - - Other 12 9.6 8 16.3 - - * The results on this question from 2011 are not included in this because they were not clustered in the four categories. ** n in this table is the number of remarks from respondents. Having ‘personal contact with students’ was mentioned by 25.6% of the respondents as the most stimulating aspect in 2022. ‘Student motivation’ continued to be important for stimulating teaching engagement, but the frequency with which it was mentioned varied from 20.9% in 2011 to 25.2% in 2016 to 15.2% in 2022. ‘Having adequate time to plan teaching’ was mentioned more frequently in 2022 from 10.8% in 2011 and 9.6% in 2016 to 15.2% in 2022. The mention of ‘application of content knowledge’ dropped from a frequency of 18.3% in 2016 to 1.6% in 2022. The most frequently added hampering aspects included ‘bureaucracy and rules’ around teaching and ‘poor (IT-related) facilities’, making up 35.5% of additions in 2022, which was in line with 34.1% of additions in 2011 and 35.6% in 2016. The ‘other’ category which made up 23.9% of the hampering aspects added, was mostly related to online education due to the COVID-19 pandemic or specific personal circumstances. Suggestions for improving teaching engagement in 2022 were related to ‘provision of resources (financial and time) for teaching’ (41.6%), ‘improvement of culture and the value of education’ (32.0%), ‘improvement of education career support and development’ (7.2%) and ‘development of teacher skills’ (3.2%). The remaining ‘other’ comments were comprised of miscellaneous suggestions or were not applicable. Discussion In general, the work engagement of HP educators in our study has been high and seems to have mainly increased since 2011, both for work in general and for the individual task areas of teaching, research , and patient care . The subgroups that showed increased engagement scores for teaching combined task areas, either teaching with patient care or teaching with research. Job-related aspects enhancing engagement in teaching included ‘freedom to determine what…’ and ‘…how I teach’ and ‘teaching about my own specialty’ consistently remained at the top. Also, in the top 5 was ‘noticeable appreciation from direct supervisors.’ ‘Teaching in large groups’ and ‘conducting research and publishing on education’ scored lowest in all three survey rounds. Added comments revealed the importance of ‘having adequate time to prepare’ and ‘good (IT-related) facilities.’ The 2011 and 2016 results showed an increase in overall work engagement over time with the largest improvement for HP educators involved in teaching only and for HP educators combining all task areas. While the 2022 results might suggest a trend for continued improvement in work engagement scores, the change was not statistically significant. This could be due to being underpowered. The 2022 results could also have been impacted by the effects of the COVID-19 pandemic, despite delaying the follow-up study by a year. The trend for decreasing engagement in teaching seen in the teaching only subgroup would be consistent with a COVID-19 effect. Respondent-added hampering aspects for their teaching included many remarks focused on challenges with technology, the rapid change to online teaching, and the institution’s lack of preparedness for it. This is consistent with reports of increased anxiety and stress and decreased teaching satisfaction in university teachers during the COVID-19 pandemic related to online teaching 19 , 20 . A follow-up study will be important to see if work engagement in teaching recovers and if increases in work engagement scores in general continue over time as the impacts from COVID diminish. Continued improvements in work engagement scores among HP educators would provide supporting evidence for the positive impact of the center’s ongoing faculty development initiatives. Interestingly, the subgroup combining all three task areas shows the largest increase in work engagement for work in general and for each of the three tasks of teaching, research , and patient care relative to the other subgroups of respondents. This stands in greatest contrast to the trend of decreased work engagement in teaching in the teaching only subgroup. One explanation might be that when stressors such as COVID-19 impact specific task areas, the respondents with jobs that include other task areas are able to find respite or additional resources in the less impacted task areas. Van den Berg and colleagues suggest that job resources and demands and the ability to job craft present in one role might be absent in other roles, resulting in different engagement for different roles 14 . Notably, increases in engagement scores for work in general were found in all subgroups despite some decreased scores for task areas. This could also suggest a protective effect of other task areas on the engagement for work in general , where work as a whole is more than the sum of its parts. A study on multiple life roles (e.g., marital, parenting, caregiver, employment) and stress found that individuals combining more than two roles experience less stress than individuals with only a single role 21 . It is also possible that as participants considered their work in general , they might have had in mind their academic career rather than their job per se. Timms and Brough differentiate between career (i.e. profession) and job (i.e. work done) and note it is career satisfaction, rather than job satisfaction, that is a robust predictor for work engagement of teachers 2 . In academic medical centers where people have multiple roles and tasks, further research needs to focus on how overall job and career perspectives impact a specific role such as teaching. The top 5 highest scoring stimulating aspects for teaching from the questionnaire can be related to autonomy (freedom to determine what and how to teach), relatedness (teaching small groups, appreciation from direct supervisor), and competence (teaching about one’s own specialty), which have been described by Deci & Ryan 22 as three basic psychological needs. The ability to meet these basic psychological needs can also be seen as job resources that can drive work engagement and job satisfaction of teachers 23 , 5 and the lack thereof. Afterall, job demands might hinder work engagement and job satisfaction as well. However, we do need to flag that within our institution, as in many HPE institutions, faculty may teach in courses that are not their ‘own’. This means they do not always have the autonomy (i.e., lack the job resource) to choose what and how they teach, and rather are asked to provide teaching that is predefined by someone else which can be considered an additional job demand. In institutions where educators mainly teach courses that are predefined by others, strategies could be employed to increase teachers’ autonomy. For example, teachers could be given freedom to adjust specific parts of a course content or delivery method to better suit their expertise or preferences. The most frequently added stimulating aspects, that could serve as job resources, also align with the need for relatedness (motivated students, having personal contact with students, and collaboration with colleagues) and highlight the importance of support (acknowledgment and support for my teaching, receiving feedback on my teaching). The respondent-added hampering aspects could be viewed as negatively impacting these psychological needs. Online teaching is a new demand on educator competence. Inadequate technology and lack of institutional preparedness as well as not having enough time suggest that the resources available were insufficient to compensate for the new demand and support their competence. Improved on demand technological support (e.g., for device setup, during technological failure) and interpersonal support from colleagues and supervisors could have served as important job resources to help sustain motivation, job satisfaction, and work engagement, and prevent educator burnout during times of new or increased job demands. Based on previous research and conversations with teachers we know that ‘conducting research and publishing on education’ is experienced as a value for research and not for teaching itself 17 . In fact, a set of published competencies for medical educators identifies educational scholarship as a specialized competence expected only of teachers occupying specific roles rather than a core competence expected of all teachers 24 . Yet others have argued that while not every teacher needs to engage in the scholarship of teaching and learning (SoTL), every teacher should work towards becoming a scholarly teacher 25 . Consistent with this sentiment, there has been increased attention to SoTL over the recent years in our institution to highlight the importance of evidence informed education in addition to the value of practitioner educational research. Our results seem aligned with the findings of Van den Berg and colleagues 15 , who found that combining roles and job crafting is related to higher engagement. They also saw that engagement scores for patient care were higher than for teaching. Their study suggests that engagement for specific roles can be further increased when faculty are given the autonomy to craft their own jobs more, which can be considered an increase of job resources. Job crafting means that educators have opportunities to make changes in their job demand and resources to shape their job into one that is more meaningful, engaging, and satisfying 26 . While job crafting is an activity that is initiated by employees themselves, when institutions recognize and approve job crafting activities, they build rapport and commitment with their employees 26 . It could therefore be beneficial for academic institutions to investigate the possibilities for job crafting in HPE as a job resource, to further improve work engagement of our educators 27 . Park and Johnson have called upon academic leaders to ensure engagement of teachers by recognizing their contributions and providing development opportunities 5 , thereby increasing the job resources for teaching. Over the years, our institution has invested heavily in efforts to do so. In addition to offering different levels of teacher and educator training, we encourage their development through grants for innovation projects, create