Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives

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Abstract

Background

Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors’ working conditions and, thus, their mental health.

Methods

We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors’ working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations.

Results

Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork.

Conclusion

We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08728-2.

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Most cited references 45

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Using thematic analysis in psychology

Virginia Braun, Victoria Clarke (2014)

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The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates.

J. Lozano, P. Gutierrez, Stacey Freedenthal … (2012)

We conducted two studies to examine the dimensions, internal consistency reliability estimates, and potential correlates of the Depression Anxiety Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995). Participants in Study 1 included 887 undergraduate students (363 men and 524 women, aged 18 to 35 years; mean [M] age = 19.46, standard deviation [SD] = 2.17) recruited from two public universities to assess the specificity of the individual DASS-21 items and to evaluate estimates of internal consistency reliability. Participants in a follow-up study (Study 2) included 410 students (168 men and 242 women, aged 18 to 47 years; M age = 19.65, SD = 2.88) recruited from the same universities to further assess factorial validity and to evaluate potential correlates of the original DASS-21 total and scale scores. Item bifactor and confirmatory factor analyses revealed that a general factor accounted for the greatest proportion of common variance in the DASS-21 item scores (Study 1). In Study 2, the fit statistics showed good fit for the bifactor model. In addition, the DASS-21 total scale score correlated more highly with scores on a measure of mixed depression and anxiety than with scores on the proposed specific scales of depression or anxiety. Coefficient omega estimates for the DASS-21 scale scores were good. Further investigations of the bifactor structure and psychometric properties of the DASS-21, specifically its incremental and discriminant validity, using known clinical groups are needed. © 2012 Wiley Periodicals, Inc.

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Author and article information

Contributors

Johanna Spiers: j.spiers@surrey.ac.uk

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 10 November 2022

Publication date PMC-release: 10 November 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 1333

Affiliations

[1 ]GRID grid.5475.3, ISNI 0000 0004 0407 4824, School of Health Sciences, Faculty of Health and Medical Sciences, , University of Surrey, ; Guildford, UK

[2 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Department of Social Work and Social Policy, School of Social Policy, , University of Birmingham, ; Birmingham, UK

[3 ]GRID grid.83440.3b, ISNI 0000000121901201, Research Department of Primary Care and Population Health, , University College London Medical School, ; London, UK

[4 ]GRID grid.9757.c, ISNI 0000 0004 0415 6205, School of Medicine, , Keele University, ; Keele, UK

[5 ]GRID grid.418449.4, ISNI 0000 0004 0379 5398, Yorkshire Quality and Safety Research Group, , Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, ; Bradford, UK

[6 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, ; Leeds, UK

[7 ]GRID grid.8391.3, ISNI 0000 0004 1936 8024, University of Exeter, ; Exeter, EX4 4PY UK

[8 ]GRID grid.88379.3d, ISNI 0000 0001 2324 0507, Department of Organizational Psychology, , Birkbeck, University of London, ; London, UK

[9 ]GRID grid.5379.8, ISNI 0000000121662407, Division of Psychology and Mental Health, School of Medicine, , University of Manchester, ; Manchester, UK

[10 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Institute of Applied Health Research, University of Birmingham, ; Birmingham, UK

Article

Publisher ID: 8728

DOI: 10.1186/s12913-022-08728-2

PMC ID: 9647238

SO-VID: 824381bb-7c27-47f2-aba8-fe281752e907

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 December 2021

Date accepted : 7 October 2022

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: junior doctors,mental health,recommendations,qualitative research

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: junior doctors, mental health, recommendations, qualitative research

Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives

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Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Related collections

Emerald: Healthier Lives

Most cited references 45

Using thematic analysis in psychology

Reflecting on reflexive thematic analysis

The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates.

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