“I’d been like freaking out the whole night”: exploring emotion regulation based on junior doctors’ narratives

Abstract

The importance of emotions within medical practice is well documented. Research suggests that how clinicians deal with negative emotions can affect clinical decision-making, health service delivery, clinician well-being, attentiveness to patient care and patient satisfaction. Previous research has identified the transition from student to junior doctor (intern) as a particularly challenging time. While many studies have highlighted the presence of emotions during this transition, how junior doctors manage emotions has rarely been considered. We conducted a secondary analysis of narrative data in which 34 junior doctors, within a few months of transitioning into practice, talked about situations for which they felt prepared or unprepared for practice (preparedness narratives) through audio diaries and interviews. We examined these data deductively (using Gross’ theory of emotion regulation: ER) and inductively to answer the following research questions: (RQ1) what ER strategies do junior doctors describe in their preparedness narratives? and (RQ2) at what point in the clinical situation are these strategies narrated? We identified 406 personal incident narratives: 243 (60%) contained negative emotion, with 86 (21%) also containing ER. Overall, we identified 137 ER strategies, occurring prior to (n = 29, 21%), during (n = 74, 54%) and after (n = 34, 25%) the situation. Although Gross’ theory captured many of the ER strategies used by junior doctors, we identify further ways in which this model can be adapted to fully capture the range of ER strategies participants employed. Further, from our analysis, we believe that raising medical students’ awareness of how they can handle stressful situations might help smooth the transition to becoming a doctor and be important for later practice.

Emotional socialisation and burnout in medicine and the role of medical educators

“…and other studies indicate there is work to be done to foster emotional well‐being and competence in medical students, as well as in junior doctors. Health care is inherently complex, dynamic and multifaceted . Medical students and trainees are said to strive to retain a sense of control in clinical practice, which is challenging, given the rapidly evolving nature of health care .…”

“…Emotions have physiological and cognitive elements, but are also shaped by cultural practices and social influences . Tam et al.…”

“…Medical students and trainees are said to strive to retain a sense of control in clinical practice, which is challenging, given the rapidly evolving nature of health care . Recent studies highlight the need for a renewed focus on helping medical students and junior doctors to understand that emotional responses, such as feeling out of control, are an inevitable part of delivering health care and should not be repressed or avoided. Depression in medical students is associated with year of study, gender, personal issues, family relationships and health status .…”

“…Depression in medical students is associated with year of study, gender, personal issues, family relationships and health status . The number and nature of the factors associated with burnout add credence to the notion that medical students and junior doctors require bespoke support to enable them to experience, express and regulate their emotions because unregulated emotions can influence the quality of the medical care they deliver. Medical schools and postgraduate educational organisations endeavour to provide person‐centred well‐being and mental health support to medical students and junior doctors.…”

Crying is an acceptable way to manage emotional stress

“…To cry—whether with the family or later in privacy—is an appropriate response to this experience and an acceptable way to manage negative feelings. If handled poorly, negative emotions such as anger and distress can negatively affect clinical decision making and patient satisfaction,3 so suppressing such feelings rather than finding an outlet for them could adversely affect patient care.…”