support via a community for educators, provide recognition using annual outstanding educator awards, and enable career paths for health professionals based on education efforts. These investments are based on previous research that revealed the importance of addressing all four areas of competence, context, community, and career that are essential to enhancing faculty development and increasing engagement in teaching 28 . Limitations and suggestions for future research There are limitations to this research. First, the response rates in 2022 (~ 14%) and 2016 (~ 20%) were low compared to 2011 (~ 50%). It is possible that the faculty who took time to participate were most likely those most engaged in teaching, leading to higher than actual mean work engagement scores. The low response rates also resulted in very low numbers in the subgroups, which could have affected the subgroup analysis results. A second limitation is that the data is not linked to individual participants longitudinally. Given that the composition of the teaching faculty changes over time, we opted to collect cross-sectional data at 5-year intervals. Therefore, we can only interpret the results through a trend analysis to draw conclusions about changes over time for the current groups of teaching faculty at the medical center. While we purposefully delayed the survey by one year to minimize the effects of the COVID-19 pandemic, this can also be considered a third limitation since we did not measure engagement during COVID-19. Data from during the COVID-19 pandemic would have helped provide context for post-pandemic results and potentially useful insights on the job resources and job demands of teaching in future pandemic-type disruptions to education. A final limitation is that we focused on teaching. Therefore, we need to be cautious about the overinterpretation of patient care and research engagement scores since we did not gather data from patient care only and research only populations for comparison. To support our findings and gain more insight into why HP educators with only teaching tasks show a trend for lower work engagement in teaching in 2022, the survey will be continued at regular intervals as a monitoring tool. Future studies with longitudinal study designs and interview approaches could examine whether the stagnation in improvement might be due to COVID-19 and explore potential reasons for improved work engagement other than the center’s faculty development initiatives to support HP educators. Conclusion As a group, HP educators at one university medical center scored high on work engagement overall and their work engagement increased over time. Faculty members report autonomy, time, and departmental support as crucial job resources to stimulate engagement in teaching. Combining different task areas might allow for an overall balance in job demands-resources and sustained engagement even when job demands increase in one task area. While we cannot demonstrate causation, our findings suggest that robust and sustained attention to institutional investments in faculty development and support may contribute to enhancing faculty teaching engagement over time. Abbreviations UWES-9: Utrecht Work Engagement Scale-9; HPE: Health Professions Education; HP: Health Professions; JD-R model: Job Demands-Resources model; NVMO: Nederlandse Vereniging voor Medisch Onderwijs (Dutch Association of Medical Education); UTQ: University Teaching Qualification. Declarations Ethics approval and consent to participate This study was approved by the Netherlands Association of Medical Education (NVMO) Ethical Review Board application number 2022.6.6 in October 2022. Informed consent was obtained from participants within the online questionnaire itself (see supplementary file A). Participants could only continue the questionnaire if they responded positively, which guaranteed all respondents signed the informed consent. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors' contributions LvB conducted the 2022 survey based on previous versions of 2011 and 2016 and imported it in the online survey tool Qualtrics. LvB and HP jointly analyzed the quantitative data using SPSS. LvB and HCC jointly analyzed the qualitative data (remarks) using the themes derived from analysis in 2011 and 2016. All authors together interpreted and discussed the analysis results to draw conclusions. Then LvB took the lead in writing the manuscript. All authors read all versions of the manuscript, provided edit suggestions, and approved the final manuscript. Acknowledgments We would like to thank the researchers who developed and started this research in 2011; prof.dr. Th.J. ten Cate (UMC Utrecht), dr. B.A.M. van den Berg (Utrecht University) and prof.dr. A.B. Bakker (Erasmus University Rotterdam). Also, we would like to thank all faculty at UMC Utrecht who were willing to take time to participate in this study. References Martin AJ. Examining a multidimensional model of student motivation and engagement using a construct validation approach. Br. J. Educ. Psychol. 2007. 77(2), 413-440. Timms, C, Brough, P. “I like being a teacher” Career satisfaction, the work environment and work engagement. J. Educ. Adm. 2013. 51(6), 768-789. Shu, K. Teachers’ commitment and self-efficacy as predictors of work engagement and well-being. Front. Psychol. 2022. 13, 850204. Addimando, L. The effect of positive working conditions on work engagement and teaching classroom practices: a large cross-sectional study in Switzerland. Front. psychol. 2019. 10, 2129. Park, KA, Johnson, KR. Job Satisfaction, Work Engagement, and Turnover Intention of CTE Health Science Teachers. Int. J. Res. Vocat. Educ. Train. 2019. 6(3), 224-242. Schaufeli WB, Salanova M, González-Romá V, Bakker AB. The measurement of engagement and burnout: A two-sample confirmatory factor analytic approach. J Happiness Stud. 2002. 3(1),71–92. Van den Broeck A, Vansteenkiste M, De Witte H, Lens W. Explaining the relationships between job characteristics, burnout, and engagement: The role of basic psychological need satisfaction. Work & stress. 2008. 22(3), 277-294. Bakker AB, Demerouti E. The job demands‐resources model: State of the art. J. Manag. Psychol. 2007. 22(3), 309-328. Tims M, Bakker AB. Job crafting: Towards a new model of individual job redesign. SA J. Ind. Psychol. 2010. 36(2), 1-9. Hakanen JJ, Perhoniemi R, Toppinen-Tanner S. Positive gain spirals at work: From job resources to work engagement, personal initiative and work-unit innovativeness. J. Vocat. Behav. 2008. 73(1), 78-91. Hakanen, JJ, Bakker, AB, & Schaufeli, WB. Burnout and work engagement among teachers. J. Sch. Psychol. 2006. 43(6), 495-513. Molenaar WM, Zanting A. Experiences with the implementation of a national teaching qualification in university medical centres and veterinary medicine in the Netherlands. Persp. Med. Educ. 2015. 4, 43-46. Van den Berg BAM, Bakker AB, Ten Cate TJ. Key factors in work engagement and job motivation of teaching faculty at a university medical centre. Persp. Med. Educ. 2013. 2, 264-275. van den Berg, JW, Mastenbroek, NJ, Scheepers, RA, & Jaarsma, ADCWork engagement in health professions education. Med. Teach. 2017. 39(11), 1110-1118. Van den Berg JW, Verberg CP, Scherpbier AJ, Jaarsma ADC, Arah OA, Lombarts KM. Faculty’s work engagement in patient care: impact on job crafting of the teacher tasks. BMC Med. Educ. 2018. 18, 1-12. de Jong, R, Mulder, J, Deneer, P, van Keulen, H. Poldering a teaching qualification system in Higher Education in the Netherlands: a typical Dutch phenomenon. REDU. 2013.11(3), 23. Van Bruggen L, Ten Cate O, Chen HC. Factors that (de)motivate teachers: A longitudinal survey study. Short Comm. at the AMEE Conf. 2017. Schaufeli W, Bakker A. UWES-Utrecht Work Engagement Scale: Test Manual. Unpublished Manuscript, Occup. Health Psychol UU, Utrecht. 2004. no. December, 60. Silva, DFO, Cobucci, RN, Lima, SCVC, & de Andrade, FB Prevalence of anxiety, depression, and stress among teachers during the COVID-19 pandemic: A PRISMA-compliant systematic review. Med. 2021. 100(44), e27684. Miguel, C, Castro, L, Marques dos Santos, JP, Serrão, C, & Duarte, I. Impact of COVID-19 on medicine lecturers’ mental health and emergency remote teaching challenges. Int. J. Environ. Res. Public Health. 2021. 18(13), 6792. Honda, A, Abe, Y, Date, Y, & Honda, S. The impact of multiple roles on psychological distress among Japanese workers. Saf. Health Work. 2015. 6(2), 114-119. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000. 55(1), 68. Shim, SS, Finch, WH, Cho, Y, & Knapke, M. Understanding teachers’ job satisfaction and flow: the dual process of psychological needs. Educ. Psychol. 2022. 42(3), 316-333. Srinivasan, M, Li, STT, Meyers, FJ, Pratt, DD, Collins, JB, Braddock, et al. “Teaching as a competency”: competencies for medical educators. Acad. Med. 2011. 86(10), 1211-1220. Cleland, JA, Jamieson, S, Kusurkar, RA, Ramani, S, Wilkinson, TJ, & van Schalkwyk, S. Redefining scholarship for health professions education: AMEE Guide No. 142. Med. Teach. 2021. 43(7), 824-838. Demerouti, E. Design your own job through job crafting. Eur. Psychol. 2014 Xanthopoulou, D, Bakker, AB, Demerouti, E, & Schaufeli, WB. Work engagement and financial returns: A diary study on the role of job and personal resources. J. Occup. Organ. Psychol. 2009. 82(1), 183-200. Van Bruggen L, Ten Cate O, Chen HC. Developing a novel 4-C framework to enhance participation in faculty development. Teach. Learn. Med. 2020. 