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Background and Aims: The study and practice of medicine are known to contribute to burnout in medical students and junior doctors. There is limited data on the degree of mental health burden for Australian medical students and doctors-in-training (DiT). This scoping review aims to explore the impact of medical training on the mental health of Australian medical students and DiT. Exploring the mental health landscape across different stages of training will help to establish putative factors underlying psychiatric comorbidities in this demographic. Methods: The Joanna Brigs Institute (JBI) framework for scoping review was utilized, involving the Population/Concept/Context (PCC) criteria to identify the target population and develop the search strategy. Peer-reviewed articles, published in English from 2012 to 2022 focusing on Australian medical students' and doctors-in-training mental health were considered. Results: Of the 177 articles identified, 24 studies were included in the review. The majority of the studies focused on DiT (n = 19) of which interns and residents were most well represented (n = 12) followed by surgical training (n = 5), with general practice (GP) (n = 2) and physician specialties (nil) being poorly represented. Most studies were quantitative (n = 18), with qualitative studies(n = 6) under represented. Common mental health themes identified were overall psychological distress, burnout, and depression/suicidal ideation with workplace harassment and discrimination being less well represented. Conclusions: Australian DiT are not equally represented in the literature with how different specialty training pathways impact their mental health. Most studies were cross-sectional, preventing a detailed longitudinal assessment of burnout and work-associated psychological distress.

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Background Surgical informed consent (SIC) is paramount in modern-day litigious surgical practice, yet numerous complaints remain about the consenting process. This paper investigated current attitudes, enablers, and barriers to obtaining SIC in clinical practice for doctors-in-training (DiT). Methodology Self-reported SIC practice among DiT (N=1,652) across three metropolitan health service regions in Western Australia (WA) was surveyed using a de-identified 20-item multiple response ranking, dichotomous quantitative and qualitative online survey. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA). Results The response rate was 23% (n=380). There was an even distribution of key demographics across all three health regions; the median postgraduate year (PGY) was two. Only 57.4% of DiT strongly felt comfortable and confident obtaining a SIC. Of the responders, 67.4% correctly identified key SIC components. There were significant positive associations between comfort and confidence with obtaining SIC and the seniority level of the DiT (p<0.001), identification of SIC components (p<0.001), and prior training in SIC (p<0.001). Most DiTs highlighted the necessity for formal SIC training with a preference for interactive workshops supported by e-learning modules. Conclusions Most DiTs can identify the key factors that constitute a valid SIC; however, the practical conversion of this skill could be better. The key enablers to improved SIC techniques were well-supported departments, with further training and clear guidelines within the institutions. The identified barriers were time constraints, inexperience, and a lack of senior support. Future practices and interventions should address these key barriers while promoting the enablers of sustainable and efficient SIC practice.

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Background Digital rectal examination (DRE) is a valuable diagnostic tool for diagnosing multiple conditions, but its use has declined in practice. This study sought to provide perspectives on current attitudes, enablers, and barriers to performing DRE for doctors-in-training (DiTs) and explore strategies to improve and facilitate consistent, efficient, and effective execution of DRE.​​​​​​​ Methodology Self-reported DRE practice among DiTs (n = 1,652) across three metropolitan health service regions in Western Australia was surveyed using a de-identified multiple-response ranking, dichotomous quantitative and qualitative survey. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results A total of 452 (27%) DiTs responded to the survey, with an even distribution of key demographics between regions and specialties. The median post-graduate year was 2. Half of DiTs reported being comfortable with performing DRE. Most had training in medical school (71%), while 9.7% had no training in DRE. Chaperone availability, perceived invasiveness, and lack of confidence were key barriers; key enablers were formal training and senior colleague/departmental support. The multivariate logistic regression showed that DiTs who reported being comfortable in performing DRE were significantly and independently associated with being a high-volume practitioner (p < 0.001), confident in diagnosing benign (p < 0.001) or malignant pathology (p < 0.001), perceived adequate DRE training (p < 0.001), prior formal DRE training (p = 0.007), and surgical subspeciality interest (p = 0.030). Conclusions Low levels of confidence and comfort in the performance of DRE among DiTs have resulted in the underutilization of a critical diagnostic tool. Future curriculum and departmental clinical practice interventions should address barriers while promoting enablers.

