Introduction: Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains.Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing. Methods: Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2-4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing. Results: Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies). Conclusions: This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.

Colorful carotenoid ornaments are sexually selected signals of health in many species. In humans too, carotenoids could provide a perceptible cue to health as they impart an attractive yellow-orange color to skin. Increasing carotenoid pigmentation and skin yellowness is associated with increased fruit and vegetable intake, but whether other aspects of human health benefit skin color is unknown. Carotenoids, as antioxidants, help maintain oxidative balance but are expended in this role. Therefore, any health factor affecting oxidative balance could alter the quantity of carotenoids available to color skin. Exercise increases endogenous antioxidant capacity and consequently may decrease expenditure of carotenoids. Fitness could also raise skin carotenoids by lowering body fat (a source of oxidative stress). Here we investigate the relationship between skin color (measured spectrophotometrically), aerobic fitness (measured by estimating the maximum volume of oxygen that a person can use per unit of time, VO 2 max), and body fat. In a cross-sectional design, we find that both higher aerobic fitness and lower body fat are predictors of skin yellowness, independent of each other and dietary fruit and vegetable intake. In a longitudinal design over 8 weeks, we found that increase in fitness and decrease in body fat were independently associated with an increase in skin yellowness. Change in self-reported stress and sleep were further predictors of skin yellowness indicating a more general relation between health and skin tone. Simulations of the skin color associated with higher fitness were found to appear healthier. Hence, our results suggest that increasing cardiovascular fitness and decreasing fat levels produce a healthier skin color. Such findings have repercussions for public health because improved attractiveness can provide an incentive for a healthier lifestyle, including exercise and weight regulation.

ObjectivesThe aim of this scoping review was to identify pre-existing interventions to support the well-being of healthcare workers during a pandemic or other crisis and to assess the quality of these interventions.DesignArksey and O’Malley’s five-stage scoping review framework was used to identify the types of evidence available in the field of well-being interventions for healthcare workers during a pandemic. PubMed, PsycINFO, Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find interventions for the well-being of doctors during pandemics. Owing to a lack of results, this search was expanded to all healthcare workers and to include any crisis. Databases were searched in June 2020 and again in October 2020.Inclusion/exclusion criteriaArticles were included that studied healthcare workers, reported an intervention design and were specifically designed for use during a pandemic or other crisis. Well-being was defined broadly and could include psychological, physical, social or educational interventions.ResultsSearching produced 10 529 total academic references of which 2062 were duplicates. This left 8467 references. Of these, 16 met our inclusion criteria and were included in data extraction. During data extraction, three more papers were excluded. This left 13 papers to summarise and report. Of these 13 papers, 6 were prospective studies and 7 were purely descriptive. None of the interventions were theoretically informed in their development and the quality of the evidence was generally deemed poor.ConclusionsThere are no high-quality, theory-based interventions for the well-being of healthcare workers during a pandemic or other crisis. Given that previous pandemics have been shown to have a negative effect on healthcare workers well-being, it is imperative this shortcoming is addressed. This scoping review highlights the need for high-quality, theory-based and evidence-based interventions for the well-being of healthcare workers during a pandemic.

The faces of people who are sleep deprived are perceived by others as looking paler, less healthy and less attractive compared to when well rested. However, there is little research using objective measures to investigate sleep‐loss‐related changes in facial appearance. We aimed to assess the effects of sleep deprivation on skin colour, eye openness, mouth curvature and periorbital darkness using objective measures, as well as to replicate previous findings for subjective ratings. We also investigated the extent to which these facial features predicted ratings of fatigue by others and could be used to classify the sleep condition of the person. Subjects (n = 181) were randomised to one night of total sleep deprivation or a night of normal sleep (8–9 hr in bed). The following day facial photographs were taken and, in a subset (n = 141), skin colour was measured using spectrophotometry. A separate set of participants (n = 63) later rated the photographs in terms of health, paleness and fatigue. The photographs were also digitally analysed with respect to eye openness, mouth curvature and periorbital darkness. The results showed that neither sleep deprivation nor the subjects’ sleepiness was related to differences in any facial variable. Similarly, there was no difference in subjective ratings between the groups. Decreased skin yellowness, less eye openness, downward mouth curvature and periorbital darkness all predicted increased fatigue ratings by others. However, the combination of appearance variables could not be accurately used to classify sleep condition. These findings have implications for both face‐to‐face and computerised visual assessment of sleep loss and fatigue.

This paper aims to outline the development of a theoretically informed and evidence-based intervention strategy to underpin interventions to support the wellbeing of doctors during COVID-19 and beyond; delineate new ways of working were employed to ensure a rapid and rigorous process of intervention development and present the resulting novel framework for intervention development. The research comprised four workstreams: literature review (WS1), qualitative study (WS2), intervention development and implementation (WS3) and evaluation (WS4). Due to time constraints, we employed a parallel design for WS1-3 with the findings of WS1-2 informing WS3 on a continual basis. WS3 was underpinned by the Behaviour Change Wheel. We recruited expert panels to assist with intervention development. We reflected on decisions taken to facilitate the rapid yet rigorous process of Kathrine Gibson Smith and Kathryn B. Cunningham are co-first authors.