32(4), 371-379. Additional Declarations No competing interests reported. Supplementary Files 20240912SuppAQuestionnaireHPEWorkEngagementinTeachingENG.pdf Cite Share Download PDF Status: Published Journal Publication published 11 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Accepted 02 Jul, 2025 Editor assigned by journal 16 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers invited by journal 03 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 First submitted to journal 28 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5043114","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437754661,"identity":"e677812e-ca7c-4a84-b1a8-8ca8d4258491","order_by":0,"name":"JME Bruggen","email":"data:image/png;base64,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","orcid":"","institution":"University Medical Center Utrecht","correspondingAuthor":true,"prefix":"","firstName":"JME","middleName":"","lastName":"Bruggen","suffix":""},{"id":437754662,"identity":"2a223fd2-beaa-4269-bb48-48f9ca708c04","order_by":1,"name":"HC Chen","email":"","orcid":"","institution":"Kaiser Permanente Bernard J. Tyson School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"HC","middleName":"","lastName":"Chen","suffix":""},{"id":437754663,"identity":"25212d3d-2f37-4adf-8d96-dc5a4f476bb2","order_by":2,"name":"MF Schaaf","email":"","orcid":"","institution":"University Medical Center Utrecht","correspondingAuthor":false,"prefix":"","firstName":"MF","middleName":"","lastName":"Schaaf","suffix":""},{"id":437754664,"identity":"99d0f204-23fe-4a6e-a2bb-259d89f23dcd","order_by":3,"name":"HJM Pennings","email":"","orcid":"","institution":"University Medical Center Utrecht","correspondingAuthor":false,"prefix":"","firstName":"HJM","middleName":"","lastName":"Pennings","suffix":""}],"badges":[],"createdAt":"2024-09-06 09:21:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5043114/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5043114/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07628-3","type":"published","date":"2025-07-11T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86699381,"identity":"93580236-f58b-4a88-a748-664a2a125f13","added_by":"auto","created_at":"2025-07-14 16:08:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4562773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5043114/v1/264e4567-0af3-4352-918e-df1373b11a79.pdf"},{"id":79881330,"identity":"82a9520b-f91b-4233-8657-50c7720a9177","added_by":"auto","created_at":"2025-04-04 04:12:44","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":92522,"visible":true,"origin":"","legend":"","description":"","filename":"20240912SuppAQuestionnaireHPEWorkEngagementinTeachingENG.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5043114/v1/ad7593c9f10e977b609a8688.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evolving Health Professions Educators’ Work Engagement in Teaching While Combining Roles in an Academic Medical Center","fulltext":[{"header":"Background","content":"\u003cp\u003eCompetent educators are indispensable for high quality health professions education. Good teaching requires knowledge, attitudes, and skills, but it starts with educators\u0026rsquo; willingness, energy, and drive to learn, to work effectively, and to achieve their potential\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Becoming a good educator requires sustained engagement with teaching tasks\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Work engagement is defined as an active, energetic state of mind that is characterized by vigor, dedication, and absorption\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Vigor is characterized by high levels of energy and mental resilience while working, the willingness to invest effort in one\u0026rsquo;s work, and persistence even in the face of difficulties. Dedication means being strongly involved in one\u0026rsquo;s work and experiencing a sense of significance, enthusiasm, inspiration, and challenge. Absorption is characterized by being fully concentrated and happily engrossed in one\u0026rsquo;s work, whereby time passes quickly, and one has difficulty detaching from work\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEmployees feel more engaged in their work when their jobs are resourceful\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. All jobs entail tasks that provide energy (i.e., job resources) or drain energy (i.e., job demands) from employees\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. How such tasks affect employees\u0026rsquo; work engagement is often studied using the job demands\u0026ndash;resources (JD-R) model\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. At the heart of this model lies the assumption that all aspects of work environments can be categorized as job demands or job resources that either positively or negatively affect work engagement\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The presence of job demands, and the absence of job resources are associated with reduced work engagement and could lead to burnout\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The presence of sufficient job resources can increase work engagement\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and may lead to employees taking initiative in their work that goes beyond what is formally required of them\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Thus, ensuring a balance between job demands and resources is essential to improving or maintaining work engagement. However, these studies have primarily looked at jobs as a whole and not considered people whose jobs combine roles/tasks where there are different demands and/or resources for those tasks and how one task can have a great impact on another.\u003c/p\u003e \u003cp\u003eTo develop as good educators, engagement in teaching is vital, and to engage in teaching, the characteristics of the teaching job need to be resourceful\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Yet being a health professions (HP) educator in an academic medical center means juggling and combining a variety of tasks and obligations\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Medical specialists also have patients to care for and both clinical and basic science faculty are often also involved in research. The current pressures in health care, to cut costs by increasing efficiency combined with staff shortages, result in increased demands on the job. Teaching is a third core task of an academic medical center that can suffer from the competing tasks in patient care and/or research. For some faculty, teaching is seen as an auxiliary task to patient care, and sometimes as forced labor, which comes with being a health professional in an academic medical center\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Thus, to understand the teaching engagement of health professions educators, it is important to consider not just the demands and resources present for their teaching task, but also the impact of their other tasks in patient care and/or research.\u003c/p\u003e \u003cp\u003eVan den Berg and colleagues conducted a study to investigate the relationship between work engagement and job crafting\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Job crafting is the process of taking proactive steps to shape one\u0026rsquo;s own job to better align with personal needs, goals, and skills\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. They compared groups of medical faculty that combined patient care and teaching tasks and found that increased engagement for a specific task was related to being able to job craft or modify one\u0026rsquo;s role for that task. The ability to job craft or modify one\u0026rsquo;s role for tasks may be particularly important and potentially more difficult for those whose jobs combine tasks, especially if one of the tasks is experienced as auxiliary (as teaching is sometimes considered within an academic medical center). As academic medical centers consider increasing resources for teaching to alter the demands/resources balance for teaching in efforts to improve faculty teaching engagement, it is important to consider whether the impact will be the same for faculty who combine patient care and/or research tasks with their teaching.\u003c/p\u003e \u003cp\u003eThe context of this study is a university medical center in the Netherlands that has made deliberate investments in faculty development. In the Netherlands, all faculty members who teach are required to obtain a University Teaching Qualification (UTQ). This institution had implemented mandatory Teaching Qualifications for all faculty members in 1995, including didactic training and reflection on one\u0026rsquo;s own teaching based on feedback from students and observing colleagues, prior to the national UTQ implementation in 2008\u003csup\u003e16\u003c/sup\u003e. It also established teaching awards, educational innovation grants, and an educational leadership program. In 2011, the center surveyed HP educators to assess their work engagement, revealing lower work engagement in teaching tasks than for research and patient care tasks\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In response, the center further implemented individualized faculty development programs at different levels to increase job resources for HP educators. This included a longitudinal two-year program focused on developing scholarly approaches to teaching (Teaching Scholars Program). A follow-up survey among HP educators, conducted in 2016, showed increased work engagement in teaching\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven the center\u0026rsquo;s continued attention to faculty development, recognition and appreciation of HP educators, and the context of increased job demands during the COVID-19 pandemic, we again examined our HP educators\u0026rsquo; work engagement for their combined task areas (i.e., patient care, research, teaching) in 2022. We conducted a descriptive survey study on measurements of HP educators\u0026rsquo; current work engagement and made comparisons to the data gathered in 2011 and 2016. We formulated the following research questions: (1) How engaged are HP educators in their teaching task and has that changed over time? (2) How does the engagement of HP educators in teaching compare to engagement in their patient care and research tasks when combining roles, and has that changed over time? (3) Which job-related aspects stimulate, and which job-related aspects hamper engagement in teaching and has that changed over time?\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis study examines measures of the teaching faculty over time, with online anonymous questionnaire measurements among faculty members conducted in 2011, 2016, and 2022. The 2022 measurement was delayed one year due to the COVID-19 pandemic. The content of the questionnaires remained the same for all measurements and included both closed and open-ended questions. In 2011 and 2016, the online questionnaire was conducted only in Dutch; the 2022 questionnaire was conducted both in English and in Dutch to be more inclusive for all educators. Translating to English was done via forward and backward translation and checked by a native speaker. The 2022 questionnaire was piloted with eleven participants, resulting in layout refinement, allowing for computer as well as smartphone completion.