Junior doctors' wellbeing at peak and post-peak pandemic: a repeated cross-sectional study.

INTRODUCTION: The impact of the COVID-19 pandemic on healthcare professionals has been significant. The aim of this study was to explore the mental state and wellbeing of UK junior doctors at different phases of the initial outbreak. METHODS: This is a cross-sectional study of UK-based junior doctors' perceptions of threat and support during and after the first wave of the COVID-19 pandemic. Levels of anxiety, depression, post-traumatic stress disorder symptoms and use of coping mechanisms were explored through a Google questionnaire. RESULTS: One hundred and ninety-six participants were included in this study (93 in period A and 103 in period B). Junior doctors reported feeling increased risk (p=0.001) and increased fear of contracting the virus (p<0.001) during period A. Increased levels of severe anxiety (Generalized Anxiety Disorder-7 score >15) along with increased cases level of depression (Patient Health Questionnaire-9 score >10) were reported for both periods. Junior doctors described suffering more frequently with flashbacks (p=0.006) and nightmares (p=0.024) in comparison with senior colleagues during period A. During period A, 21.4% of participants felt isolated at work (p<0.001), whereas 13% reported being easily annoyed on a daily basis, 11.7% reported very low morale (p<0.001) and 66% were not aware of any psychological support being available. The use of exercise, peer support and mindfulness apps increased during period B (p=0.023). CONCLUSIONS: Healthcare systems need to urgently establish robust psychological support mechanisms and infrastructure to protect junior doctors and provide institutional resilience against the adverse consequences of the long physical and mental battle with COVID-19.

Resistance: Faces of power and how identity is reflected

Purpose: Burn to be heard, #Blacklivesmatter, #COVID-19. These slogans have sharpened society's focus on inequality and resistance to injustice. Power in organisational management literature has predominantly been confined to power dynamics related to organisational structure or hierarchy and applying an identity lens has been limited to subjective forms of power. This study applied the typology of Fleming and Spicer, who identified four forms or faces of power, explaining resistance and articulating forms of potentially hidden disenfranchisement. The research aimed to expand on Fleming and Spicer's discourse on power in organisations and resistance against this power. Design: The explorative nature of the research question called for the application of an interpretive lens - through qualitative research - using the grounded theory approach in a case study design. Semi-structured interviews were conducted with stakeholders involved in the process we set out to explore. Findings: It was found that domineering power-constrained people and a subjectified identity led to a state of patiency. Through a collective identity and discursive resistance, manipulation gave rise to coercion. Practical implications: Understanding how systemic as well as episodic forms of power are present in the organisation and experienced by different stakeholders will help leaders avoid negative unintended consequences of power and potential marginalisation. Value: Fleming and Spicer described systemic and episodic dynamics as two broad constructs of power but questioned how and why one dimension may dominate the other. By explicating the interplay between power and resistance, through an identity lens, this study explains how different forms of power are effective at different times.