Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study

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Abstract

<div class="section"> <a class="named-anchor" id="d4275443e176">  </a> <h5 class="section-title" id="d4275443e177">Objectives</h5> <p id="d4275443e179">The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an ‘F3’ year. There is a paucity of qualitative research exploring why increasingly doctors are taking F3s. The aim of this study is to explore the reasons why F2 doctors are choosing to take a year out of training and the impact upon future career choices. </p> </div><div class="section"> <a class="named-anchor" id="d4275443e181">  </a> <h5 class="section-title" id="d4275443e182">Design</h5> <p id="d4275443e184">This is an exploratory qualitative study, using in-depth interviews and content analysis. </p> </div><div class="section"> <a class="named-anchor" id="d4275443e186">  </a> <h5 class="section-title" id="d4275443e187">Setting</h5> <p id="d4275443e189">UK.</p> </div><div class="section"> <a class="named-anchor" id="d4275443e191">  </a> <h5 class="section-title" id="d4275443e192">Participants</h5> <p id="d4275443e194">Fourteen participants were interviewed from one foundation school. Participants included five doctors who commenced their F3 in 2015, five who started in 2016 and finally four recently starting this in 2017. </p> </div><div class="section"> <a class="named-anchor" id="d4275443e196">  </a> <h5 class="section-title" id="d4275443e197">Main outcome measures</h5> <p id="d4275443e199">Content analysis was conducted to distill the themes which exemplified the totality of the experience of the three groups. </p> </div><div class="section"> <a class="named-anchor" id="d4275443e201">  </a> <h5 class="section-title" id="d4275443e202">Results</h5> <p id="d4275443e204">There were four predominant themes arising within the data set which can be framed as ‘unmet needs’ arising within foundation years, sought to be fulfilled by the F3 year. First, doctors describe exhaustion and stress resulting in a need for a ‘break’. Second, doctors required more time to make decisions surrounding specialty applications and prepare competitive portfolios. Third, participants felt a loss of control which was (partially) regained during their F3s. The final theme was the impact of taking time out upon return to training (for those participants who had completed their F3 year). When doctors returned to NHS posts they brought valuable experience. </p> </div><div class="section"> <a class="named-anchor" id="d4275443e206">  </a> <h5 class="section-title" id="d4275443e207">Conclusions</h5> <p id="d4275443e209">This study provides evidence to support the important ongoing initiatives from Health Education England and other postgraduate bodies, exploring approaches to further engage, retain and support the junior doctor workforce. </p> </div>

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Burnout and engagement among resident doctors in the Netherlands: a national study.

Josette E. H. M. Hoekstra-Weebers, Arnold B. Bakker, Gea Dillingh … (2010)

This study was performed in order to gather insight into the well-being of Dutch medical residents. In 2005, all Dutch residents registered through the Medical Registration Committee (n = 5245) were sent a self-report questionnaire to assess socio-demographic and work-related characteristics, burnout and engagement. Of the 5140 eligible residents, 2115 completed the questionnaire (41%). Of those, 21% fulfilled the criteria for moderate to severe burnout and 27% were highly engaged with their work. Women reported more emotional exhaustion and less depersonalisation than men; age was weakly but significantly related to depersonalisation, and married residents and parents reported less depersonalisation than their single or childless counterparts. More men than women were found to be highly engaged and men specifically reported more vigour. Number of years in training was weakly but significantly related to absorption. With regard to occupational risk factors, significant between-group differences were found for the effects of clinical setting on emotional exhaustion, engagement, vigour and absorption. Residents in training in a mental health clinic were most emotionally exhausted and those in a rehabilitation centre were least engaged. General surgery represented the specialty with the lowest number of residents suffering from burnout, followed by obstetrics and gynaecology and any supportive specialty. General surgery residents were also found to be more highly engaged, vigorous, dedicated and absorbed than others. As more than a fifth of the medical residents who responded could be diagnosed as suffering from burnout, we conclude that this problem needs addressing in the Dutch health care system, especially given that a relationship was proven between burnout and suboptimal patient care. We must look for solutions and interventions which will improve the work situation of medical residents. Striving for healthy workers in health care has to become daily practice.

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Understanding the stresses and strains of being a doctor.

Kasandra J-L Riley (2004)

Stress in doctors is a product of the interaction between the demanding nature of their work and their often obsessive, conscientious and committed personalities. In the face of extremely demanding work, a subjective lack of control and insufficient rewards are powerful sources of stress in doctors. If demands continue to rise and adjustments are not made, then inevitably a "correction" will occur, which may take the form of "burnout" or physical and/or mental impairment. Doctors need to reclaim control of their work environment and employers need to recognise the need for doctors to participate in decisions affecting their working lives. All doctors should be aware of predictors of risk and signals of impairment, as well as available avenues of assistance. Relevant medical organisations (eg, the Colleges, hospital administrations, and medical defence organisations) need to develop and rehearse effective response pathways for assisting impaired doctors.