Impact of COVID-19 Policies on Hospitalists' Psychological Safety.

OBJECTIVES: The coronavirus disease 2019 pandemic brought about many changes in work environment and interpersonal interactions to prevent the spread of infection. Policies such as ubiquitous masking, virtual meetings, physician distancing, and decreased communal eating changed the inpatient work environment. This study aims to look at the impact of these changes on hospitalists' psychological safety. METHODS: We surveyed hospitalists on how these changes affected their well-being and feelings of psychological safety. RESULTS: Masking, virtual meetings, and fewer opportunities to eat together decreased connection with colleagues. Virtual meetings and social distancing decreased some aspects of psychological safety. CONCLUSIONS: This study highlights the importance of finding ways to foster connection and decrease burnout while continuing to prevent the spread of infection.

Drexit: Understanding why junior doctors leave their training programs to train overseas: An observational study of UK physicians.

INTRODUCTION: Drexit ("Doctor-Exit") is the exponentially growing trend for junior doctors in the UK to walk away from their jobs in the National Health Service (NHS). Our objective was to identify the reasons why junior doctors in the UK leave their NHS training programs to train overseas. MATERIALS AND METHODS: A simultaneous and convergent mixed-methods study was performed to analyze both an online survey and semi-structured interviews from junior doctors who had left the NHS. Social media, online professional media, and networks of junior doctors were used to recruit doctors. All were UK medical school graduates who had left the NHS within the last 15 years (2003-2018). RESULTS: 96.1% (149/155) of respondents reported not being offered an exit interview on leaving the NHS. 94.8% (147/155) of respondents did not regret quitting the NHS. Participants were more satisfied with their pay and work life balance in their overseas posts when compared to training in the NHS (P < 0.05). Burnout was variably defined and was prominent in doctors who left 53.8% (113/210) but was reversed when they practiced medicine overseas in 89.2% (74/83) of cases. Qualitative data identified four key themes which were categorized into push factors, which were lack of interest in retention and bleak outlook; and pull factors, which were financial vs social capital and things are different overseas. CONCLUSION: Listening to the frontline junior doctors' voices lend insights into a better understanding of the push and pull factors that appear to be exacerbating the exodus of junior doctors from the NHS. Our results indicate that exit interviews should be performed routinely. There needs to be a shift to focus on the training of doctors rather than service provision, with efforts to support, appreciate, and value junior doctors. Further exploration is needed to identify what is happening in training programs overseas to improve retention within the NHS. Furthermore, identifying issues perceived by junior doctors in the UK in the context of workforce planning may be applicable to healthcare systems across the globe.