Qualitative exploration of stressors in anaesthesia training in the UK and mechanisms to improve resident wellbeing

We commend Gale et al. on their investigation into resident doctor stressors and wellbeing in years 2–5 of training [1]. This work complements a recent survey undertaken by the Severn Deanery Training Program Director and ST4+ resident representatives exploring anaesthesia resident doctors' welfare and burnout risk, alongside seeking feedback on how to improve the training experience. Our survey received a 96% response rate from stage 2 and 3 resident doctors (89/93). The 2017 Royal College of Anaesthetists' survey of trainee morale and welfare found that, nationally, 85% of anaesthetic resident doctors were at a high risk of burnout [2]. Our findings identified this risk as 67% (60/89), with a comprehensive picture of issues experienced locally. We aim to address these concerns and want to compare our findings with those of Gale et al. to highlight resident doctors' wellbeing.

Our results largely reflect the national picture, with most resident doctors feeling satisfied overall in their job (72/89, 81%). Common stressors were related to training and career progression, including exam preparation; consultant applications; work–life balance; financial wellbeing; and incorrect pay. The desire for a single lead employer was the most cited suggestion to improve wellbeing. Although there is national guidance to support a lead employer model, there appear to be many barriers to implementation, and we hope the drive to achieve this is not neglected with the abolition of NHS England. Lack of support (including peer support) and rota problems were cited rarely as stressors but, interestingly, were common themes in suggestions on how to improve training experiences. Particularly prevalent was the theme of improving the sense of the resident community, echoing the importance of social spaces recognised in the work by Gale et al.

These two pieces of work illustrate how stressors can evolve throughout training. In the survey, clinical stressors such as intensive care medicine and obstetrics were mentioned rarely. This may indicate the higher clinical confidence of the senior resident doctors who participated. The burden of participating in ‘tick box’ projects was also not mentioned, possibly because our survey participants were more senior than the cohort in the study by Gale et al. and, therefore, more likely to be assigned projects aligning with their interests. Conversely, concerns around consultant job applications were more frequent, as well as the pressure to improve portfolios and inter-trainee competition. Meeting wellbeing needs will require tailored approaches for each stage of training; a universal solution is unrealistic.

Resident doctors had varied levels of confidence in discussing their mental health with supervisors and their knowledge of workplace mental health resources. Despite this, mental health support was listed rarely as a suggestion for ways to improve the quality of training. We feel this may relate to the observation in the study by Gale et al. that many resources are only felt to be paying ‘lip service’ to mental health and are not designed to meet the needs of anaesthesia resident doctors. More work needs to be undertaken locally and nationally to address this issue, alongside tackling the persistent stigma of discussing mental health within the medical profession.

We hope that the study by Gale et al., supported by our own local survey, will be the first step in an improved understanding by stakeholders of the issues facing resident doctors in the Severn Deanery. This not only allows us to tackle barriers to wellbeing at a local level but also to advocate on a regional and national level for systemic improvements to enhance the anaesthesia training experience.