Burning the candle at both ends: an evaluation of junior doctor wellbeing in the UK

Wellbeing, defined as ‘a state of positive feelings and meeting full potential in the world' and burnout (the opposite of wellbeing) are increasingly being recognized as important factors in healthcare workforces. Junior doctors are subject to a high rate of burnout and as a result the numbers leaving the NHS continue to rise. The cause of this is multifactorial and reflects societal and political changes as well as demand on an already strained service. Key components include the lingering effects of the COVID-19 pandemic, the financial turmoil of the cost-of-living crisis, the loss of team and social structure at work, and uncertainty around the future of the NHS. Addressing the contributory factors is an important challenge for coming years to maintain a healthy, motivated, and effective medical workforce.

The junior doctor shadow board

Before 2020, North Manchester General Hospital had a history of poor feedback from junior doctors, regarding both their overall experience and access to non-clinical development opportunities. The circumstances of the COVID-19 pandemic resulted in the medical leadership team giving junior doctors the opportunity to lead the reorganisation of services and redeployment. The aim of this was to increase engagement, representation and development opportunities. This led to the formation of the Junior Doctor Leaders Group, using similar principles as the 'shadow boards' seen in the corporate sector. This article reviews the impact of the group. Analysis was conducted using internal key performance indicators, identifying improvement initiatives generated by the Junior Doctor Leaders Group and surveying group members. Initial results suggest that junior doctors felt their voices had gained recognition in the organisation, with 95% of group members stating that it increased junior doctor representation and 90% agreeing that the group made them feel more confident representing and advocating for their colleagues. Increased transparency and trust between junior and senior staff facilitated escalation of concerns to higher management, and the design and implementation of solutions. Members of the Junior Doctor Leaders Group also reported improvements to their work and educational experiences. In the first year after the group was established, members led or co-led a total of 14 organisation-wide improvement projects. Results from the General Medical Council training survey showed improvement across almost all indicators. Therefore, the authors believe that the Junior Doctor Leaders Group offers a novel approach to improving junior doctor engagement and experience, and can be beneficial to both the cohort of junior doctors and the wider organisation. © 2023 MA Healthcare Ltd.

Barriers on Setting up Simulation Learning from Ground up during Covid Pandemic

BACKGROUND AND AIM: Tell me and I will forget, show me and I may remember;involve me and I will understand Confucius Simulation training is well established in improving patient care by learning from mistakes in a safe environment. During COVID pandemic, lot of junior doctor workforce were redeployed and having not worked in paediatrics was a cause of concern and need of the hour. METHOD(S): We formulated a team of enthusiastic, passionate and dedicated registrars and identified the barriers to setting up simulation for the first time in Leicester children hospital targeting specifically junior doctors. 1. Social distancing whilst working in a team. 2. Accessibility for time out from busy workload on the wards. 3. Being put on spot fear when already stressed with workload. RESULT(S): We took the support of college tutors, Senior Consultant and Nursing team to developed robust structured pathway for simulation scenarios and how to conduct them so that learning needs are achieved. This enabled registrars let the junior doctors to attend and adapt into existing teaching rota as a simulation session. We rotated to different wards and different day of the week to cover wide range of junior doctors and kept the scenarios specific for their workplace which in turn made them more relaxed and interested. CONCLUSION(S): Simulation is a great learning tool and be able to share experience and knowledge in difficult time of pandemic was a challenging but achievable. We learned and adapted changes from each simulation as coordinators which helped in running the subsequent sessions better.

Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic.

OBJECTIVES: This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic. DESIGN: This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data. SETTING: Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes. PARTICIPANTS: The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021. RESULTS: High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services. CONCLUSIONS: While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.

Perceived stress & sentiments of housemen starting work during the COVID-19 Pandemic in Singapore

Introduction: The transition from medical student to houseman is well recognised as a stressful period for newly qualified doctors. This stress is likely to be heightened when the transition occurs during a pandemic. We aimed to evaluate the perceived stress levels of housemen as they begin housemanship and explore their sentiments and preparedness in starting work amidst the coronavirus disease 2019 (COVID-19) pandemic. Methods: Housemen starting work at a tertiary institution in Singapore in May 2020 completed the following: (1) Perceived Stress Scale, (2) open-ended questions on perceived challenges and concerns and (3) questionnaire on preparedness and confidence in starting work. Descriptive statistics were used to analyse quantitative data and modified thematic analysis performed for qualitative data. Results: Sixty-one housemen participated. Thirty-five (57.4%) reported high perceived stress. The themes for perceived challenges in this transition included coping with constant change, lack of reliable information from authorities, dealing with disappointment, physical fatigue, and loss of autonomy. The themes for concerns in beginning housemanship elicited relate to clinical competence, transitioning into new responsibilities, risk of infection with COVID-19, senior expectations, physical fatigue and training-related concerns. Despite these challenges and concerns, housemen were prepared to begin work during this pandemic. Conclusion: Housemen transitioning during this pandemic experienced additional stressors and unique challenges pertaining to working in a pandemic. Encouragingly, they remain prepared to start work. Institutions and departments should be mindful of the specific concerns and challenges so that appropriate support can be put in place to support these junior doctors. [ FROM AUTHOR] Copyright of Asia Pacific Scholar is the property of Centre for Medical Education (CenMed) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The workplace and psychosocial experiences of Australian junior doctors during the COVID-19 pandemic.

