Newly qualified doctors' perceived effects of assistantship alignment with first post: a longitudinal questionnaire study

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

Clinical support during covid-19: An opportunity for service and learning? A cross-sectional survey of UK medical students

PURPOSE

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements.

METHODS

We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March-July 2020). Analysis was informed by the conceptual framework of service and learning.

RESULTS

1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop.

CONCLUSION

The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.[Box: see text].

Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals

OBJECTIVES

Student assistantships are recommended to prepare medical graduates for clinical practice. Traditionally, assistantships have consisted of longer placements, often up to 15 weeks. However, within the constraints of the final year, medical schools need to carefully balance the time required for specialty placements, assessments and the risk of student burnout. We set out to evaluate the effectiveness of shorter, personalised student assistantships.

DESIGN

An evaluative study on the changes in final year student confidence in preparedness for practice after a 3-week assistantship with defined learning objectives and learning needs assessment.

SETTING

Eight hospitals affiliated with Imperial College School of Medicine.

OUTCOMES

Student confidence in 10 learning outcomes including organising ward rounds, documentation, communication with colleagues, communication with patients and relatives, patient handover, practical procedures, patient management, acute care, prioritisation and out-of-hours clinical work.

RESULTS

Two hundred and twenty final year medical students took part in the student assistantship, of whom 208 completed both the pre-assistantship and post-assistantship confidence rating questionnaires (95% completion rate). After the assistantship, 169 (81%) students expressed increased confidence levels in one or more learning objectives. For each individual learning objective, there was a significant change in the proportion of students who agreed or strongly agreed after the assistantship (p<0.0001).

CONCLUSION

Overall, the focused 3-week, personalised student assistantships led to significant improvement across all learning objectives related to preparedness for practice. The use of the pre-assistantship confidence rating questionnaire allowed students to identify and target areas of learning needs during their assistantship.

COVID-19 pandemic interim Foundation Year 1 post and confidence in core skills and competencies: a longitudinal survey

OBJECTIVES

The interim Foundation Year 1 (FiY1) post was created in response to the COVID-19 pandemic to help bolster the workforce and manage increased clinical pressures. This study aimed to assess the impact of the FiY1 post on medical graduates' self-reported confidence in common tasks, core skills, competencies and procedures prior to starting FY1, as a measure of increasing preparedness for practice.

SETTING

A longitudinal survey was performed at a tertiary teaching hospital in the South East of England. FiY1 posts ran from June to July 2020.

PARTICIPANTS

Questionnaires were sent to 122 medical graduates from a single medical school (recipients included FiY1s and non-FiY1s) and to 69 FiY1s at a single Teaching Hospital NHS Trust, irrespective of medical school attended. Initial and follow-up questionnaires had 86 and 62 respondents, respectively. Of these, 39 graduates were matched; 26 were FiY1s and 13 non-FiY1s. The 39 matched results were analysed.

PRIMARY OUTCOME MEASURES

Confidence levels in common FY1 tasks, core procedures and competencies were gathered before and after the FiY1 post through online questionnaires. Change in confidence comparing FiY1s and non-FiY1s was measured and analysed using linear regression.

RESULTS

On a 5-point scale, the FiY1 post increased overall confidence in starting FY1 by 0.62 (95% CI 0.072 to 1.167, p=0.028). The FiY1 post increased confidence in performing venepuncture by 0.32 (95% CI 0.011 to 0.920, p=0.045), performing intravenous cannulation by 0.48 (95% CI 0.030 to 1.294, p=0.041) and recognising, assessing and initiating the management of the acutely ill patient by 0.32 (95% CI 0.030 to 1.301, p=0.041).

CONCLUSIONS

The COVID-19 pandemic FiY1 post improved confidence in core skills and competencies. These findings may help guide future educational interventions in conjunction with further larger scale studies, ultimately aiding to bridge the transition gap between being a medical student and a doctor.

Role of social comparison in preparedness for practice as a junior doctor in Singapore: a longitudinal qualitative study

OBJECTIVES

To date, most research on medical graduates' preparedness for practice has conceptualised preparedness as something possessed by the individual. However, new doctors work within social settings with other people and, given this, we argue that preparedness has a social and comparative dimension. The aim of this paper is to explore medical students'/graduates' self-assessments of their preparedness for practice using the lens of social comparison theory.

SETTING

We invited medical students from one of Singapore's three medical schools who were in their final-year Student Assistantship Programme to participate in semi-structured interviews, and follow-up interviews 6 months later when they were working as junior doctors. Data was collected from two cohorts, in 2018 and 2019. Initial analysis of interview transcripts was inductive and thematic. Social comparison theory was used for subsequent theory-driven analysis.

PARTICIPANTS

31 participants took part, of whom 21 also engaged in follow-up interviews.

RESULTS

We identified three uses of social comparison: as coping strategy to manage uncertainties in transitions where there was no formal, objective testing of their performance; as a means to confirm their self-perceived preparedness (upwards or downwards, eg, being better or worse prepared than comparator others); and as the basis for decision-making (eg, changing career choices).