\u003c/p\u003e \u003cp\u003eTo decrease the potential risk to faculty of having work engagement information linked to specific individuals, participants completed the questionnaire anonymously. For privacy purposes, individual participation was not tracked, and questionnaire responses were therefore not linked over the three timepoints. Participants received information on the study via an email invitation, and the questionnaire was opened only after consent was given. The study was approved by the Netherlands Association of Medical Education (NVMO) Ethical Review Board application number 2022.6.6 in October 2022.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Procedures\u003c/h3\u003e\n\u003cp\u003e For all three survey rounds, all HP educators teaching in the curricula of the Faculty of Medicine at the University Medical Center Utrecht were invited to participate. This group included basic scientists and clinicians from all divisions. In 2011 and 2016, the questionnaire was distributed using snowball-sampling via the medical center\u0026rsquo;s directors of educational programs and courses. They were asked to forward an e-mail request to all educators in their programs to fill out the electronic questionnaire. We assume most of the teaching faculty were captured using this approach but acknowledge that some educators may have been missed. The exact number of invited participants is not specified due to snowball-sampling and is estimated to be 600 in 2011 and 750 in 2016 based on the UTQ administration. For the 2022 measurement, based on an updated UTQ-administration, faculty were invited via direct email if they were registered: (1) as requiring the UTQ, (2) to have started the UTQ trajectory, or (3) to have obtained the UTQ (both mandatory and voluntarily). A total of 1044 HP educators were invited.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was comprised of two sections to answer our specific research questions. For a full English version of the questionnaire see supplementary file A.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eWork Engagement\u003c/span\u003e. To answer research questions 1 and 2, work engagement was measured using the validated 9-item Utrecht Work Engagement Scale (UWES-9)\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Items such as \u0026lsquo;At my work, I feel bursting with energy\u0026rsquo;, \u0026lsquo;When I get up in the morning, I feel like going to work\u0026rsquo;, \u0026lsquo;I am proud of the work that I do\u0026rsquo; were rated from 1 (never) to 7 (always)\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Participants completed this scale multiple times: first, for their job as a whole (\u003cem\u003ework in general\u003c/em\u003e). Then, they were asked to complete the scale for the different task areas (\u003cem\u003eteaching\u003c/em\u003e, \u003cem\u003eresearch\u003c/em\u003e, and \u003cem\u003epatient care\u003c/em\u003e) relevant to their job. The estimated reliability of the UWES was good: Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;.76 in 2011, alpha\u0026thinsp;=\u0026thinsp;.92 (2016); alpha\u0026thinsp;=\u0026thinsp;.93 (2022).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDemands and Resources\u003c/span\u003e. To answer question 3 and assess which job-related aspects of teaching represent job demands or resources, participants were asked to rate how 22 teaching experiences affected their willingness to teach. Each task was rated using a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;very negative, 5\u0026thinsp;=\u0026thinsp;very positive). These 22 items were selected through thematic analysis of semi-structured interviews with faculty members in 2010\u003csup\u003e13\u003c/sup\u003e. Examples of items are: \u0026lsquo;Teaching large groups (for example, in the lecture hall)\u0026rsquo;, \u0026lsquo;Feedback on my teaching performance\u0026rsquo;, and \u0026lsquo;The possibility of a teaching career.\u0026rsquo; These items could be perceived as either a job demand or resource. Text boxes were added to the questionnaire to allow participants to provide additional aspects that positively or negatively impacted their engagement with teaching and provide suggestions on how the medical center could support work engagement in teaching.\u003c/p\u003e\n\u003ch3\u003eData analyses\u003c/h3\u003e\n\u003cp\u003eFor work engagement, means and standard deviations (SD) were calculated for the participants\u0026rsquo; work engagement in general and separately for teaching, for research, and for patient care. Based on the combination of their indicated tasks, respondents were grouped into four different subgroups: (1) teaching\u0026thinsp;+\u0026thinsp;research\u0026thinsp;+\u0026thinsp;patient care, (2) teaching\u0026thinsp;+\u0026thinsp;research, (3) teaching\u0026thinsp;+\u0026thinsp;patient care, and (4) teaching-only. After an assumption check, two-way ANOVA was used to determine how work engagement (dependent variable) differed between these groups (independent factor 1) and over time (independent factor 2). To test differences between the 2011, 2016, and 2022 survey rounds, we used a one-way ANOVA and Games-Howell post hoc test. Descriptive statistics (means and SD) were calculated to rank the job-related aspects as demands or resources. The data was analyzed using SPSS (version 28).\u003c/p\u003e \u003cp\u003eComments provided in the open-ended questions in the 2022 survey round were analyzed using content analysis. The first and second author first met to review content categories inductively identified in 2011 and 2016 and updated their definitions and understanding of these categories. Then, the first and second author, using a deductive approach, independently coded the 388 comments from the participants in 2022 into these categories and compared their results, discussed differences, and reached consensus. The first author calculated the frequency of comments in each category and compared them to those of previous years.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe response rate was lower in 2022 (~\u0026thinsp;14%) compared with 2011 (~\u0026thinsp;50%) and 2016 (~\u0026thinsp;20%). Demographics for all groups of participants in the survey rounds were similar. Across the three survey rounds, most respondents were between 30 and 50 years of age, and 20\u0026ndash;30% reported having\u0026thinsp;\u0026gt;\u0026thinsp;20 years of teaching experience. About 30% reported spending on average more than 2 days a week on teaching activities. The majority of participants indicated that their teaching duties consisted primarily of teaching medical students in a classroom.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eWork engagement among participants overall\u003c/h2\u003e \u003cp\u003eWork engagement among all participants as a group generally increased between 2011 and 2022. This included work engagement for the job as a whole (\u003cem\u003ework in general\u003c/em\u003e) and for the task areas of teaching and research. The one-way ANOVA for \u003cem\u003ework in general\u003c/em\u003e showed a significant difference in work engagement among the three survey rounds. Post-hoc analysis showed that engagement scores were higher in 2016 and 2022 compared to 2011 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but the difference between 2016 and 2022 was not statistically significant. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the means and SDs of the UWES-9 for all three survey rounds, broken down by participant subgroups based on their task combinations and for all participants overall (last row).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Work engagement in general and on (combinations of) subtasks\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTask combination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eWork in general\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eResearch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e \u003cp\u003ePatient Care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeaching\u0026thinsp;+\u0026thinsp;research\u0026thinsp;+\u0026thinsp;patient care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.22\u003csup\u003e⁎\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.59\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5.31\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5.60\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e4.95\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e(0.77)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(0.84)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e(0.82)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e(1.06)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e(0.80)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e(1.11)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003e(1.04)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cem\u003e(1.59)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e(1.29)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cem\u003e(0.89)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u003cem\u003e(1.54)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u003cem\u003e(0.91)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeaching\u0026thinsp;+\u0026thinsp;patient