Junior doctors benefit from working in emergency departments, study finds

Junior doctors benefit significantly from working in hospital emergency departments despite reporting reduced job satisfaction, a study has found.

The researchers behind the study said that, although some elements of wellbeing worsened, juniors felt more confident and competent, “with no significant adverse impact on anxiety levels.” They said that their findings gave “a more positive picture” of junior doctors’ wellbeing than previous studies, which showed high levels of psychological distress, depression, and burnout.

The research was led by Sheffield University’s School of Health and Related Research and published in the Emergency Medicine Journal.1 The longitudinal study examined wellbeing, confidence, and competence among junior doctors and the effects of emergency medicine placements. It involved 28 acute hospital trusts and nine postgraduate deaneries in England. The 217 junior doctors who took part had a placement in an emergency department as part of their second year of foundation training.

The researchers expected to find evidence of increased effort and anxiety among junior doctors because of the increased decision making and unpredictable workloads in emergency department placements. But they hypothesised that there would be significant benefits, relative to other specialties.

Data were collected online from junior doctors four times during their second year of foundation training. The researchers found that junior doctors did not report “statistically significant” changes in either anxiety or depression across the four time points. However, they typically showed the “steepest rise” in mean anxiety levels during their time working in an emergency department.

Most participants reported their “steepest decline in extrinsic job satisfaction” during their time in an emergency department rather than in their other placements. The researchers said that the increased levels of anxiety and reduced extrinsic job satisfaction were “within the normal range for other healthcare worker.” These “deficits” were also balanced by “greater improvements” in other measures, such as motivation, confidence in managing common acute clinical conditions, and perceived competence in performing acute procedures.

The researchers wrote, “Our study also demonstrated that this significant increase in confidence in the management of conditions also applied to each of 23 specific conditions individually, including acute mental health problems, collapse, cardiac arrest, seizure, back pain and elderly fall.”

Similarly, there was significant improvement in self reported competence in four of five acute care procedures. The authors said that although self reported conclusions about abilities have limitations, there was evidence that a subsample of this cohort of juniors was providing care of “good quality.” The findings were also based on average data, so within groups of junior doctors some individuals may have required additional support at specific times or in certain placements, the researchers said.

The authors said that greater patient demand in emergency departments since the data were collected in 2010-11 could mean that doctors were now at “higher risk of anxiety and reduced job satisfaction” than those in the study. They added, “However, we believe this study provides evidence that working within the specialty as a junior doctor is beneficial in terms of gaining confidence and competence with no significant adverse impact on anxiety levels.”