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One in four junior doctors feels ‘burnt out,’ national training survey shows

Many trainees clock up more than rostered hours and say they are forced to work beyond their competence

Caroline White

Friday, 30 November 2018

One in four junior doctors feels ‘burnt out’, with many reporting that they are forced to work beyond their competence and clock up more than their rostered hours, reveal the results* of the General Medical Council’s (GMC) latest annual national training survey.

The latest training survey draws on the views and experiences of more than 70,000 doctors in training and senior doctors who act as trainers.

For the first time it asked doctors about burnout. The responses showed that burnout was more prevalent among trainees who disagreed that rotas helped them optimise their education and development; while more trainers reported burnout in posts where they weren’t always able to use the time allocated to them for training.

Doctors in emergency medicine reported the highest rates of burnout. Nearly three out of four emergency medicine trainees rated the intensity of their workload as either ‘heavy’ or ‘very heavy’, and they reported feeling short of sleep while at work more than doctors in any other specialty.

Other specialties where trainees reported higher than average workloads and tiredness were surgery, medicine, obstetrics and gynaecology, and paediatrics.

The survey also found that while trainers and training organisations continue to provide high quality medical education, trainees rated their experience as worse when they had poor handovers, inadequate inductions, and gaps in rotas.

GMC chief executive, Charlie Massey, commented: “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. These warning signs must not be ignored.”

Overall, around one in six doctors in training said handover arrangements did not always ensure continuity of care between different clinical departments, and one in three said handovers were not used as learning opportunities, which GMC standards say they should be.

The quality of inductions also varied, with more than 4000 trainees (8.1%) reporting that they didn’t get an explanation of their role and responsibilities at the start of their most recent post.

And over half of doctors in training – almost 53% – told the GMC that they received less than the recommended six weeks’ notice of their rota. Around one in 10 had only a week’s notice, or even less.

Charlie Massey added: “We know that where these issues exist there are likely to be wider problems as well. An unsupportive environment doesn’t just disrupt training, but can be a sign that inexperienced doctors are working beyond their clinical competence.

“The majority of doctors in training say they are satisfied with the teaching and supervision they receive, and most trainers enjoy their roles. But we cannot take the continued high quality of medical training for granted. Time for training must be protected; it is too often at the mercy of gaps in rotas and pressures that divert resources elsewhere.”

Dr Jeeves Wijesuriya, British Medical Association’s junior doctors committee chair, said the large number of junior doctors who felt burnt out was “deeply concerning,” but no surprise given the intense workload pressures they faced.

“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 two 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,” he said.

Physical and mental health issues remain some of the key drivers behind junior doctors taking time out of their training programmes, he added.

“But burnout affects so much more than quality of training, and as this report notes, heavy workloads can have patient safety implications. With a high proportion of junior doctors working beyond their rostered hours and as many as half of trainees in some specialties regularly feeling short of sleep, high quality patient care cannot be guaranteed.”

He continued: “That more than two-thirds of trainees feel forced to work beyond their clinical competence at times makes for stark reading – and the potential risk that this poses should be obvious.”

The GMC’s focus on exception reporting and raising concerns was to be welcomed, he said, but added: “Reports like this show there is still a lot of work to be done in improving both the training that junior doctors need to guarantee the quality and resilience of our future NHS, and the quality of working life that they so deserve.”

The GMC has commissioned a UK-wide review, led by Dame Denise Coia and Professor Michael West, into the causes of poor wellbeing faced by doctors. The findings will help it to identify priority areas for improving support and working conditions.

*Training environments 2018: Key findings from the national training surveys. Prepared by the General Medical Council, November 2018.

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