BACKGROUND: Junior doctors experience high levels of psychological distress and emotional exhaustion. The current Coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes to healthcare globally, with quantitative studies demonstrating increased fatigue, depression and burnout in junior doctors. However, there has been limited qualitative research to examine junior doctors' experiences, challenges and beliefs regarding management of future crises. AIMS: To investigate the workplace and psychosocial experiences of Australian junior doctors working during the second wave of the COVID-19 pandemic. METHODS: Australian healthcare workers were invited to participate in a nationwide, voluntary, anonymous, single time point, online survey between 27 August and 23 October 2020. A qualitative descriptive study of responses to four free-text questions from 621 junior doctors was undertaken, with responses analysed using inductive content analysis. RESULTS: Participants were predominantly female (73.2%), aged 31-40 years (48.0%) and most frequently reported working in medical specialties (48.4%), emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) participants had 0-5 years of clinical experience since medical graduation. Junior doctors described experiences related to four key themes: a hierarchical, difficult workplace culture; challenging working conditions; disrupted training and career trajectories; and broader psychosocial impacts. The COVID-19 pandemic exacerbated longstanding, workplace issues and stressors for junior doctors and highlighted the threat that crises pose to medical workforce retention. There is an urgent need for authentic, positive workplace cultural interventions to engage, validate and empower junior doctors. CONCLUSIONS: Challenging workplace cultures and conditions, which have worsened during the COVID-19 pandemic, are associated with poor psychological well-being in junior doctors. There exists a need for long-term, widespread improvements in workplace culture and working conditions to ensure junior doctors' well-being, facilitate workforce retention and enhance the safety and quality of patient care in Australia.

COVID 19: are South African junior doctors prepared for critical care management outside the intensive care unit?

INTRODUCTION: the coronavirus disease 2019 (COVID-19) pandemic has negatively impacted countries across the globe. Infected individuals will seek aid at various health care facilities. Many patients will recover without requiring specialised treatment. A significant percentage of infected individuals will need critical care management, which will begin in the emergency department, generally staffed by junior doctors. Junior doctors will need to stabilize, triage and manage these patients prior to referral to specialized units. Above and beyond the usual occupational demands that accompany junior doctors in state facilities, this pandemic will thrust further responsibility on them. The objectives were to describe crisis preparedness of junior doctors in the areas of triage decision-making and critical care management, outside the intensive care unit. METHODS: this is a descriptive, cross-sectional study, utilizing a web-based survey. Junior doctors in South Africa, being doctors in year one or year two of internship and community service, were invited to participate anonymously via various social media platforms. Results: a total of 210 junior doctors across South Africa answered the survey. Junior doctors expressed confidence with knowledge of intubation drugs, to perform intubation and cardiopulmonary arrest resuscitation without supervision. Only 13.3% of respondents expressed comfort with setting and adjusting ventilator settings independently. 57% of participants expressed discomfort with making critical care triage decisions. Ninety-three percent (93%) of participants expressed benefit from a telemedicine intervention. CONCLUSION: junior doctors in South Africa indicate that they are prepared to initiate management of the critically ill patient outside the intensive care unit but remain uncertain in their ability to provide ongoing critical care management. The COVID-19 pandemic has highlighted the need to prepare junior doctors with the ability to manage critical care triage and management in emergency rooms. Leveraging of the workforce in South Africa may be potentiated by telemedicine interventions.

Factors relating to working hours restriction that have impacted the professional identity of trainees in the last decade.

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or 'being a doctor'. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

Sick leave accessibility in junior doctors at an Australian health service.

BACKGROUND: Doctors commonly continue to work when they are unwell. This norm is increasingly problematic during the COVID-19 (SARS-CoV-2) pandemic when effective infection control measures are of paramount importance. This study investigates the barriers existing before COVID-19 that prevent junior doctors with an acute respiratory illness working in Canberra, Australia, from taking sick leave, and offers suggestions about how to make sick leave more accessible for junior doctors. METHODS: Anonymous online survey study. RESULTS: 192 junior doctors were invited to participate in the study. Fifty-four responded, and only those who had worked whilst unwell with an acute respiratory illness were included, providing a total number of fifty responses. Of these, 72% believed they were infectious at the time they worked whilst unwell. 86% of respondents did not feel supported by the workplace to take sick leave when they were unwell, and 96% identified concerns about burdening colleagues with extra workload and lack of available cover as the main deterrents to accessing sick leave. CONCLUSION: Junior doctors at our health service, pre-COVID-19, do not widely feel empowered to take sick leave when they have an acute respiratory illness. Junior doctors are primarily concerned about burdening their colleagues with extra workloads in an environment where they perceive there to be a lack of available cover. Having more available cover, leadership from seniors, and clearer guidelines around the impact of sick leave on registration may contribute to a culture where junior doctors feel supported to access sick leave.