care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.27\u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.13\u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e(0.59)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(1.00)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e(0.88)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e(1.12)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e(1.16)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e(0.94)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cem\u003e(0.72)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u003cem\u003e(0.67)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u003cem\u003e(1.07)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeaching\u0026thinsp;+\u0026thinsp;research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.52\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.17\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.36\u003csup\u003e⁎\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e(0.81)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(0.57)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e(0.90)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e(1.12)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e(0.77)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e(1.12)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003e(1.09)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cem\u003e(0.75)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e(1.04)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.36\u003csup\u003e\u0026iquest;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e(1.01)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(0.81)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e(0.85)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e(1.05)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e(0.81)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e(0.84)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall average (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e(0.82)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(0.77)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e(0.85)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e(1.09)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e(0.82)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e(1.10)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003e(1.06)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cem\u003e(1.36)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e(1.25)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cem\u003e(0.90)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u003cem\u003e(1.40)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u003cem\u003e(0.93)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003csup\u003e⁎\u003c/sup\u003e2011 lower than 2016 and 2022 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e2011 lower than 2016 and 2022 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003csup\u003e\u0026sect;\u0026nbsp;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e022 higher than 2011 and 2016 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e2022 higher than 2016 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003csup\u003e\u0026para;\u003c/sup\u003e2011 lower than 2022 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003csup\u003e\u0026iquest;\u003c/sup\u003e2011 lower than 2016 and 2022 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e\u003cinsert Table – separate document in landscape)\u003c/h3\u003e\n\u003cp\u003eSchaufeli and Bakker\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e interpret UWES-9 scores\u0026thinsp;\u0026lt;\u0026thinsp;1.77 as very low, 1.78\u0026ndash;2.88 as low, 2.89\u0026ndash;4.66 as average, 4.67\u0026ndash;5.50 as high and \u0026gt;\u0026thinsp;5.51 as very high. With this interpretation, work engagement of the HP educators surveyed was generally high across all survey rounds with 77% of mean work engagement scores falling in the high range and 17% in the average range. In 2011, work engagement was measured in the average range for \u003cem\u003ework in general\u003c/em\u003e among all participants and within each subgroup. By 2022, very high work engagement was found for \u003cem\u003ework in general\u003c/em\u003e in the subgroup of participants who conducted teaching and research and patient care (teaching\u0026thinsp;+\u0026thinsp;research\u0026thinsp;+\u0026thinsp;patient care) and in the subgroup of participants doing teaching and research (teaching\u0026thinsp;+\u0026thinsp;research).\u003c/p\u003e\n\u003ch3\u003eWork engagement among participant subgroups with different task combinations\u003c/h3\u003e\n\u003cp\u003eComparing groups of HP educators with jobs involving different combinations of task areas revealed differences in engagement scores between and within the groups for their different task areas (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details).\u003c/p\u003e \u003cp\u003eFirst, for the subgroup \u0026lsquo;teaching\u0026thinsp;+\u0026thinsp;research\u0026thinsp;+\u0026thinsp;patient care\u0026rsquo;, engagement scores for \u003cem\u003ework in general\u003c/em\u003e and for \u003cem\u003eteaching\u003c/em\u003e increased from 2011 to 2016 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017) and 2022 (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Yet, work engagement was not significantly different between 2016 and 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.062 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.171). Work engagement scores for \u003cem\u003eresearch\u003c/em\u003e and \u003cem\u003epatient care\u003c/em\u003e did not change from 2011 to 2016 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.534 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.059) but increased in 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.018).\u003c/p\u003e \u003cp\u003eSecond, the subgroup \u0026lsquo;teaching\u0026thinsp;+\u0026thinsp;patient care\u0026rsquo; showed an increase of work engagement scores for their \u003cem\u003ework in general\u003c/em\u003e from 2011 to 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) but neither the 2011 nor 2022 scores were significantly different from the 2016 scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.291 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.658). The work engagement scores for the separate task areas of \u003cem\u003eteaching\u003c/em\u003e and \u003cem\u003epatient care\u003c/em\u003e did not change over the years (p\u0026thinsp;=\u0026thinsp;0.743 and p\u0026thinsp;=\u0026thinsp;0.485).\u003c/p\u003e \u003cp\u003eThird, the subgroup \u0026lsquo;teaching\u0026thinsp;+\u0026thinsp;research\u0026rsquo; also shows a statistically significant increase of work engagement for their \u003cem\u003ework in general\u003c/em\u003e between 2011 and 2016 and 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between 2016 and 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.029). Yet, the work engagement for their separate task areas of \u003cem\u003eteaching\u003c/em\u003e and \u003cem\u003eresearch\u003c/em\u003e did not change (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.354 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.896).\u003c/p\u003e \u003cp\u003eFinally, the subgroup \u0026lsquo;teaching-only\u0026rsquo; increased their work engagement scores for \u003cem\u003ework in general\u003c/em\u003e between 2011 and 2016 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.022). There was no significant difference between 2016 and 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.403). When looking at work engagement scores for the task area \u003cem\u003eteaching\u003c/em\u003e, this subgroup differs from the other subgroups in that their work engagement scores for \u003cem\u003eteaching\u003c/em\u003e showed a downward trend, but no significant difference between 2011 and 2016 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.987) and between 2016 and 2022 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.109). Post hoc analysis showed the decrease from 2011 to 2022 was also not significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemands and resources related to teaching\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the mean ratings and SDs of job-related aspects of teaching that can be considered demands (i.e., \u0026lsquo;hampering aspects\u0026rsquo;) or resources (i.e., \u0026lsquo;stimulating aspects\u0026rsquo;) impacting work engagement. They are ranked by decreasing ratings (in 2022) and compared across the survey rounds.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAspects that stimulate or hamper teaching engagement\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;154\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;154\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;306\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching about my own specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreedom to determine what I teach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreedom to determine how I teach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching to small groups (~\u0026thinsp;12 students)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNoticeable appreciation for teaching from my direct supervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNoticeable appreciation for teaching from my immediate colleagues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore secretarial support for my educational tasks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeedback on my teaching performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching with an emphasis on the learning process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching with colleagues from other disciplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching in which the transfer of content is paramount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe possibility of a teaching career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeedback from other teachers or teacher teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGive more publicity to good teachers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore educational assistance from the UMCU Education department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching to medium-sized groups (~\u0026thinsp;40\u0026ndash;60 students)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEasing procedures of basic and senior teaching qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWider range of teacher training courses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial reward for obtaining a teaching qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumerical rating/scores from student evaluations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching large groups (e.g., in the lecture hall)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConducting research and publishing about education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e Dark grey cells represent the 5 highest scoring aspects; light grey cells represent the 5 lowest scoring aspects.