Recognising and reducing stress in the transition
from medical student to foundation trainee
Dr Liz Donovan,1 Dr Jo Mountfield,1 Dr Kerry Ball,2 Dr Rachel Locke2 and Dr Samantha Scallan2
1University
Hospital Southampton NHS Foundation Trust
2Faculty of Education, Health and Social Care, The University of Winchester
Context
Existing research highlights that transition from medical school to
clinical practice at foundation year 1 (FY1) is a time of potential of
stress and identifies areas of practice where trainees can feel less
well-prepared.[1,2,3].
The aim of this project was to evaluate the impact of an education
programme to support FY1 doctors on entering the clinical
workplace. They attended a workshop which was intended to
provide practical skills and strategies to enhance resilience and
awareness of their well-being.
Graph 2: % of ‘agree’ and ‘strongly agree’ ratings
of statements
As a result of the workshop I ...
would like more teaching on this
continue to find managing stress a challenge
strongly disagree
have integrated new ways to manage stress
disagree
neutral
am more aware of ways to manage stress
agree
strongly agree
am better able to recognise stress in others
Summary of work
56 participants attended workshops developed from the SAFEMED
programme of education (Dr Margaret O’Rourke, University
College Cork).[4] The evaluation considers:
1. the workshops with participants, gathering data to determine
the extent to which the programme meets its aims and their
expectations;
2. the reflections of the participants’ in written entries for their
e-portfolios to describe the value of the learning; and
3. the benefits and possible areas for strengthening the
programme of education, to inform its further development.
Results
22 FY1s completed an online survey; 15 participated in two
focus groups; and 26 submitted written reflections.
am better able to recognise stress in myself
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2. Qualitative thematic analysis of written
reflection and focus group data
Both these data strands reflected the findings of the survey feedback.
The relevance of the workshop was acknowledged, and its content
served to remind the FY1s of the importance of self-care and to raise
awareness of how to manage difficult situations. The aim of the
session to be supportive and experience–led was recognised and
valued, in terms of hearing the experiences of seniors as well as peers.
Recommendations
Findings will inform the development of the content of future
teaching sessions. The evaluation suggests:
1. Descriptive statistics
• Workshops should run as close to the start of the FY1 as possible;
73% of respondents had not previously received stress
management training.
• Working with facilitators who are not in an educational/clinical
80% of respondents thought that the workshop was relevant;
70% believed it was ‘useful’ or ‘somewhat useful.’
The majority of respondents reported that they agreed
positively that the programme of education had improved
awareness, recognition and management of stress: see graph 1.
supervisory relationship with trainees is more likely to allow the
FY1s to speak openly;
• Hearing senior colleagues’ experiences was reassuring and sharing
their own was useful but this should be in a constructive way;
• Reinforcement of their awareness of well-being in the workplace
and adopting positive, practical strategies to observe it should be
emphasised;
Main stressors for the trainees were ‘lack of experience’ and
‘systems/ processes at work:’ see graph 2.
Graph 1: Main stressors for respondents
• Shadowing FY2s was valuable at the start of the year as it provided
‘the knowledge’ about posts, and similarly shadowing the FY1 about
to leave a post during the year; and
• The curriculum needs to be grounded in practice and reflect issues
they face in the workplace.
1.
Brennan, N. et al (2010) The transition from medical student to junior doctor: today’s
experiences of Tomorrow’s Doctors Medical Education 44, pp. 449-458.
2.
Illing, J. et al (2013) Perceptions of UK medical graduates’ preparedness for practice: A multicentre qualitative study reflecting the importance of learning on the job Medical Education
13(34), pp. 1-12.
3.
Bullock, A. et al, (2013) Transitions in medicine: trainee doctor stress and support mechanisms,
Journal of Workplace Learning, 25(6), pp.368–382.
4.
O’Rourke, M. (2013) SAFEMED handbook, Ireland: Tivoli Academic Publishing