Supporting doctors to return to clinical practice after absence: tackling psychological barriers

07/04/2020

In 2011, 71.3% of junior doctors moved on to complete higher training. This dropped to 50.4% is 2016, and went further down to 37.7% in 2018 according to BMJ. The retention of our NHS staff has never been more important as we face the COVID-19 pandemic. Thus, it seems of utmost importance that the issues related to dropout are identified and addressed. It appears that major contributing factors such as a loss of respect, lack of values, fragmented teamwork, and burnout contribute to many doctors leaving the NHS. Further reasons may include personal health, carer duties, pursuit of further education, research, and parental leave.  

The act of leaving the medical profession can have profound effects on an individual; many doctors report that leaving work can often make them struggle with ‘self-stigmatisation’, concerned that they will lose support from their colleagues and gain negative reception from their families. Feelings of shame often follow, with many doctors reporting that they feel like failures after quitting the profession. Self-stigma also creates further issues, with beliefs that doctors should be ‘invincible’ rooted deep into medical culture, particularly regarding taking leave for illness. 

These can create barriers for doctors intending to return to work, which are important to address. Not only is individual wellbeing at risk, but patient care too. Multiple studies have found that doctors with higher job satisfaction and occupational wellbeing will adhere more closely to treatment guidelines, be more optimistic and supportive towards patients, and concern themselves more with a patient’s psychological health.

There are currently thousands of doctors who are either retired or have left the medical field in the last 3 years. Many of these individuals are preparing to re-enter the workforce in light of the current COVID-19 pandemic and mounting pressure on the NHS. It is imperative that we support our returning staff now and in the future to foster a culture of wellbeing, support and community within our healthcare system. 

Maudsley Simulation, supported by Health Education England, has created a 3 day ‘bootcamp’ for returning workers in order to tackle the psychosocial barriers they may face, with the aim of building a support network and improving confidence, clinical skills, self-care, and wellbeing. The online course is ideal for GP’s and doctors wanting to take care of their mental wellbeing and prepare for their return to work, in order to help cope with any anxiety they may feel. The multi-disciplinary, inter-professional bootcamp involves a range of simulated scenarios involving actors portraying distressed patients and carers, as well as medical emergencies using manikins. For example, participants take part in scenarios where they review and assess an elderly patient, as well as navigate through signs of potential financial abuse from their neighbour. Manikin-style simulations are used for scenarios such as cardiac arrest. You can learn more about the course here.

The boot camp also features team-building exercises, self-care, and wellbeing sessions that focus on tools such as ‘5 Ways to Wellbeing’ and the ‘Wheel of Life’, and teaching of recent changes in practice. A ‘Skills Station’ is conducted, in which participants can improve and brush up on clinical skills, such as cannulation and nasogastric tube insertion. The bootcamp further features action planning for the participant’s journeys back to work, as well as reflections on their personal and health needs. 

A report on the bootcamp has recently been accepted by the BMJ Simulation and Technology Enhanced Learning. Results found that psychological concepts such as self-esteem, identify, and care were identified by the participants as important to develop alongside clinical skills. Confidence appeared to be the main concern of most doctors returning to work, and participants reported feeling higher self-worth and value after training. Peer support was also crucial, as a major theme of concern regarding returning to work appeared to be a sense of loneliness. Many participants expressed that they were relieved to know they were not the only ones with concerns of returning to work, and this shared experience facilitated through the course became a powerful tool, allowing participants to engage in a strong support network.

Maudsley Simulation intend to publish further academic articles on more comprehensive evaluations. It appears that high quality training could play a crucial step in strengthening the workforce and supporting doctors who intend on returning to the profession after a long absence.

This article is based on current scientific evidence and clinical expertise of our mental health professionals and researchers at Maudsley Learning, South London & Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.

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Article Author: Aleks Saunders