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll 22 aspects had mean scores above 3.0 in all survey rounds. The five aspects with the highest scores (dark grey) remained nearly constant, but the five lowest scoring aspects (light grey) varied in 2022 compared to 2011 and 2016. The highest scoring aspect in all three survey rounds was \u0026lsquo;teaching about my own specialty.\u0026rsquo; \u0026lsquo;Freedom to determine what\u0026hellip;\u0026rsquo; and \u0026lsquo;\u0026hellip;how I teach\u0026rsquo; were the top 2 and 3 in 2022 and 2016 and increased significantly compared to 2011. HP educators found \u0026lsquo;noticeable appreciation from direct supervisors\u0026rsquo; important, and \u0026lsquo;teaching in small groups\u0026rsquo; was rated higher in 2022, compared to 2016 and 2011. \u0026lsquo;Teaching in large groups\u0026rsquo; and \u0026lsquo;conducting research and publishing on education\u0026rsquo; scored lowest in all three survey rounds.\u003c/p\u003e \u003cp\u003eParticipants added other stimulating and hampering teaching aspects using two open-ended questions, providing 125 and 138 responses in 2022 which were fewer than in the previous survey rounds. These responses were categorized into 11 stimulating aspects, 8 hampering aspects, and 5 suggestions for improvement using the same categories that were defined and used previously for 2016 and 2011. See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eStimulating and hampering aspects in open-ended queries\u003c/b\u003e .\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdditional stimulating aspects listed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;218\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;296\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving personal contact with students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotivated students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate time to plan teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaboration with colleagues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcknowledgement and support for my teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving feedback on my teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate teaching facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClear organization and expectations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApplication of my content knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching fixed groups over time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAdditional hampering aspects listed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBureaucracy and rules around teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToo little time provided to properly teach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of appreciation/support for teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmotivated students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot sufficiently familiar with content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonotonous repeated group teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSuggestions for improvements*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProviding resources (time/money)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproving culture (importance/value of education)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCareer support and development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher skill development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* The results on this question from 2011 are not included in this because they were not clustered in the four categories.\u003c/p\u003e \u003cp\u003e** n in this table is the number of remarks from respondents.\u003c/p\u003e \u003cp\u003eHaving \u0026lsquo;personal contact with students\u0026rsquo; was mentioned by 25.6% of the respondents as the most stimulating aspect in 2022. \u0026lsquo;Student motivation\u0026rsquo; continued to be important for stimulating teaching engagement, but the frequency with which it was mentioned varied from 20.9% in 2011 to 25.2% in 2016 to 15.2% in 2022. \u0026lsquo;Having adequate time to plan teaching\u0026rsquo; was mentioned more frequently in 2022 from 10.8% in 2011 and 9.6% in 2016 to 15.2% in 2022. The mention of \u0026lsquo;application of content knowledge\u0026rsquo; dropped from a frequency of 18.3% in 2016 to 1.6% in 2022. The most frequently added hampering aspects included \u0026lsquo;bureaucracy and rules\u0026rsquo; around teaching and \u0026lsquo;poor (IT-related) facilities\u0026rsquo;, making up 35.5% of additions in 2022, which was in line with 34.1% of additions in 2011 and 35.6% in 2016. The \u0026lsquo;other\u0026rsquo; category which made up 23.9% of the hampering aspects added, was mostly related to online education due to the COVID-19 pandemic or specific personal circumstances.\u003c/p\u003e \u003cp\u003eSuggestions for improving teaching engagement in 2022 were related to \u0026lsquo;provision of resources (financial and time) for teaching\u0026rsquo; (41.6%), \u0026lsquo;improvement of culture and the value of education\u0026rsquo; (32.0%), \u0026lsquo;improvement of education career support and development\u0026rsquo; (7.2%) and \u0026lsquo;development of teacher skills\u0026rsquo; (3.2%). The remaining \u0026lsquo;other\u0026rsquo; comments were comprised of miscellaneous suggestions or were not applicable.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn general, the work engagement of HP educators in our study has been high and seems to have mainly increased since 2011, both for \u003cem\u003ework in general\u003c/em\u003e and for the individual task areas of \u003cem\u003eteaching, research\u003c/em\u003e, and \u003cem\u003epatient care\u003c/em\u003e. The subgroups that showed increased engagement scores for \u003cem\u003eteaching\u003c/em\u003e combined task areas, either teaching with patient care or teaching with research. Job-related aspects enhancing engagement in teaching included \u0026lsquo;freedom to determine what\u0026hellip;\u0026rsquo; and \u0026lsquo;\u0026hellip;how I teach\u0026rsquo; and \u0026lsquo;teaching about my own specialty\u0026rsquo; consistently remained at the top. Also, in the top 5 was \u0026lsquo;noticeable appreciation from direct supervisors.\u0026rsquo; \u0026lsquo;Teaching in large groups\u0026rsquo; and \u0026lsquo;conducting research and publishing on education\u0026rsquo; scored lowest in all three survey rounds. Added comments revealed the importance of \u0026lsquo;having adequate time to prepare\u0026rsquo; and \u0026lsquo;good (IT-related) facilities.\u0026rsquo;\u003c/p\u003e \u003cp\u003eThe 2011 and 2016 results showed an increase in overall work engagement over time with the largest improvement for HP educators involved in teaching only and for HP educators combining all task areas. While the 2022 results might suggest a trend for continued improvement in work engagement scores, the change was not statistically significant. This could be due to being underpowered. The 2022 results could also have been impacted by the effects of the COVID-19 pandemic, despite delaying the follow-up study by a year. The trend for decreasing engagement in \u003cem\u003eteaching\u003c/em\u003e seen in the teaching only subgroup would be consistent with a COVID-19 effect. Respondent-added hampering aspects for their teaching included many remarks focused on challenges with technology, the rapid change to online teaching, and the institution\u0026rsquo;s lack of preparedness for it. This is consistent with reports of increased anxiety and stress and decreased teaching satisfaction in university teachers during the COVID-19 pandemic related to online teaching\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. A follow-up study will be important to see if work engagement in teaching recovers and if increases in work engagement scores in general continue over time as the impacts from COVID diminish. Continued improvements in work engagement scores among HP educators would provide supporting evidence for the positive impact of the center\u0026rsquo;s ongoing faculty development initiatives.\u003c/p\u003e \u003cp\u003eInterestingly, the subgroup combining all three task areas shows the largest increase in work engagement for \u003cem\u003ework in general\u003c/em\u003e and for each of the three tasks of \u003cem\u003eteaching, research\u003c/em\u003e, and \u003cem\u003epatient care\u003c/em\u003e relative to the other subgroups of respondents. This stands in greatest contrast to the trend of decreased work engagement in \u003cem\u003eteaching\u003c/em\u003e in the teaching only subgroup. One explanation might be that when stressors such as COVID-19 impact specific task areas, the respondents with jobs that include other task areas are able to find respite or additional resources in the less impacted task areas. Van den Berg and colleagues suggest that job resources and demands and the ability to job craft present in one role might be absent in other roles, resulting in different engagement for different roles\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Notably, increases in engagement scores for \u003cem\u003ework in general\u003c/em\u003e were found in all subgroups despite some decreased scores for task areas. This could also suggest a protective effect of other task areas on the engagement for \u003cem\u003ework in general\u003c/em\u003e, where work as a whole is more than the sum of its parts. A study on multiple life roles (e.g., marital, parenting, caregiver, employment) and stress found that individuals combining more than two roles experience less stress than individuals with only a single role\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. It is also possible that as participants considered their \u003cem\u003ework in general\u003c/em\u003e, they might have had in mind their academic career rather than their job per se. Timms and Brough differentiate between career (i.e. profession) and job (i.e. work done) and note it is career satisfaction, rather than job satisfaction, that is a robust predictor for work engagement of teachers\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. In academic medical centers where people have multiple roles and tasks, further research needs to focus on how overall job and career perspectives impact a specific role such as teaching.