Burnout 'Threatens High Quality Training for Junior Doctors'

Peter Russell

December 03, 2018

High levels of burnout and workplace stress could threaten good quality training for junior doctors, a survey has revealed.

The General Medical Council (GMC) said that poor handovers and inductions, and gaps in rotas, should be seen by employers as tell-tale indicators of more significant problems in the workplace.

The warning came as the regulator published a review of its latest national surveys of doctors in training and those who train them.

Results suggested a continuing high quality of postgraduate medical education and training, with trainers delivering a high standard of education and mentoring "in challenging circumstances," the report said.

Heavy Workload and Tiredness

However, of the more than 70,000 trainee and senior doctors who took part, a significant proportion reported feeling burnt out. A quarter of those in training and a fifth of trainers said they felt burnt out to a 'high' or 'very high' degree.

Those in emergency medicine and trainees in their second year of postgraduate training were feeling it most, results showed. Nearly 74% of emergency medicine trainees rated the intensity of their workload as either 'heavy' or 'very heavy', leading to tiredness at work.
Other specialties where trainees reported higher than average workloads and tiredness were surgery, medicine, obstetrics and gynaecology, and paediatrics.

Over half of all GP trainers said they worked beyond their normal working hours on a daily basis.

The GMC said it was not possible to compare the results to previous years as this was the first time the question about burnout had been asked. However, it said that heavy workloads, rota gaps and the lack of a supportive working environment were key factors that employers should not ignore if they wanted to preserve high standards of training.

Burnout 'Can Erode the Quality of Training'

Charlie Massey, the GMC's chief executive, said: "Handovers, inductions and well-organised rotas are indicators of workplaces where teamwork and positive cultures are fostered, and where trainees feel well supported. But where these aspects run less well doctors more commonly report poor experiences.
"Proportionally more doctors who feel unsupported at work with high workloads tell us they experience exhaustion and burnout. That can erode the quality of their training as well as potentially putting patients at risk."

Overall, around 1 in 6 doctors in training said handover arrangements did not always ensure continuity of care between different clinical departments, and 1 in 3 said handovers were not used as learning opportunities, which GMC standards say they should be.
Also, 8.1% of trainees said they did not get an explanation of their role and responsibilities at the start of their most recent post.

And almost 53% of doctors in training said they received less than the recommended 6 weeks' notice of their rota, with around 1 in 10 only receiving a week's notice, or even less.

Results were consistent in England, Scotland, Wales, and Northern Ireland.

The GMC said it had commissioned a UK-wide review, led by Dame Denise Coia and Professor Michael West, to investigate the causes of poor wellbeing faced by doctors.

'Deeply Concerning': BMA

Responding to the survey, Dr Jeeves Wijesuriya, British Medical Association (BMA) junior doctors' committee chair, said: "To see such a large number of junior doctors burnt out is deeply concerning, but no surprise given the intense workload pressures experienced by trainees, and as reported in this survey.

"These statistics lay bare the real-terms impact of poor planning; if a doctor is working in an understaffed department, not getting a rota until 2 weeks before they are due to begin a new role and even when they do start they are receiving no proper induction, this is bound to be detrimental to their wellbeing and affect how they feel about the quality of their training.

"Indeed, we know from our research that physical and mental health issues remain some of the key drivers behind junior doctors taking time out of their training programmes.

"But burnout affects so much more than quality of training, and as this report notes, heavy workloads can have patient safety implications."

Prof Russell Viner, president of the Royal College of Paediatrics and Child Health (RCPCH), commented: "It cannot be right that doctors who treat and care for children and young people are experiencing such high levels of stress, exhaustion and burnout. As the GMC's survey points out, paediatricians are among the specialties where trainees are finding it hard to find the time to learn and develop their skills, and they are reporting above average workloads and tiredness.

"Our members love working in paediatrics and find it a rewarding career, but there are simply not enough doctors to meet demand.  This means they are working in challenging environments leading to low morale and exhaustion.

"This is not good for their health or for the health of their young patients."


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