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OBJECTIVES: This article explores the increasing number of medical women speaking out about gender inequity and sexual harassment, using the Royal Australian and New Zealand College of Psychiatry Congress 2022 as a reference. It explores the barriers for women in medical leadership known under the themes of capacity, perceived capability, and credibility and how this relates to experiences for women at work. CONCLUSIONS: Sexual harms occur in the context of ongoing gender bias in our profession, even at college events. The author calls on the college to investigate and take action on sexual harms in the workplace and gender equity.

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BACKGROUND: The COVID19 pandemic is one of the greatest modern global healthcare crises. The resultant morbidity and mortality of public and healthcare professionals has led to psychological impacts and economic repercussions. We set out to assess the concerns of doctors in training during this crisis. METHODS: A questionnaire was developed and delivered via Survey Monkey to doctors in training from 27 March to 6 April 2020, 2 weeks prior to the expected surge in Ireland and UK. The Perceived Stress Scale (PSS) was incorporated to gauge respondent stress as they prepared for the COVID19 impact. RESULTS: A total of 285 participants engaged with 197 (69%) completing all questions. Almost 86% of respondents had been trained in donning and doffing personal protective equipment (PPE), and nearly 85% felt confident in the process. Overall, most respondents felt somewhat prepared (60%) or well prepared (20%) to treat COVID19 patients. However, 42% worried that their hospital would struggle, or not cope at all; in particular, 91% highlighted the risk of running out of PPE. Family health (86%), personal health (72%), and social life (47%) topped the list of junior doctor concerns. According to the PSS, the majority of respondents (62%) had moderate stress. CONCLUSIONS: This survey is the first to measure the concerns of doctors in training in Ireland as regards the COVID19 pandemic. Worries included PPE exhaustion and personal and family health. A significant majority had moderate stress. Additional supports for doctors in training are essential to aid stress and manage concerns better.

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This article discusses the use of the Most Significant Change (MSC) technique in a mixed-methods evaluation of a pilot wellbeing programme for obstetrics and gynaecology doctors-in-training introduced at a large public hospital during Melbourne, Australia's second coronavirus (COVID-19) lockdown, which occurred from 7 July to 26 October 2020. The evaluation was conducted remotely using videoconferencing technology, to conform with pandemic restrictions. MSC complemented the program's participatory principles and was chosen because it seeks to learn about participants' perceptions of programme impacts by evaluating their stories of significant change. Stakeholders select one story exemplifying the most significant change resulting from the evaluated program. Inductive thematic analysis of all stories is combined with reasons for making the selection, to inform learnings (Dart & Davies, 2003; Tonkin et al., 2021). Nine stories of change were included in the selection. The most significant change was a more supportive workplace culture brought about by enabling basic needs to be met and breaking down hierarchical barriers. This was linked to five interconnected themes - connection, caring, communication, confidence and cooperation. The evaluation learnings are explored and reflections on remotely conducting MSC evaluation are shared.

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Research carried out in 2016 by the authors investigated the challenges that doctors in training experience around leadership and followership in the NHS. The study explored contemporary healthcare leadership culture and the role of followership from the perspective of early career doctors. It found that the leadership and followership challenges for these doctors in training were associated with issues of social and professional identity, communication, the medical hierarchy, and relationships with senior colleagues (support and trust). These challenges were exacerbated by the busy and turbulent clinical environment in which they worked. To cope with various clinical situations and forms of leadership, doctors in training engage in a range of different followership behaviours and strategies. The study raised implications for medical education and training and suggested that followership should be included as part of formal training in communication and team working skills. The importance of both leadership and followership in the delivery of safe and effective patient care has been brought sharply into focus by the COVID-19 pandemic. This article revisits these challenges in light of the pandemic and its impact on the experiences of doctors in training.

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Although international medical graduates (IMGs) constitute considerable percentage of doctors in the National Health Service (NHS), they face several challenges in acclimatizing to the NHS health system. Communication skills, language subtleties, and career progression difficulties are among the most important challenges that overseas doctors face. Some resources are already available to support these doctors and several trusts across the UK have developed local interventions and educational programs to help their doctors bridge the gaps in their knowledge. However, there is no proof of the external validity of these programs and none are identified as effective on a national level. Senior IMGs are leading very popular and inspiring projects using digital platforms, especially social media. We identified several social media pages, groups, and websites subscribed to by hundreds of thousands of doctors in the UK and around the world, including doctors who are planning a future career in the UK. These platforms provide information, resources, support, and answers to questions posed by junior IMGs. Inspired by these projects and also by an Australian project that transformed a local IMG education program, we studied whether using digital platforms and transforming evidence-based local programs to national ones would be the best way forward to support IMGs.

