Why junior doctors need more autonomy

Penfold, Rose

doi:10.1136/bmj.k4525

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…221 However, lack of control and autonomy are also described in UK literature. 182 Crucially, the feeling of lack of autonomy and control is a potential cause of stress in itself, irrespective of other variables such as workload.…”

Section: Loss Of Autonomymentioning

confidence: 99%

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Carrieri

Pearson

Mattick

et al. 2020

Health Serv Deliv Res

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Background The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem. Objectives Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Design Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards. Data sources Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites. Review methods We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations. Results A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective. Limitations Variable quality of included literature; limited UK-based studies. Future work Use this evidence synthesis to refine, implement and evaluate interventions. Study registration This study is registered as PROSPERO CRD42017069870. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

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Section: Loss Of Autonomymentioning

confidence: 99%

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Carrieri

Pearson

Mattick

et al. 2020

Health Serv Deliv Res

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“…So, some patients go to emergency services. In our case, only one Integrated Continuous Healthcare Point (ICHP) exists in urban areas, which may imply an extra healthcare burden on occasions and, thus, stress and emotional fatigue [13,27], which could explain the differences between urban and rural areas. Another possibility is that as healthcare staff's job posts remain longer in employment exchanges, they may opt for rural areas with less WL, which might explain why these staff members are older than those in urban areas [4,11,12,18].…”

Section: Discussionmentioning

confidence: 90%

“…Nonetheless compared to other healthcare professionals, ESPC personnel quantify both autonomy (AU) ( p < 0.05) and relationships/social support (RSS) ( p > 0.05) as higher risk situations, while psychological demands (PD) come over as a lower risk situation ( p > 0.05) [ 1 , 3 , 13 ]. The fact that ESPC or PH staff tend to be younger than other healthcare professionals could explain why these professionals wish more autonomy to do their job [ 5 , 6 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Occupational Psychosocial Factors in Primary Care Continuing Care Staff

Fonseca

Romo‐Barrientos

Criado‐Álvarez

et al. 2020

IJERPH

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This involves studying the psychosocial factors among the emergencies staff of primary care and seeing if there are differences with the primary health care staff at the Primary Care of the Integrated Care Management of Talavera de la Reina (Spain). Descriptive epidemiological study of type transversal. They have participated 51 emergencies staff of primary care and 50 primary health professionals from a sample of urban and rural health centres. The F-Psico 3.1 questionnaire has been used to evaluate the nine psychosocial risk factors. The emergencies staff quantify the psychosocial factors of working time (19.6 SD 5.7) and autonomy (69.8 SD 23.2) as a higher risk situation compared to the other health care staff with 3.7 SD 4, 7 and 52.1 SD 21.8, respectively (p < 0.05). In addition, the role performance is valued as a lower risk situation by the emergencies staff of primary care (p < 0.05). The workload assessment is the only difference between the emergencies staff of primary care in urban centres (61.5 SD 17.6) and rural (45.2 SD 18.4) (p < 0.05). Women have the highest workload (p < 0.05). It is necessary to apply preventive measures and policies applicable to women who work in emergencies, especially in urban areas to reduce their workload.

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“…Workload 11 36–55 : High workload, exacerbated by rota gaps and excess administrative work, detracts from learning and building relationships and is believed to be unsustainable.…”

Section: Resultsmentioning

confidence: 99%

“…Development opportunities 11 28 39–41 43 44 47 51–54 58 60 66 67 71 : There is little time or support for personal and professional development during work. Taking a break from training provides an opportunity to experience different specialties, improve one’s curriculum vitae, attend conferences, travel and work abroad, and pursue wider qualifications and interests such as teaching, management or research.…”

Section: Resultsmentioning

confidence: 99%

Factors affecting the UK junior doctor workforce retention crisis: an integrative review

Lock

Carrieri

2022

BMJ Open

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ObjectivesTo determine the factors contributing to the junior doctor workforce retention crisis in the UK using evidence collected directly from junior doctors, and to develop recommendations for changes to address the issue.DesignIntegrative review.Data sourcesSearches were conducted on Ovid Medline and HMIC to locate evidence published between January 2016 and April 2021. This was supplemented by publications from relevant national organisations.Eligibility criteriaEnglish-language papers relating to UK junior doctor retention, well-being or satisfaction which contained data collected directly from junior doctors were included. Papers focusing solely on the pandemic, factors specific to one medical specialty, evaluation of interventions, or numerical data with no evidence relating to causation were excluded. Review papers were excluded.Data extraction and synthesisData were extracted and coded on NVivo by FKL, then thematic analysis was conducted.Results47 papers were included, consisting of academic (qualitative, quantitative, mixed and commentary) and grey literature. Key themes identified were working conditions, support and relationships, and learning and development, with an overarching theme of lack of flexibility. The outcomes of these factors are doctors not feeling valued, lacking autonomy, having a poor work–life balance, and providing compromised patient care. This results in need for a break from medical training.ConclusionThis review builds on findings of related literature regarding working environments, isolation, stigma, and desire for autonomy, and highlights additional issues around learning and training, flexibility, feeling valued, and patient care. It goes on to present recommendations for tackling poor retention of UK junior doctors, highlighting that the complex problem requires evidence-based solutions and a bottom-up approach in which junior doctors are regarded as core stakeholders during the planning of interventions.

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Why junior doctors need more autonomy

Cited by 6 publications

References 3 publications

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Occupational Psychosocial Factors in Primary Care Continuing Care Staff

Factors affecting the UK junior doctor workforce retention crisis: an integrative review

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