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| EDITORIAL |
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| Year : 2016 | Volume
: 7
| Issue : 1 | Page : 1-3 |
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Person-environment (P-E) fit in dental practice
Francesco Chiappelli1, Marena Martinez Kutschman2
1 Oral Biology and Medicine, Center for the Health Sciences UCLA; Health Sciences, California State University, Northridge; Evidence-Based Decisions Practice-Based Research Network, California, USA
2 Oral Biology and Medicine, Center for the Health Sciences UCLA, Northridge, USA
| Date of Web Publication | 24-Feb-2016 |
Correspondence Address:
Francesco Chiappelli
UCLA School of Dentistry, California
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2155-8213.177372
How to cite this article:
Chiappelli F, Kutschman MM. Person-environment (P-E) fit in dental practice. Dent Hypotheses 2016;7:1-3 |
The person-environment (P-E) fit model arises from the the personality-job fit theory that proposed that a person's personality can determine one's adaptability in an organization and synergy within a work environment. [1],[2],[3],[4],[5],[6],[8],[9] From its original domain of occupational and health psychology assessment of work stress, the P-E fit model was soon expanded to offer a framework for assessing and predicting the extent to which the employee's traits, jointly with the characteristics of work environment, determine the worker's satisfaction, health, and psychoemotional well-being.
In practical terms, the P-E fit model leads to identifying the key points of preventive intervention to improve the person's reality contact, quality of life, and overall well-being. To a large extent, the perception of being fit of an individual within the environment is dependent upon one's ability to discern the distinction versus overlap between perception and reality, and could be equated to the person's emotional intelligence, although, emotional intelligence specifically pertains to interpersonal communication skills. [10],[11],[12]
Emotional intelligence is distinct from personality trait and independent from environmental factors, and pertains specifically to:
- The perception of emotions, intended as the ability to accurately perceive and identify emotions both in oneself and in others,
- The utilization of emotions, that is the ability to harness emotions appropriately to facilitate communication, learning, teaching, and thinking,
- The understanding of emotions, conceived as the ability to express and, when appropriate, verbalize emotions and to correctly infer from analyses of emotions to interpret fine variations of emotional responses or the lack thereof, and
- The managing of emotions, defined as the ability to control, mediate, and modulate emotions in the proper social context, conscientiously and consciously in one self and others.
By contrast, the premise of the P-E fit model states that a misfit between the person and the environment leads to seriously impaired outcomes in terms of satisfaction and performance, consequential to psychoemotional stress associated with the perception of not being equipped to deal efficiently with environmental demands. [1],[3],[8] In brief:
- The "subjective P-E fit" refers to the fit between the subjective person (i.e., the view the person has subjectively of his/her abilities, traits, strengths, and deficiencies) and the subjective environment (i.e., the person's own subjective evaluation of the environmental demands and reality);
- The "objective P-E fit" refers to the fit between the objective person (i.e., the real person's set of strengths and weaknesses) and the objective environment (i.e., the reality of the environmental demands) [Figure 1];
 | Figure 1: In the person-environment fit model, the difference between objective environment (Eo) and objective person (Po) gives the relative objective fit (Fo). The ideal fit is where the objective person and the objective environment meet, where the psychoemotional stress of stress is minimized. By contrast, the right of this point illustrates the situation of overload and the left of the curve represents an underload
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- The "reality contact" corresponds to the degree to which the subjective view of the environment by the person corresponds to the objective environment;
- The "accuracy or accessibility of the self" represents the degree of correspondence between the subjective views of the person and the objective person.
We applied this novel model to elucidate dental wants and needs in patients with senile dementia of the Alzheimer's type. [13] And, in addition, recently extended the P-E fit model further into the domain and comparative effectiveness research for translational science in general and evidence-based dental practice in particular. [14] Ongoing research is validating a novel assessment tool for stakeholder engagement (Sama et al., [14],[15] in preparation).
It is timely and critical to propose that the reliable assessment of P-E fit in dental patients can provide the ability or inability to meet a demand, and its effects on both the psychological and physiological well-being of the patient, and for that matter, of the dental staff. The P-E fit concept involves constructing and validating novel dental anxiety/stress instruments conceptualized to quantify both the subjective person and the environment and the objective demands of dental practice environment and the objective ability of the patient to face these challenges successfully. Novel well-crafted novel instruments will permit reliable assessment of accuracy of the self and of the dental practice environment, as well as reality contact: Two parameters of essential value in formulating both a business plan for the practice and individual treatment plans for each patient.
Specifically, in the context of the patient's adaptation to the stress and anxiety associated with undergoing dental treatment, particularly from an evidence-based dental practice perspective, the ability of the dentist to identify the variables that enhance and improve the patient's ability to adjust, to have a better fit, as dependent upon the ability to change either the subjective or objective environment and/or the patient will undoubtedly improve these patient-clinician encounters, and overall, patient satisfaction. Therefore, we argue, identifying the objective-subjective dental environment-dental patient divergences is paramount in successful patient-centered dental practice for the twenty-first century. The accuracy of objective environment and patient assessment is critical in understanding and ultimately adjusting good fit (eu-fit) and avoiding ill-fit.
In brief, we favor launching a new area of research in the domain of dental stress and anxiety: One that is focused to improve patient-centered dentistry and stakeholder engagement, one that details the objectively sound aspects of a dental practice and objectively highlights its deficiencies specifically in terms of patient care, one that can focus on the patient's subjective and objective needs, wants, strengths, and frailties, with the ultimate goal of improving patient and clinician satisfaction. We suggest that applying this concept to dentistry, future work in dental anxiety, and related to the stress in patients should be assessed by integrating the P-E fit by asking case specific questions in order to quantify the difference between objective fit and subjective fit - allowing for potential adjustment and reconciliation.
Case in point, the obvious stress from pediatric patients can be attributed to a poor P-E fit as well. The patient's subjective need from the environment - to be comfortable at all times - is not possible to be met and, thus, an underload is created. In this simple example, it is hard to remedy because of the almost unattainable comfort demand of children. However, when applied to more flexible patients, it can be used in conjunction with a quantified scale in order to correct obtuse perspectives and can better attend to patient needs. This was observed as early as our previous attempt to rectify the differences of dental needs and wants in Alzheimer's patients. [13] In that study, we determined that the patients' (or the caregivers') reality contact was relatively sound and, thus, clinicians could firmly place their trust in the patients' ability to relay their needs.
Taken together, it follows that by identifying and analyzing the P-E fit, stress in dental patients can be identified, and be more effective intervention potentially deployed by the dentist in the practice. By finding the origin of the stress, whether it is an ingrained phobia or a concern about safety, patient-centered clinical guidelines that are both safe and effective can be entertained.
Acknowledgements
The authors thank the Evidence-Based Decisions Active Groups of Stakeholders (EBD-AGS) of the EBD-Practice-Based Research Network (ebd-pbrn.org), the students and colleagues of the EBD Study Group for edifying discussions, and in particular, Ms. Nateli Sama, now a dental student, whose concerted efforts while a perdental student in our group greatly contributed to our improved conceptualization of the P-E fit model in dentistry. Funded in part by UCLA Senate grants and Fulbright Specialist grant (5077) to Francesco Chiappelli.
| References | |  |
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1 In the same vein as Selye′s nomenclature of good stress as "eu-stress" vis à vis dis-stress
[Figure 1]
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