\u003c/p\u003e \u003cp\u003eThe top 5 highest scoring stimulating aspects for teaching from the questionnaire can be related to autonomy (freedom to determine \u003cem\u003ewhat\u003c/em\u003e and \u003cem\u003ehow\u003c/em\u003e to teach), relatedness (teaching small groups, appreciation from direct supervisor), and competence (teaching about one\u0026rsquo;s own specialty), which have been described by Deci \u0026amp; Ryan\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e as three basic psychological needs. The ability to meet these basic psychological needs can also be seen as job resources that can drive work engagement and job satisfaction of teachers\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e and the lack thereof. Afterall, job demands might hinder work engagement and job satisfaction as well. However, we do need to flag that within our institution, as in many HPE institutions, faculty may teach in courses that are not their \u0026lsquo;own\u0026rsquo;. This means they do not always have the autonomy (i.e., lack the job resource) to choose what and how they teach, and rather are asked to provide teaching that is predefined by someone else which can be considered an additional job demand. In institutions where educators mainly teach courses that are predefined by others, strategies could be employed to increase teachers\u0026rsquo; autonomy. For example, teachers could be given freedom to adjust specific parts of a course content or delivery method to better suit their expertise or preferences.\u003c/p\u003e \u003cp\u003eThe most frequently added stimulating aspects, that could serve as job resources, also align with the need for relatedness (motivated students, having personal contact with students, and collaboration with colleagues) and highlight the importance of support (acknowledgment and support for my teaching, receiving feedback on my teaching). The respondent-added hampering aspects could be viewed as negatively impacting these psychological needs. Online teaching is a new demand on educator competence. Inadequate technology and lack of institutional preparedness as well as not having enough time suggest that the resources available were insufficient to compensate for the new demand and support their competence. Improved \u003cem\u003eon demand\u003c/em\u003e technological support (e.g., for device setup, during technological failure) and interpersonal support from colleagues and supervisors could have served as important job resources to help sustain motivation, job satisfaction, and work engagement, and prevent educator burnout during times of new or increased job demands.\u003c/p\u003e \u003cp\u003eBased on previous research and conversations with teachers we know that \u0026lsquo;conducting research and publishing on education\u0026rsquo; is experienced as a value for research and not for teaching itself\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. In fact, a set of published competencies for medical educators identifies educational scholarship as a specialized competence expected only of teachers occupying specific roles rather than a core competence expected of all teachers\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Yet others have argued that while not every teacher needs to engage in the scholarship of teaching and learning (SoTL), every teacher should work towards becoming a scholarly teacher\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Consistent with this sentiment, there has been increased attention to SoTL over the recent years in our institution to highlight the importance of evidence informed education in addition to the value of practitioner educational research.\u003c/p\u003e \u003cp\u003eOur results seem aligned with the findings of Van den Berg and colleagues\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, who found that combining roles and job crafting is related to higher engagement. They also saw that engagement scores for patient care were higher than for teaching. Their study suggests that engagement for specific roles can be further increased when faculty are given the autonomy to craft their own jobs more, which can be considered an increase of job resources. Job crafting means that educators have opportunities to make changes in their job demand and resources to shape their job into one that is more meaningful, engaging, and satisfying\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. While job crafting is an activity that is initiated by employees themselves, when institutions recognize and approve job crafting activities, they build rapport and commitment with their employees\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. It could therefore be beneficial for academic institutions to investigate the possibilities for job crafting in HPE as a job resource, to further improve work engagement of our educators\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePark and Johnson have called upon academic leaders to ensure engagement of teachers by recognizing their contributions and providing development opportunities\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, thereby increasing the job resources for teaching. Over the years, our institution has invested heavily in efforts to do so. In addition to offering different levels of teacher and educator training, we encourage their development through grants for innovation projects, create support via a community for educators, provide recognition using annual outstanding educator awards, and enable career paths for health professionals based on education efforts. These investments are based on previous research that revealed the importance of addressing all four areas of competence, context, community, and career that are essential to enhancing faculty development and increasing engagement in teaching\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and suggestions for future research\u003c/h2\u003e \u003cp\u003eThere are limitations to this research. First, the response rates in 2022 (~\u0026thinsp;14%) and 2016 (~\u0026thinsp;20%) were low compared to 2011 (~\u0026thinsp;50%). It is possible that the faculty who took time to participate were most likely those most engaged in teaching, leading to higher than actual mean work engagement scores. The low response rates also resulted in very low numbers in the subgroups, which could have affected the subgroup analysis results. A second limitation is that the data is not linked to individual participants longitudinally. Given that the composition of the teaching faculty changes over time, we opted to collect cross-sectional data at 5-year intervals. Therefore, we can only interpret the results through a trend analysis to draw conclusions about changes over time for the current groups of teaching faculty at the medical center. While we purposefully delayed the survey by one year to minimize the effects of the COVID-19 pandemic, this can also be considered a third limitation since we did not measure engagement during COVID-19. Data from during the COVID-19 pandemic would have helped provide context for post-pandemic results and potentially useful insights on the job resources and job demands of teaching in future pandemic-type disruptions to education. A final limitation is that we focused on teaching. Therefore, we need to be cautious about the overinterpretation of patient care and research engagement scores since we did not gather data from patient care only and research only populations for comparison.\u003c/p\u003e \u003cp\u003eTo support our findings and gain more insight into why HP educators with only teaching tasks show a trend for lower work engagement in teaching in 2022, the survey will be continued at regular intervals as a monitoring tool. Future studies with longitudinal study designs and interview approaches could examine whether the stagnation in improvement might be due to COVID-19 and explore potential reasons for improved work engagement other than the center\u0026rsquo;s faculty development initiatives to support HP educators.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAs a group, HP educators at one university medical center scored high on work engagement overall and their work engagement increased over time. Faculty members report autonomy, time, and departmental support as crucial job resources to stimulate engagement in teaching. Combining different task areas might allow for an overall balance in job demands-resources and sustained engagement even when job demands increase in one task area. While we cannot demonstrate causation, our findings suggest that robust and sustained attention to institutional investments in faculty development and support may contribute to enhancing faculty teaching engagement over time.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUWES-9: Utrecht Work Engagement Scale-9; HPE: Health Professions Education; HP: Health Professions; JD-R model: Job Demands-Resources model; NVMO: Nederlandse Vereniging voor Medisch Onderwijs (Dutch Association of Medical Education); UTQ: University Teaching Qualification.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study was approved by the Netherlands Association of Medical Education (NVMO) Ethical Review Board application number 2022.6.6 in October 2022. Informed consent was obtained from participants within the online questionnaire itself (see supplementary file A). Participants could only continue the questionnaire if they responded positively, which guaranteed all respondents signed the informed consent.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eLvB conducted the 2022 survey based on previous versions of 2011 and 2016 and imported it in the online survey tool Qualtrics. LvB and HP jointly analyzed the quantitative data using SPSS. LvB and HCC jointly analyzed the qualitative data (remarks) using the themes derived from analysis in 2011 and 2016. All authors together interpreted and discussed the analysis results to draw conclusions. Then LvB took the lead in writing the manuscript. All authors read all versions of the manuscript, provided edit suggestions, and approved the final manuscript.