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BACKGROUND: Burnout for doctors-in-training is increasingly cause for concern. Our objectives were to assess the feasibility, acceptability and impact of a novel intervention to reduce burnout and improve wellbeing. This is the first wellbeing intervention for medical doctors to include strategies for work-life boundary management and digital wellbeing. METHODS: Twenty-two doctors participated in face-to-face workshops which included group discussion of challenges experienced and strategies to enhance self-care and wellbeing. A pre-post-test mixed-methods evaluation was undertaken. Questionnaire measures were the Oldenburg Burnout Inventory, Warwick-Edinburgh Mental Wellbeing Scale and the boundary control subscale of the Work-Life Indicator (i.e., the degree of perception of control of the boundaries between work and personal life). Paired t-tests examined whether there were statistically significant differences. Eleven doctors also participated in post-intervention semi-structured interviews. Transcripts were analysed using thematic analysis. RESULTS: The intervention was well-received, with all trainees finding the workshop useful and saying they would recommend it to others. At baseline most participants had scores indicative of burnout on both the disengagement (82%) and exhaustion (82%) subscales of the Oldenburg Burnout Inventory. One month post-intervention, participants had a statistically significant reduction in burnout (both disengagement and exhaustion) and improvement in boundary control. Wellbeing scores also improved, but differences were not statistically significant. Qualitative analysis indicated participants had welcomed a safe space to discuss stressors and many had implemented digital wellbeing strategies to manage their smartphone technology, and increased self-care such as mindfulness practice and walking in green space. CONCLUSIONS: The intervention reduced burnout and improved boundary control. We suggest that having protected time for doctors to share personal experiences, adopt digital wellbeing and self-care strategies are effective tools to support doctors' wellbeing and should be investigated further.

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Doctors in training are particularly vulnerable to stress and burnout, with the transition into the early parts of training being a period of acute anxiety. Supervisors and mentors have a key role to play in helping trainees make the transition from medical student to practising doctor. This often involves professional conversations, ranging from the relatively routine to difficult issues. The Swansea 6D model has been designed as a guidance tool which provides a simple, memorable framework around which conversations can be structured in terms of identifying meaningful expectations, providing explanations and reframing situations.

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The mental health of doctors in training raises two major concerns, first that they are reluctant to, and have difficulty accessing, treatment, and second that undiagnosed and untreated doctors expose patients to unacceptable risks. Four 1-h focus groups were held, with participants' views explored on their observations about mental health as an issue amongst doctors, their personal knowledge of, and preferences for, sources of support, and other related factors. Transcripts were analysed using a thematic framework approach.

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There is some disagreement in the literature whether doctors in training suffer more from mental illness than an age-matched population. However, mental illness among doctors in training is a cause for concern because of the dual problems of reticence about accessing help and the clinical risk of doctors practising while mentally ill. The belief that is widely held among doctors in training is that to disclose a mental illness would be seen as weakness and may damage their career. A biographical narrative interview technique was used that enables the informant to tell the story of a painful episode in their lives in their own way and in their own words. Interviews were transcribed, and a thematic framework developed by consensus and then used to analyse all of the narrative interview data. Four major themes were detected: (1) Doing the job while ill, (2) Sick leave (initiating, being on, returning from), (3) Interaction with the employer; and (4) Sources of support. Practising while mentally ill caused significant challenges. Interviewees did the minimum, hated having to make decisions, and failed to study for postgraduate exams. All interviewees took sick leave at some stage. However, most were reluctant to do so. Being on sick leave meant being absent from the career that identified them and running the risk of being perceived as weak. Returning to work from sick leave was often difficult. Back to work interviews and occupational health support did not always happen. This study demonstrates the suffering encountered by doctors in training with mental illness. The job becomes much more difficult to do safely when mentally unwell. A great deal of presenteeism exists, which inhibits doctors in training from getting the medical care they need. It is imperative that confidential medical care is made available to doctors in training, which is sufficiently distanced from their place of work.

