ABSTRACT
Introduction: Junior doctors have reported high levels of burnout and additional stressors emerging from the COVID-19 pandemic may further accelerate burnout. There is a need to identify which stressors are most likely to lead to burnout in order to develop appropriate interventions. This project therefore aims to compile a comprehensive list of stressors relevant to junior doctors and assesses which stressors are most strongly associated with burnout. Materials and Methods: An anonymous online questionnaire was sent in July 2020 to 1000 randomly selected junior doctors in the North West of England. It included 37 questions on general and pandemic specific stressors and the Maslach Burnout Inventory Health Services Survey. Stepwise regression analysis was undertaken to explore associations between stressors and burnout. Results and Conclusions: In total, 326 responses were received. Six of the 10 highest rated stressors were specific to the pandemic. Fatigue (β=0.43), pandemic-related workload increase (β=0.33) and feeling isolated (β=0.24) had the strongest associations with Emotional Exhaustion. Fatigue (β=0.24), uncertainty around COVID-19 information (β=0.22) and doing unfulfilling tasks (β =0.22) had the strongest associations with Depersonalisation. Lacking in ability (β=-0.24) and not feeling valued (β=-0.20) had the strongest associations with Personal Accomplishment. In conclusion, junior doctors reported a combination of general and pandemic-specific stressors that significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigate burnout in junior doctors.
ABSTRACT
BACKGROUND: By law, covid-19 disease and deaths in workers may lead to coroners' inquests and/or Health and Safety Executive (HSE) investigations. AIMS: This study assesses the adequacy of these statutory means to yield recommendations for prevention of acquiring covid-19 infection from work. METHODS: Covid-19 guidance from the chief coroner and the HSE was appraised, including using Office for National Statistics (ONS) data. Practitioners were asked to estimate the likelihood that covid-19 disease may have arisen from 'near-miss' scenarios. Data from the judiciary and the HSE were analysed. RESULTS: The coroners' guidance allowed a wider range of reports of death than did the HSE and conformed better with ONS data on covid-19 mortality by occupation. In the practitioner survey, 62 respondents considered a higher likelihood that reported covid-19 cases would have arisen from the scenario deemed unreportable as a 'dangerous occurrence' by HSE than the reportable scenario (P < 0.001). On average there was only one coroner's report to prevent future death from occupational disease every year in England and Wales. The HSE dealt with a yearly average of 1611 reports of work-related disease including 104 on biological agents, but has received about 9000 covid-19 reports. CONCLUSIONS: Current HSE guidance for reporting work-related covid-19 may miss many thousands of cases and needs further iteration. Coroners have very limited experience of inquiry into occupational disease caused by biological agents compared with the HSE. Concerns regarding national policy such as on protective equipment warrant a full public inquiry.