During November, Anna Goulding and Daniele Carrieri have been busy interviewing a sample of those who volunteered to be interviewed. Thank you to all of those who have taken part. There are still some more to do – and if you have an invitation you have not yet responded to there will still be time – but December will be largely devoted to analysis.

There are already some very interesting findings emerging, and we look forward to sharing this in our final report next year.

Some of our early findings have been included in the GMC’s State of Medical Education and Practice (SoMEP) 2020. SoMEP is an annual report which reviews trends across medicine. This year it is obviously dominated by COVID-19, and we are pleased our research contributes to understanding of the FiY1 response.

The key points from these interim findings are:

– Graduates undertook FiY1 for a range of reasons, including a desire to help and put their skills into practice, and a pragmatic desire to earn money and do something during lockdown.

-Many graduates were unable to do FiY1 even though they would have liked to, due to logistical and communication issues.

– FiY1s worked in a range of settings, although most worked in clinical wards. A large number had worked in areas where there were COVID-19 patients, with around 30% working in COVID-specific clinical areas.

– F1s who had done an FiY1 post were more prepared for F1 than those who had not.

Full analysis will be in our final report in 2021. You can read SoMEP 2020 here.

One of our key objectives in this study has been to understand how working as an FIY1 and F1 during the pandemic affects wellbeing. This strand links to other work being undertaken by team members in Exeter. In this post, Daniele Carrieri describes that work.

Before the COVID-19 pandemic, stress levels amongst doctors were already incredibly high. As this pandemic unfolds, and as clinical work and training is changing beyond recognition in so many ways, tackling mental ill-health in doctors and medical students is ever more relevant. The growing pressures, uncertainty, demands and challenges of a doctor’s work environment can lead to high levels of stress, anxiety, depression, suicidal feelings, and to broader organisational issues including recruitment and retention of clinical workforce. 

The Care Under Pressure project team undertook a review of the large body of existing literature on interventions, support and advice on treatment for doctors and synthesized it to take in to account factors such as individual, organizational, social and cultural; an approach not considered in existing interventions and initiatives.

The team also drew on the perspectives of a range of stakeholders such as patient representatives, clinicians, doctors in training, medical educators and academics to gain a rounded view on how to develop strategies to effectively tackle mental ill-health and its impacts. 

Feelings of isolation and ill-preparedness for difficult situations were key causes of mental ill-health amongst doctors. A sense of belonging to a team and to a profession and receiving and giving mutual support were key to promoting well-being at work. Experiencing feelings of trust in work colleagues and individuals’ organizations alongside the support of balanced feedback were also found to be key aspects of positive work cultures. These findings were used to produce a report offering guidance and recommendations to policy makers and organization leaders involved in the design of interventions as well as contributing to the development of new approaches to the research of doctors’ mental health. The Care Under Pressure project was undertaken pre-COVID-19. However, the high-level evidence-based principles are transferrable to the current context. 

To support and bring to life the project findings and recommendations the team collaborated with artists and film makers to produce cartoons, a short film, and an animation (see an example of cartoon below). 

Care Under Pressure is funded by the by the National Institute for Health Research (NIHR) HS&DR (project number 16/53/12). For more information, please visit http://sites.exeter.ac.uk/cup/