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe would like to thank the researchers who developed and started this research in 2011; prof.dr. Th.J. ten Cate (UMC Utrecht), dr. B.A.M. van den Berg (Utrecht University) and prof.dr. A.B. Bakker (Erasmus University Rotterdam). Also, we would like to thank all faculty at UMC Utrecht who were willing to take time to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMartin AJ. Examining a multidimensional model of student motivation and engagement using a construct validation approach. Br. J. Educ. Psychol. 2007. 77(2), 413-440.\u003c/li\u003e\n\u003cli\u003eTimms, C, Brough, P. \u0026ldquo;I like being a teacher\u0026rdquo; Career satisfaction, the work environment and work engagement. J. Educ. Adm. 2013. 51(6), 768-789.\u003c/li\u003e\n\u003cli\u003eShu, K. Teachers\u0026rsquo; commitment and self-efficacy as predictors of work engagement and well-being. Front. Psychol. 2022. 13, 850204.\u003c/li\u003e\n\u003cli\u003eAddimando, L. The effect of positive working conditions on work engagement and teaching classroom practices: a large cross-sectional study in Switzerland. Front. psychol. 2019. 10, 2129.\u003c/li\u003e\n\u003cli\u003ePark, KA, Johnson, KR. Job Satisfaction, Work Engagement, and Turnover Intention of CTE Health Science Teachers. Int. J. Res. Vocat. Educ. Train. 2019. 6(3), 224-242.\u003c/li\u003e\n\u003cli\u003eSchaufeli WB, Salanova M, Gonz\u0026aacute;lez-Rom\u0026aacute; V, Bakker AB. The measurement of engagement and burnout: A two-sample confirmatory factor analytic approach. J Happiness Stud. 2002. 3(1),71\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eVan den Broeck A, Vansteenkiste M, De Witte H, Lens W. Explaining the relationships between job characteristics, burnout, and engagement: The role of basic psychological need satisfaction. Work \u0026amp; stress. 2008. 22(3), 277-294.\u003c/li\u003e\n\u003cli\u003eBakker AB, Demerouti E. The job demands‐resources model: State of the art. J. Manag. Psychol. 2007. 22(3), 309-328.\u003c/li\u003e\n\u003cli\u003eTims M, Bakker AB. Job crafting: Towards a new model of individual job redesign. SA J. Ind. Psychol. 2010. 36(2), 1-9.\u003c/li\u003e\n\u003cli\u003eHakanen JJ, Perhoniemi R, Toppinen-Tanner S. Positive gain spirals at work: From job resources to work engagement, personal initiative and work-unit innovativeness. J. Vocat. Behav. 2008. 73(1), 78-91.\u003c/li\u003e\n\u003cli\u003eHakanen, JJ, Bakker, AB, \u0026amp; Schaufeli, WB. Burnout and work engagement among teachers. J. Sch. Psychol. 2006. 43(6), 495-513.\u003c/li\u003e\n\u003cli\u003eMolenaar WM, Zanting A. Experiences with the implementation of a national teaching qualification in university medical centres and veterinary medicine in the Netherlands. Persp. Med. Educ. 2015. 4, 43-46.\u003c/li\u003e\n\u003cli\u003eVan den Berg BAM, Bakker AB, Ten Cate TJ. Key factors in work engagement and job motivation of teaching faculty at a university medical centre. Persp. Med. Educ. 2013. 2, 264-275.\u003c/li\u003e\n\u003cli\u003evan den Berg, JW, Mastenbroek, NJ, Scheepers, RA, \u0026amp; Jaarsma, ADCWork engagement in health professions education. Med. Teach. 2017. 39(11), 1110-1118.\u003c/li\u003e\n\u003cli\u003eVan den Berg JW, Verberg CP, Scherpbier AJ, Jaarsma ADC, Arah OA, Lombarts KM. Faculty\u0026rsquo;s work engagement in patient care: impact on job crafting of the teacher tasks. BMC Med. Educ. 2018. 18, 1-12.\u003c/li\u003e\n\u003cli\u003ede Jong, R, Mulder, J, Deneer, P, van Keulen, H. Poldering a teaching qualification system in Higher Education in the Netherlands: a typical Dutch phenomenon. REDU. 2013.11(3), 23.\u003c/li\u003e\n\u003cli\u003eVan Bruggen L, Ten Cate O, Chen HC. Factors that (de)motivate teachers: A longitudinal survey study. Short Comm. at the AMEE Conf. 2017.\u003c/li\u003e\n\u003cli\u003eSchaufeli W, Bakker A. UWES-Utrecht Work Engagement Scale: Test Manual. Unpublished Manuscript, Occup. Health Psychol UU, Utrecht. 2004. no. December, 60.\u003c/li\u003e\n\u003cli\u003eSilva, DFO, Cobucci, RN, Lima, SCVC, \u0026amp; de Andrade, FB Prevalence of anxiety, depression, and stress among teachers during the COVID-19 pandemic: A PRISMA-compliant systematic review. Med. 2021. 100(44), e27684.\u003c/li\u003e\n\u003cli\u003eMiguel, C, Castro, L, Marques dos Santos, JP, Serr\u0026atilde;o, C, \u0026amp; Duarte, I. Impact of COVID-19 on medicine lecturers\u0026rsquo; mental health and emergency remote teaching challenges. Int. J. Environ. Res. Public Health. 2021. 18(13), 6792.\u003c/li\u003e\n\u003cli\u003eHonda, A, Abe, Y, Date, Y, \u0026amp; Honda, S. The impact of multiple roles on psychological distress among Japanese workers. Saf. Health Work. 2015. 6(2), 114-119.\u003c/li\u003e\n\u003cli\u003eRyan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000. 55(1), 68.\u003c/li\u003e\n\u003cli\u003eShim, SS, Finch, WH, Cho, Y, \u0026amp; Knapke, M. Understanding teachers\u0026rsquo; job satisfaction and flow: the dual process of psychological needs. Educ. Psychol. 2022. 42(3), 316-333.\u003c/li\u003e\n\u003cli\u003eSrinivasan, M, Li, STT, Meyers, FJ, Pratt, DD, Collins, JB, Braddock, et al. \u0026ldquo;Teaching as a competency\u0026rdquo;: competencies for medical educators. Acad. Med. 2011. 86(10), 1211-1220.\u003c/li\u003e\n\u003cli\u003eCleland, JA, Jamieson, S, Kusurkar, RA, Ramani, S, Wilkinson, TJ, \u0026amp; van Schalkwyk, S. Redefining scholarship for health professions education: AMEE Guide No. 142. Med. Teach. 2021. 43(7), 824-838.\u003c/li\u003e\n\u003cli\u003eDemerouti, E. Design your own job through job crafting. Eur. Psychol. 2014\u003c/li\u003e\n\u003cli\u003eXanthopoulou, D, Bakker, AB, Demerouti, E, \u0026amp; Schaufeli, WB. Work engagement and financial returns: A diary study on the role of job and personal resources. J. Occup. Organ. Psychol. 2009. 82(1), 183-200.\u003c/li\u003e\n\u003cli\u003eVan Bruggen L, Ten Cate O, Chen HC. Developing a novel 4-C framework to enhance participation in faculty development. Teach. Learn. Med. 2020. 32(4), 371-379.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Profession Educators, Faculty Development, Work Engagement, Job Roles, Teaching","lastPublishedDoi":"10.21203/rs.3.rs-5043114/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5043114/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHigh quality professional education requires good educators who show engagement with teaching in addition to content knowledge and didactic skills. In health professions education it is common that teaching faculty combine their teaching role with roles in patient care and/or research. However, previous studies on work engagement have mainly focused on jobs as a whole and not considered people who combine roles or tasks that could have different demands. This study aims to describe how health professions educators\u0026rsquo; work engagement in \u003cem\u003eteaching\u003c/em\u003e, in combination with \u003cem\u003eresearch\u003c/em\u003e and \u003cem\u003epatient care\u003c/em\u003e, evolved over time at an academic medical center in the Netherlands.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAll teaching faculty at the center were invited to complete the same online questionnaire in 2011, 2016, and 2022, where their work engagement was measured using the Utrecht Work Engagement Scale (UWES-9) and they rated 22 items affecting their engagement in \u003cem\u003eteaching\u003c/em\u003e. We calculated descriptive statistics; computed engagement score means for overall work and individual task areas (\u003cem\u003eteaching\u003c/em\u003e, \u003cem\u003eresearch\u003c/em\u003e, and \u003cem\u003epatient care\u003c/em\u003e); and compared means across groups with various task area combinations and across years. We also performed content analysis of responses to the open-ended questions in the questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWork engagement scores overall and for each task area (\u003cem\u003eteaching\u003c/em\u003e, \u003cem\u003eresearch\u003c/em\u003e, and \u003cem\u003epatient care\u003c/em\u003e) fluctuated over time. Job-related aspects enhancing engagement in \u003cem\u003eteaching\u003c/em\u003e included \u0026lsquo;autonomy\u0026rsquo; and \u0026lsquo;appreciation.\u0026rsquo; \u0026lsquo;Teaching about my own specialty\u0026rsquo; consistently scored high.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTeaching faculty in our center are engaged with \u003cem\u003eteaching\u003c/em\u003e tasks and their work engagement is consistently high over time. Combining roles might be positively related to teaching engagement by maintaining balance when job demands in other tasks increase. To maintain and increase teaching engagement, organizations should focus on the provision of time, autonomy, and support to health professions educators. Teaching engagement may increase more through content knowledge and autonomy in teaching than by facilitating educational research and dissemination opportunities.\u003c/p\u003e","manuscriptTitle":"Evolving Health Professions Educators’ Work Engagement in Teaching While Combining Roles in an Academic Medical Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-04 04:04:40","doi":"10.21203/rs.3.rs-5043114/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-07-02T10:50:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-16T15:15:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T13:50:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49211674741710518714130151387606197046","date":"2025-04-04T16:07:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-03T05:56:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T15:14:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-28T12:09:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f7bad3c-a5aa-480d-977b-05c458c9bbe0","owner":[],"postedDate":"April 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T16:01:09+00:00","versionOfRecord":{"articleIdentity":"rs-5043114","link":"https://doi.org/10.1186/s12909-025-07628-3","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-07-11 15:57:27","publishedOnDateReadable":"July 11th, 2025"},"versionCreatedAt":"2025-04-04 04:04:40","video":"","vorDoi":"10.1186/s12909-025-07628-3","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07628-3","workflowStages":[]},"version":"v1","identity":"rs-5043114","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5043114","identity":"rs-5043114","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}