Fighting from the COVID-19 Frontline: A Junior Doctor's Perspective on Fear, Duty and Calling.

As the COVID-19 pandemic ravages the whole world, the frontline clinicians are tirelessly fighting to contain and manage the disastrous effects of the virus from their communities. Stress, despair, fear, physical and psychological burn out, decreased work out put and lowered morale are some side effects this endless battle has had on the frontline healthcare worker. Although there have been many accounts of surgeons working in the frontline, there have only been few reflections on this ongoing battle from the junior clinician's point of view. In this article, we feature the perspectives of young residents from the orthopaedic unit at the epicenter of the COVID-19 fight in Singapore. We highlight the thoughts, fears, emotions, morale, motivating factors and reflections of junior clinicians while they work at frontlines. Fear in a dangerous new environment and amidst uncertainty is natural. However, a doctor's call of duty goes far above fear.

COVID-19: an FY1 on the frontline.

The global spread of COVID-19 has put increased pressure on the NHS. The Government has put in a number of strategies to cope with this pandemic, which includes increasing funding for the NHS. However, increased funding itself will not ease the workload. With a number of our staff isolating from work due to COVID-19, we as the workforce have to step out of comfort zones and work in unfamiliar specialties. These are unprecedented times and are placing strains on our health service. Nonetheless, we as healthcare professionals have taken oaths that we are honouring and will continue to do so, till this virus is put to rest.

Enhancing junior doctors' working lives.

Junior doctor wellbeing has been a topic of increasing interest in recent years. There is increasing evidence of poor workplace satisfaction, rising levels of burnout and increasing diaspora of UK-trained junior doctors. There is therefore a pressing need to address the wellbeing of our trainees and recent concerted efforts at local, national and international levels are working towards this, with the ultimate goal of also improving patient care. The tension between the personal and the professional may never be so keenly felt as during the unique challenges we are facing this year, in 2020, as we tackle the biggest global health emergency of our lives brought about by COVID-19. There are many positive examples of new initiatives aimed at supporting the medical community at this time; however, we must all work together to sustain these endeavors in post-pandemic times. We here summarize a number of pertinent issues affecting trainee wellbeing, outline current attempts at addressing these and make further suggestions as how to enhance the working lives of our junior doctors. However there is much still to be done.

First impressions of the foundation interim year 1 postings: positives, pitfalls, and perils.

COVID-19 has placed an increased burden on the NHS. Changes were made to expand patient capacity including hospital restructuring, cancellation of most elective surgeries and early graduation of final year medical students. 1 The UK foundation programme (UKFP) curated a new training position for graduates as foundation interim year 1 (FiY1) doctors, where they voluntarily work in paid positions prior to entering formal foundation year 1 (FY1) roles. 2 Expediting the process of fulfilling these positions, the General Medical Council facilitated early provisional registration of doctors. We discuss the positives, pitfalls, and perils of the new roles and the first impressions of three newly qualified FiY1 s in medical, obstetrics and gynaecology and surgical posts, a surgical FY1 doctor and a clinical supervisor in surgery.

Novel coronavirus (COVID-19) infection: What a doctor on the frontline needs to know.

Coronavirus disease 2019 (COVID-19) is a zoonotic respiratory infection originating from Wuhan, China. Rapidly spreading from Wuhan to all inhabited continents of the world, the World Health Organisation declared COVID-19 a pandemic on March 11, 2019. Infected patients present with fever and cough; radiological features include bilateral infiltrates on chest x-ray and computed tomography scanning. Management is supportive with oxygen supplementation, broad-spectrum antibiotics as well as careful fluid balancing. A number of drugs, both new and old, are currently in clinical trials and being used on an experimental basis in clinical practice. The COVID-19 pandemic is the greatest worldwide public health crisis of a generation, and has led to seismic political, economic and social changes. This review provides an overview of COVID-19 for junior doctors who find themselves on a new frontline of healthcare.

Professional autonomy and liability of the resident doctor: Between the hammer and the anvil.

Within the regime of professional liability of doctors in training, the limits and the medico-legal aspects of their professional duties are not well-defined. The Italian Court of Cassation established in its sentence no. 26311/2019 that resident doctors do not work at hospitals just to receive their professional training. They are, indeed, licensed physicians and therefore bear full responsibility for the acts performed within the compass of their professional activity. The purpose of this article is to briefly define the possible consequences of this judgment.