‘Running on empty’: understanding more about the concerns around burnout in a cohort of trainee doctors, and the value of reflective practice as an intervention

Esme Ingram; Louise Restrick; Sarah Lunn

doi:10.7861/fhj.7.1.s96

Introduction

The impact and risks of burnout for health professionals, patients and the NHS are increasingly recognised as a major issue for our healthcare system.^1,2 28% of doctors currently report feeling unable to cope with their workload at least weekly and 12% took leave due to stress.²

While the issue of working in an under-resourced, under-staffed system needs to be systematically addressed, reflective practice (RP) is an evidence-based approach that can increase wellbeing.³ As an acute trust with an integrated clinical psychology team, a number of our multidisciplinary teams already use RP to support staff in their work.⁴

The aim of this study was to explore concerns regarding burnout and wellbeing in a cohort of trainee doctors in one acute trust and to design, pilot and evaluate a clinical psychologist reflective practice facilitated programme for medical trainees, focusing on wellbeing.

Materials and methods

Trainees working in one acute trust were asked to complete a survey (1–10 scaling) concerning wellbeing and attitude to RP. An RP wellbeing-focused programme, comprising three 1-hour sessions held every 2 months, was designed, facilitated and piloted by a clinical psychologist. Core medical trainees and specialist medical registrars (n=24) were invited to attend sessions during a weekly lunchtime teaching slot. Feedback was collected during and after each RP session.

Results and discussion

45/161 (28%) trainee doctors completed the survey. The majority were very concerned about the impact of their work demands on their wellbeing (mean 7.7/10; range 1–10) and welcomed the offer of supervised RP sessions (mean 7.2/10); 88% requested as monthly sessions.

Attendance at all three RP sessions was the same, or more than, other timed teaching offered to the same cohort of medical trainees. RP sessions were highly valued with mean helpfulness/importance scores of 9.5/10 (n=21; range 9–10). When asked to what extent they felt they would benefit from further RP sessions, the mean score from all attendees was 8.3/10 (n=21).

Key qualitative survey findings and themes around risk of burnout identified in RP sessions are shown in Fig 1, and the impact of RP and assets identified during RP sessions are described in Fig 2.

Fig 1.

Themes on risk of burnout from trainee survey and reflective practice sessions with medical trainee doctors in one acute trust.

Fig 2.

Value of reflective practice sessions: themes on impact of sessions and identified assets from reflective practice sessions with medical trainee doctors in one acute trust.

Conclusion

Concern about burnout was widespread in this cohort of trainee doctors working in an acute trust. There have been urgent calls at a national level to address workforce wellbeing and the impact of ‘running on empty’.^1,2,5,6 While it is well-recognised that system factors play a significant role in the development of burnout, and under-staffing needs to be addressed at a national level, individual factors are also important.^1,2

Following feedback that reflective practice sessions would be welcomed, we piloted a psychologist-led wellbeing programme. This was well-attended and highly valued by trainees. Sessions were described as enabling a ‘safe-space’ for trainees to talk about themes that contribute to risk of burnout including under-resourcing, impact of ‘feeling alone’, and of ‘not talking’ but also importantly, as developing a community of support that enabled discussion of shared challenges and coping initiatives.

As a result of this successful pilot, clinical psychologist reflective practice facilitated sessions are now being provided on a monthly basis for medical trainees in our trust.

Conflicts of interest

None declared.

References

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