The Personal Impact of COVID-19 on Trainees
The GMC National Training Survey highlights the considerable disruption to training caused by the COVID-19 pandemic (1) and the effects this has had on junior doctors’ wellbeing must not be overlooked.
Medical education is fundamental to the progress of junior doctors. When training is hindered it can have a considerable impact on the psychological and social wellbeing of trainees. This must not be overlooked or overshadowed by the system as training institutions focus on creating novel training resources and adapting normal processes to enable career progression.
Before the pandemic the morale amongst junior doctors was already low due to a loss of firm structure, increasingly busy shifts and frequent changes between specialties (2). COVID-19 has brought additional pressures including disruption to rotas, concerns over personal protective equipment and redeployment to unfamiliar clinical environments. This has led to nearly half of junior doctors experiencing burnout, depression or anxiety (3).
In addition to the changes in clinical practice there has been a major impact on specialty recruitment. For those applying to core and specialty training, the changes to the application process have required both resilience and adaptation. Momentous efforts have been made by the Royal Colleges, GMC, BMA, Health Education England and other training institutions to ensure a fair selection process. However, it is clear that unexpected changes to the selection process has caused stress and frustration to many trainees (4).
The loss of regular face-to-face teaching has also had wider social implications. Most junior doctors will agree that attending regular teaching sessions is both educational and has a valuable social component. Weekly teaching is often a place where trainees at the same level can meet and relate to each other in the day-to-day struggles of working on the frontline. Whilst virtual learning has been utilised well, it can never truly replace the camaraderie and social support that meeting face-to-face instils. This has been taken away at a time when peer support has been needed most.
It is somewhat reassuring to see that around two thirds of junior doctors responding to the GMC survey stated that they felt the support they received for their personal health and wellbeing was 'good' or 'very good'. However, we must strive to support the other third of junior doctors who did not feel the same way.
To improve the support doctors have had during the pandemic, many encouraging initiatives have been instigated to boost morale and prevent burnout amongst trainees. For example, peer support groups conducted virtually have been cost-effective and efficient (5). These trainee-led initiatives should be whole-heartedly encouraged by senior doctors.
The guidance and mentorship of experienced and retired doctors is invaluable for trainees. Both authors have been privileged to find approachable and encouraging mentors throughout their training that could provide insight, advice, experience and support when needed. One author was privileged to be mentored by the late Dr John Geater in their first year as a doctor. (6) As a retired GP he made it his aim to encourage junior doctors in their wellbeing by organising workshops on topics such as ‘Compassion without Burnout’. These were led by doctors who had long, fulfilling careers in medicine and were well-placed to impart their wisdom to the new generation.
Schwartz rounds have had a profound effect on hospitals nationwide with improvements to staff mental health and resilience. It is essential during this time that similar initiatives should continue in socially distanced formats to promote wellbeing of staff.
Clinicians will need guidance on what resources exist locally and nationally to support them in these difficult and uncertain times. It may seem obvious to trainers or training institutions but for trainees that rotate regularly, it can be difficult to find out what resources exist or how to access them.
Improving the working lives of trainees by implementing small and effective changes can reduce burnout. Ensuring that rest facilities are provided during on call shifts as well as having a doctors’ mess available may go a long way towards ensuring better wellbeing and social support among doctors.
As we continue to adapt to working in the new clinical landscape that has been forged by the ongoing COVID-19 pandemic we must take steps to support trainees during these times of stress, anxiety and uncertainty. The importance of developing novel training resources and mechanisms for career progression cannot be overstated. Yet, we feel it is equally important that resources are developed, adequately funded and advertised that will support the wellbeing of doctors through this difficult period.
Thomas Fonseka and Ricky Ellis
University Hospitals Derby and Burton, UK.
1. Rimmer A. Covid-19: Most trainees have faced disruption to their training, GMC survey shows. BMJ [Internet]. 2020 Oct 21 [cited 2020 Nov 16];371. Available from: https://www.bmj.com/content/371/bmj.m4093
2. Rimmer A. The firm: does it hold the answers to teamworking and morale? BMJ Br Med J Online. 2019;365.
3. McArdle J. Stress and burnout warning over COVID-19 [Internet]. The British Medical Association. [cited 2020 Nov 13]. Available from: https://www.bma.org.uk/news-and-opinion/stress-and-burnout-warning-over-...
4. Rimmer A. Training: BMA expresses concern over changes to specialty recruitment. BMJ [Internet]. 2020 Oct 29 [cited 2020 Nov 13];371. Available from: https://www.bmj.com/content/371/bmj.m4230
5. Behrman S, Baruch N, Stegen G. Peer support for junior doctors: a positive outcome of the COVID-19 pandemic? Future Healthc J. 2020 Oct;7(3):e64–6.
6. Villanueva T. An international health guru. BMJ. 2008 May 3;336(7651):s155–s155.
Competing interests: No competing interests