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OBJECTIVE: A mentoring programme was established in South Australia in 2014 by psychiatry trainees, with the goal of reducing stress and burnout amongst first-year trainees. All first-year trainees are offered the opportunity to have a senior trainee as a mentor. This article describes the mentoring programme, presents feedback from participants and identifies areas for further development. METHOD: The majority (72/76) of first-year trainees entering psychiatry training in South Australia from 2014-2018 were allocated a mentor. Surveys were sent out in 2014, 2015 and 2017. Twenty of 42 (48%) mentors and 17 of 42 (40%) of mentees completed a 10-item questionnaire, with free text responses. RESULTS: Mentee feedback was mostly positive, reporting that mentors offered them reassurance and support. The most common challenges were advice about training, managing work-life balance and issues with supervision. The main barrier to the mentoring programme was lack of time to meet. Mentors identified that they would have liked more training in mentoring. CONCLUSION: The trainee mentoring programme has been a useful initiative. As consultant psychiatrists are likely to provide mentoring for more junior colleagues, the authors propose that training in mentoring should be part of the Royal Australian and New Zealand College of Psychiatrists education programme.

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METHODS: We conducted a descriptive cross-sectional study of a sample of 300 physicians using self-administered questionnaire over the period 2013- 2014. Burnout has been operationally defined through a French translation of the Maslach Burnout Inventory (MBI). RESULTS: A total of 191 physicians participated in the study (response rate 63.7%) with a female predominance at 79.1% and an average age of 26.7 years (N = 3). The average scores of sub-dimensions of the MBI: emotional exhaustion, depersonalization and personal fulfilment were (33.7±10.7), (12.2±6.5) and (30.6±8.3) respectively. 31.8% of participants suffered from severe burnout. It was associated with communication problems within the healthcare team (p < 0.01), insufficient accompaniment (p < 0.05), dissatisfaction among seniors (p = 0.01), fear of making medical errors (p<0.05), use of a psychotherapist (p<0.001), use of psychotropic drugs (p = 0.001), anxiety disorders (p < 0.01), depression (p < 0.01) and suicidal ideation (p < 0.05). Protective factors were: sense of equity within the healthcare team (p < 0.01) and practice of leisure (p<0.05). Changing career direction was associated with severe burnout (p<0.05). CONCLUSION: These results are consistent with those of previous studies and justify the importance of a prevention program at different levels.

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OBJECTIVE: To analyse how training doctors' demographic and socioeconomic characteristics vary according to the specialty that they are training for. DESIGN: Descriptive statistics and mixed logistic regression analysis of cross-sectional survey data to quantify evidence of systematic relationships between doctors' characteristics and their specialty. SETTING: Doctors in training in the United Kingdom in 2013. PARTICIPANTS: 27 530 doctors in training but not in their foundation year who responded to the National Training Survey 2013. MAIN OUTCOME MEASURES: Mixed logit regression estimates and the corresponding odds ratios (calculated separately for all doctors in training and a subsample comprising those educated in the UK), relating gender, age, ethnicity, place of studies, socioeconomic background and parental education to the probability of training for a particular specialty. RESULTS: Being female and being white British increase the chances of being in general practice with respect to any other specialty, while coming from a better-off socioeconomic background and having parents with tertiary education have the opposite effect. Mixed results are found for age and place of studies. For example, the difference between men and women is greatest for surgical specialties for which a man is 12.121 times more likely to be training to a surgical specialty (relative to general practice) than a woman (p-value<0.01). Doctors who attended an independent school which is proxy for doctor's socioeconomic background are 1.789 and 1.413 times more likely to be training for surgical or medical specialties (relative to general practice) than those who attended a state school (p-value<0.01). CONCLUSIONS: There are systematic and substantial differences between specialties in respect of training doctors' gender, ethnicity, age and socioeconomic background. The persistent underrepresentation in some specialties of women, minority ethnic groups and of those coming from disadvantaged backgrounds will impact on the representativeness of the profession into the future. Further research is needed to understand how the processes of selection and the self-selection of applicants into specialties gives rise to these observed differences.

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OBJECTIVE: To explore the effects of the UK Working Time Regulations (WTR) on trainee doctors' experience of fatigue. DESIGN: Qualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data. SETTING: 9 deaneries in all four UK nations; secondary care. PARTICIPANTS: 82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry. RESULTS: Implementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity. CONCLUSIONS: Long-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors' true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.

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