Interventions for the well-being of healthcare workers during a pandemic or other crisis: scoping review.

OBJECTIVES: The aim of this scoping review was to identify pre-existing interventions to support the well-being of healthcare workers during a pandemic or other crisis and to assess the quality of these interventions. DESIGN: Arksey and O'Malley's five-stage scoping review framework was used to identify the types of evidence available in the field of well-being interventions for healthcare workers during a pandemic. PubMed, PsycINFO, Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find interventions for the well-being of doctors during pandemics. Owing to a lack of results, this search was expanded to all healthcare workers and to include any crisis. Databases were searched in June 2020 and again in October 2020. INCLUSION/EXCLUSION CRITERIA: Articles were included that studied healthcare workers, reported an intervention design and were specifically designed for use during a pandemic or other crisis. Well-being was defined broadly and could include psychological, physical, social or educational interventions. RESULTS: Searching produced 10 529 total academic references of which 2062 were duplicates. This left 8467 references. Of these, 16 met our inclusion criteria and were included in data extraction. During data extraction, three more papers were excluded. This left 13 papers to summarise and report. Of these 13 papers, 6 were prospective studies and 7 were purely descriptive. None of the interventions were theoretically informed in their development and the quality of the evidence was generally deemed poor. CONCLUSIONS: There are no high-quality, theory-based interventions for the well-being of healthcare workers during a pandemic or other crisis. Given that previous pandemics have been shown to have a negative effect on healthcare workers well-being, it is imperative this shortcoming is addressed. This scoping review highlights the need for high-quality, theory-based and evidence-based interventions for the well-being of healthcare workers during a pandemic.

Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors.

OBJECTIVE: Studies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making. To address this gap, we examined the link between career intention at the start of the 2-year UK Foundation Programme (FP) and career intentions on its completion. METHODS: Data came from the 2017 UK National Career Destination Survey, a cross-sectional study completed by all second year foundation doctors. We included respondents' demographics (gender, graduate status on entry to medical school, career intention on starting the FP) and career intention as an outcome measure (eg, specialty (residency) training (UK), NHS non-training posts/further study, career break, working abroad). Multinomial regression was used to assess the independent relationship between background characteristics and career intention. RESULTS: There were 6890 participants and 5570 usable responses. 55.9% of respondents were female and 43.1% were male, 77.1% were non-graduates and 22.9% were graduate entrants to medical school. Approximately two-thirds (62.3%, n=2170) of doctors who had an original intention to pursue specialty training after F2, still intended to do so on completion. Most of those who stated at the start of F2 that they did not want to pursue specialty indicated at the end of F2 they would be undertaking other employment opportunities outwith formal training. However, 37.7% of respondents who originally intended to pursue specialty training on FP completion did something different. Graduate entrants to medicine were more likely to immediately progress into specialty training compared with their peers who did medicine as a primary first degree. CONCLUSION: Original intention is a strong predictor of career intentions at the end of the FP. However, a considerable proportion of doctors changed their mind during the FP. Further research is needed to understand this behaviour.

Does perceived organisational support influence career intentions? The qualitative stories shared by UK early career doctors.

INTRODUCTION: The wish to quit or take time out of medical training appears to be related, at least in part, to a strong desire for supportive working and learning environments. However, we do not have a good understanding of what a supportive culture means to early career doctors, and how perceptions of support may influence career decision making. Our aim was to explore this in UK Foundation doctors. METHODS: This was a qualitative study using semistructured interviews incorporating a narrative inquiry approach for data collection. Interview questions were informed by the literature as well as data from two focus groups. Interviews were carried out in two UK locations. Initial data coding and analysis were inductive, using thematic analysis. We then used the lens of Perceived Organizational Support (POS) to group themes and aid conceptual generalisability. RESULTS: Twenty-one interviews were carried out. Eleven interviewees had applied for specialty training, while ten had not. Support from senior staff and colleagues influenced participants' job satisfaction and engagement. Positive relationships with senior staff and colleagues seemed to act as a buffer, helping participants cope with challenging situations. Feeling valued (acknowledgement of efforts, and respect) was important. Conversely, perceiving a poor level of support from the organisation and its representatives (supervisors and colleagues) had a detrimental impact on participants' intentions to stay working within the National Health Service (NHS). CONCLUSION: Overall, this is the first study to explore directly how experiences in early postgraduate training have a critical impact on the career intentions of trainee/resident doctors. We found perceived support in the early stages of postgraduate training was critical to whether doctors applied for higher training and/or intended to stay working in the NHS. These findings have transferable messages to other contexts struggling to recruit and retain junior doctors.

What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment.

OBJECTIVES: Multiple personal and work-related factors influence medical trainees' career decision-making. The relative value of these diverse factors is under-researched, yet this intelligence is crucially important for informing medical workforce planning and retention and recruitment policies. Our aim was to investigate the relative value of UK doctors' preferences for different training post characteristics during the time period when they either apply for specialty or core training or take time out. METHODS: We developed a discrete choice experiment (DCE) specifically for this population. The DCE was distributed to all Foundation Programme Year 2 (F2) doctors across Scotland as part of the National Career Destination Survey in June 2016. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo additional potential income and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. RESULTS: 677/798 F2 doctors provided usable DCE responses. Location was the most influential characteristic of a training position, followed closely by supportive culture and then working conditions. F2 doctors would need to be compensated by an additional 45.75% above potential earnings to move from a post in a desirable location to one in an undesirable location. Doctors who applied for a training post placed less value on supportive culture and excellent working conditions than those who did not apply. Male F2s valued location and a supportive culture less than female F2s. CONCLUSION: This is the first study focusing on the career decision-making of UK doctors at a critical careers decision-making point. Both location and specific job-related attributes are highly valued by F2 doctors when deciding their future. This intelligence can inform workforce policy to focus their efforts in terms of making training posts attractive to this group of doctors to enhance recruitment and retention.