CONCLUSIONS

Senior medical students and newly-graduated doctors compare themselves with peers and near-peers in terms of prior learning and current performance to evaluate and understand their own performance at work. Future studies need to examine further how the feeling of preparedness or unpreparedness generated from social comparisons may affect subsequent clinical performance and professional development.

Care of the dying - medical student confidence and preparedness: mixed-methods simulation study

OBJECTIVES

Of all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.

METHODS

A mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis.

RESULTS

Thirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change.

CONCLUSION

Using simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

A systematic review of interventions aiming to improve newly-qualified doctors' wellbeing in the United Kingdom

Background

Newly-qualified doctors in the United Kingdom experience a great deal of stress and have poor wellbeing when compared to more senior counterparts. A number of interventions have been put in place to boost healthcare professionals’ wellbeing, but little is known about interventions aimed to improve the wellbeing of newly-qualified doctors in the United Kingdom. This study aims to systematically review current evidence of interventions which improved the wellbeing of newly-qualified junior doctors in the United Kingdom.

Methods

Five key electronic databases were searched. Subsequently, reference scanning and citation search was performed. Studies were included if they were conducted from the commencement of the Foundation Programme in 2004, until 2019. In addition, studies had to be performed on junior doctors: working in the United Kingdom and within their first five years post-qualification and have a quantitative outcome. Studies which did not meet these criteria were excluded. Quality was assessed using the modified Newcastle-Ottawa scale. Bias was not formally assessed using a standardised tool.

Results

Seven papers met the inclusion criteria and identified three main types of interventions: mentorship, mindfulness and clinical preparation interventions. The majority of included studies reported a positive result from the performed intervention, suggesting these to be beneficial in improving junior doctor wellbeing, and thereby reducing anxiety and stress levels. However, most of the studies used small sample sizes.

Conclusions

This review reveals that there is dearth of evidence on the effectiveness of intervention to improve the wellbeing of newly-qualified doctors in the United Kingdom. Most of the identified interventions focused on relieving stress and anxiety inherent within newly-qualified doctors’ training programmes. However, wellbeing interventions need to take into cognisance all the factors which impact on wellbeing, particularly job-related factors. We recommend that future researchers implement large-scale holistic interventions using appropriate research methods.

Systematic review registration: PROSPERO CRD42019127341.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00868-8.

A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry

Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.

Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

INTRODUCTION

The assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.

METHODS AND ANALYSIS

The intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might 'work' to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.

ETHICS AND DISSEMINATION

Ethics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

COVIDReady2 study protocol: cross-sectional survey of medical student volunteering and education during the COVID-19 pandemic in the United Kingdom

BACKGROUND

The coronavirus disease 2019 pandemic has led to global disruption of healthcare. Many students volunteered to provide clinical support. Volunteering to work in a clinical capacity was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience or which volunteering roles were of most benefit to students.

METHODS

The COVIDReady2 study is a national cross-sectional study of all medical students at medical schools in the United Kingdom. The primary outcome is to explore the experiences of medical students who volunteered during the pandemic in comparison to those who did not. We will compare responses to determine the educational benefit and issues they faced. In addition to quantitative analysis, thematic analysis will be used to identify themes in qualitative responses.

DISCUSSION

There is a growing body of evidence to suggest that service roles have potential to enhance medical education; yet, there is a shortage of studies able to offer practical advice for how these roles may be incorporated in future medical education. We anticipate that this study will help to identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future, and help inform medical education in a non-pandemic setting.

TRIAL REGISTRATION

Not Applicable.

Assessing the preparedness of foundation year 1 (FY1) doctors during the transition from medical school to the foundation training programme

BACKGROUND

To assess how ready current FY1 doctors felt when starting their first posting as newly qualified doctors.

METHODS

We created an online survey where 45 FY1 doctors in South Yorkshire rated how confident they were across different domains (Induction and Assistantship, Hospital Systems, and Skills) using a scale ranging from 0 (no confidence performing task) to 5 (highly confident).

RESULTS

The ICE system and observations had a mean rating of 3.645 (95% CI 3.446 to 3.844), and 4.425 (95% CI 4.248 to 4.602) with a standard deviation (SD) of 1.10 and 0.83 respectively. The radiological platform, referral system, telephone system, and hospital notes had a mean score of 3.149 (95% CI 2.876 to 3.422), 2.340 (95% CI 2.096 to 2.584), 3.573 (95% CI 3.407 to 3.739) and 4.061 (95% CI 3.931 to 4.191), with a SD of 1.281, 1.153, 0.961 and 0.752 respectively. Patient needs and diagnostic procedures had a mean score of 3.933 (95% CI 3.749 to 4.117) and 4.250 (95% CI 4.140 to 4.360) with a SD of 1.190 and 0.944 respectively. Patient care, prescribing, and therapeutic procedures gave a mean score of 3.634 (95% CI 3.432 to 3.836), 4.130 (95% CI 3.959 to 4.301), 3.386 (95% CI 3.228 to 3.544) with a SD of 1.133, 0.958 and 1.256 respectively. No statistically significant difference in the overall mean score was found between respondents who attended medical schools in Yorkshire, and those who had not.

CONCLUSION

Overall, confidence differs across different domains and categories. A larger sample size across a wider geographical area would allow us to compare and contrast results across the different regions in the UK.