Researchers call for improvements to working culture and conditions for junior doctors

Researchers are calling for changes to working culture and conditions for junior doctors in the UK after their new research has highlighted a lack of access to clinical and emotional support.

The National Institute for Health Research-funded study, detailed in two papers published in BMJ Open, examined the psychological, cultural and occupational contexts associated with reduced psychological wellbeing in junior doctors, and protective factors which may mitigate against this.

Professor Carolyn Chew-Graham, Professor of General Practice Research at Keele University, has co-authored the study which was led by Dr Ruth Riley of the University of Birmingham, and carried out in collaboration with experts from University College London, Oxford University Hospitals NHS Foundation Trust, the London School of Hygiene and Tropical Medicine, and the Universities of Leeds and Manchester.

The findings showed four key themes relating to work-related stress - workload and working conditions; toxic work cultures including abuse and bullying, sexism and racism, and a culture of blaming and shaming; lack of support; stigma and a perceived need to appear invulnerable.

Analysis from the interviews also pin-pointed themes that protect junior doctors and facilitate support, with these including emotional and practical support from work colleagues to help manage workloads; supportive leadership strategies including those that challenge stigma; and access to professional support such as counselling, cognitive behavioural therapy and medication.

Co-author, Professor Chew-Graham of Keele University, said: “Participants reported stress and distress attributable to working conditions, such as unrealistic workloads and long hours, toxic work cultures including bullying, sexism and discrimination, a 'blame and shame' culture, and fear of whistleblowing.

“We call for a cultural shift within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.”

First author and Chief Investigator of the research Dr Ruth Riley of the University of Birmingham, said: “Normalising vulnerability through disclosure and creating emotionally open cultures where vulnerability is accepted and understood, allows junior staff greater confidence to be open about factors affecting their own wellbeing and to seek and receive support when needed.

“Supporting doctors who request time out or time off and facilitating access to support could reduce the potential for isolation in the workplace and reduce stigma-related barriers to seeking help.

“Examples of effective interventions and solutions to minimise distress and support staff are evidenced in existing leadership and collegial support, but need to be more consistently practiced across the NHS.”

The research is the first study to qualitatively examine how junior doctors view their working conditions, work cultures, and the factors which may protect them from psychological distress or offer them support.

There are currently 115,376 doctors working in the NHS, almost half of whom (56,404) are termed ‘junior doctors’, which includes doctors in specialist training or at pre-Consultant grade, and Foundation Year doctors.