Surveying, shoring, strengthening: rebuilding medical morale from its foundations

Abstract

Significant uncertainty surrounds the sustainability of healthcare services in which junior doctors work. It is essential that student and foundation doctors (SFDs) are actively engaged if workforce morale is rebuilt. This narrative review explores the evidence driving the individual work-streams of the Royal College of Physicians' newly formed Student and Foundation Doctor Network. Undergraduate and postgraduate training reform has coincided with concerning feedback from newly qualified doctors. System-level efforts to address this include a focus on extra-contractual matters, where small, sustainable changes could address training and work issues. Fewer foundation year-2 doctors are entering specialty training immediately after the foundation programme. Providing dedicated careers guidance and highlighting opportunities within traditional placements and other career paths can support doctors who undertake non-traditional career routes, including those who take time out of programme. Disseminating these resources through an effective peerto-peer framework and a well-established mentoring scheme could be the most appropriate way to spread good practice.

The benefits, barriers and facilitators of mentoring programs for first‐year doctors: A systematic review

“…This review supported existing evidence that the junior doctor's first year is pervasive with unrealistic expectations of resilience. 12,19 Progressive amounts of fatigue and anger were demonstrated as the year continues, 19 with poor work-life balance leading to disillusionment, and a 50% attrition rate in their second year. 44 However, it also revealed that the mentoring relationship permits vulnerability and emotionality, 44 which may facilitate the creation of first-year doctors with greater overall well-being, who are less susceptible to burn-out, and better supported through the otherwise silenced psychosocial, professional and cultural demands of their transition.…”

“…1,7 In contrast, mentoring, aims for individualised outcomes, long-term transformational development, 6 conscious and dynamic interest in the mentee's success 9 and a fostering of trust that provides guidance through their personal and professional development. 1 To the knowledge of the authors, although the benefits of mentorship in broader medical cohorts are already known, no systematic reviews exist that synthesise articles on mentorship for first-year doctors specifically, despite the unique transition difficulties and vulnerability identified within this group; the shift from medical student to first-year doctor is widely described as notoriously challenging, 3,[10][11][12][13][14] with graduates and supervisors in one study reporting a failure rate of 28.3%. 12 Transition failure, or transition shock, 10,15 is attributed to performance gaps between academia and clinical practice, which manifest in relation to increasing complexity of communication, responsibility, time management, ability to cope with emergencies and capacity to manage overall resilience and professionalism.…”

“…1 To the knowledge of the authors, although the benefits of mentorship in broader medical cohorts are already known, no systematic reviews exist that synthesise articles on mentorship for first-year doctors specifically, despite the unique transition difficulties and vulnerability identified within this group; the shift from medical student to first-year doctor is widely described as notoriously challenging, 3,[10][11][12][13][14] with graduates and supervisors in one study reporting a failure rate of 28.3%. 12 Transition failure, or transition shock, 10,15 is attributed to performance gaps between academia and clinical practice, which manifest in relation to increasing complexity of communication, responsibility, time management, ability to cope with emergencies and capacity to manage overall resilience and professionalism. 13 It is theorised, that participation in a professional community is required in the formation of a professional identity, and thus, medical school cannot wholly prepare students for the reality of life as a doctor.…”

“…16 Feelings of uncertainty, fear of making mistakes, 21 power imbalances and lack of support from senior staff are reported to repeat cyclically at each change of specialty, with distressed thoughts ruminating beyond working hours, and into the home environment. 16,22 Qualitative data describes unrealistic expectations of resilience and endurance, 12,19 sleep deprivation, 10,20,22 social isolation, 22 lack of lunch or bathroom breaks, 12,22,23 untenable working hours and insufficient supervision, which perpetuate the burnout cycle. 19,20 Ultimately, the working conditions of the junior doctor are directly correlated to suicidal ideation, 10,11,20,24 poor workforce retention, 19,21,25 unethical behaviour, 11,20 reduced empathy, 20,24 medication errors 11,24,26,27 and patient harm 11,[25][26][27] ; factors that are further exacerbated by the high prevalence of bullying culture within medicine.…”

“…9,[22][23][24][25][26][27]31,32 Lastly, studies reveal the recent impact of the COVID-19 pandemic significantly interrupted first-year pathways, forcing this cohort beyond their skill capacity, increasing social isolation, stress, anxiety and further amplifying the pre-pandemic burnout crisis. 10,12,21,33 Therefore, this systematic review aims to address a gap in the literature, by isolating mentorship specifically, and its potential impact on the first-year doctor cohort. Given the known benefits of mentorship in broader cohorts, and given the unique challenges faced by the transition of first-year doctors, an enhanced understanding of mentorship for this group may help inform the development and enhancement of a mentoring framework (benefits, barriers, and facilitators).…”