Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives.
Johanna Spiers, Farina Kokab, Marta Buszewicz, Carolyn A Chew-Graham, Alice Dunning, Anna K Taylor, Anya Gopfert, Maria van Hove, Kevin Rui-Han Teoh, Louis Appleby, James Martin, Ruth Riley
Author Information
Johanna Spiers: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK. j.spiers@surrey.ac.uk.
Farina Kokab: Department of Social Work and Social Policy, School of Social Policy, University of Birmingham, Birmingham, UK.
Marta Buszewicz: Research Department of Primary Care and Population Health, University College London Medical School, London, UK.
Carolyn A Chew-Graham: School of Medicine, Keele University, Keele, UK.
Alice Dunning: Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Anna K Taylor: Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Anya Gopfert: University of Exeter, Exeter, EX4 4PY, UK.
Maria van Hove: University of Exeter, Exeter, EX4 4PY, UK.
Kevin Rui-Han Teoh: Department of Organizational Psychology, Birkbeck, University of London, London, UK.
Louis Appleby: Division of Psychology and Mental Health, School of Medicine, University of Manchester, Manchester, UK.
James Martin: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Ruth Riley: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
BACKGROUND: Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors' working conditions and, thus, their mental health. METHODS: We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors' working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations. RESULTS: Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork. CONCLUSION: We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.
