Survey Summary:

This report presents 323 survey responses of trainee doctors from 25 NHS Trusts in England and Wales. Four out of ten (40%) respondents are Foundation Year 1 /2, a quarter (25%) are F3, the rest are core /speciality trainees. More than half (52%) is female, the majority (68%) is the first in their family to be a medical doctor. In terms of ethnicity, 53%, are from Asian or Black ethnic groups, followed by white ethnic group, 40%; 39% (127) in the survey are doctors who attained primary medical qualification out of the UK. The research team also interviewed 13 trainee doctors.

First Findings:

• A concern of career and future in the NHS. Almost all doctors (94%) agree that the current state of the NHS concerns themselves; 91% of doctors worry the future of the NHS and 80% trainee doctors worry about their future in the NHS.

• A need to engage with the Senior Management Team (SMT). Despite being aspired to become leaders in the NHS, only one in six (18%) respondents agree that SMT understands the issues that affect trainee doctors; one is five (21%) agree that SMT listen/invest in their interest.

• A higher level of mistreatment/discrimination. It is concerning to see that 47% of trainee doctors have witnessed mistreatment/discrimination from external source (patient, relatives or visitors) and almost one in three (30%) experienced such incident from the above source. Internally, one in six (18%) witnessed mistreatment/discrimination from seniors/co-workers; One in seven (14%) experienced such incident from internal sources. Both measures (external and internal mistreatment) are higher than the national average (GMC 2023).

• Poor mental health and burnout: 36% (117) doctors often feel one or more symptoms of burnout, 1 in 5 (20%) feel completely burned out and at the point to seek change or help. One in three (30%) is considering to take a break.

• Career development needs. 86% would like to have career guidance; 83% would like to have a mentor.

Recommendations

The survey echoes some findings by GMC (2023), but also identified the extradentary level high level of uncertainty endured by trainee doctors derived from the nature of their training-to rotate every 4/6 months:  new working place/system, new accommodation, new travelling routine, new relationships on top of the uncertainty innate in the complexity of medical care. The current state of the NHS and the passive response to their strikes for pay rise by the government have further exacerbated their anxiety about the future.

As a generation who values and were instilled Equality, Inclusion and Diversity during their medical school education, they are more sensitive and better equipped to identify EID issues, they are the catalysts to implement EID and to shape the future healthcare. They are savvy with social media when decide which Trust to apply for training or to work in the future, it is thus important to listen and to act upon. This is a great opportunity that could not afford to be missed by those NHS Trusts who have trainee doctors to address the current and future doctors’ shortage.

We thus recommend 3 Rs for NHS Trust and trainee doctors as well as share good practices identified among these participating NHS Trusts/doctors.

1. Responsiveness /voice. To increase commutations/engagement activities between trainee doctors and SMT. This provides a voice channel, when act upon, can help to better working lives of trainee doctors and all staff. The new ones are sharp to identify deep-rooted issues.

Trainee doctors: take the advantage of opportunities offered to interact with SMTs, HR, EID groups, Department Head/Directors.

Good practices: leaders present at Induction days, CEO monthly ward walk, open office, payroll was ready when they start or resolved swiftly.

2. Relationship Given the high uncertainty faced by trainee doctors, NHS Trust management at all levels need to regularly remind staff to be empathetic to each other; especially towards trainee doctors, to be patient, supportive, and kind.

Trainee doctors: making friends with everyone; addressing team members (including porter, domestic staff, etc.) by name. Being an empathetic leader to support other team members.

Good practices have been identified: NHS Trust have regular social events (i.e. pizza night) for F1 only and all trainee doctors, respectively; department induction day, team building activities.

3. Recognition. To recognise the valuable work that trainee doctors by recognised their needs and celebrating their success. NHS Trusts provide supportive rota by taking into account moving days, night shifts, induction or important exam days. Involve them when make medical or work-related decisions.

Trainee doctors: Always ask questions if you are not unsure, you are here to learn. Recognising the leading role, you have in a team to provide quality care, you can build a new norm for being an approachable, supportive and kind Doctor!

Good practices have identified among participating NHS Trusts: let trainee doctors block study leave days before rota. consultants give trainee doctors opportunities to ask questions through ward walk or designated office hour, offer constructive and positive feedback; praise their good decision or good work when it happens. Director of Medical Education releases regular newsletter to update opportunities for trainee doctors to participate research projects, new initiatives and to celebrate those who passed ARCP or significant milestones.

Acknowledgement: we would like to thank all the doctors who give their time to fill in the survey and to offer insights through interviews. We are in debt to the Research Team, co-creation panel, and the support from Research and Development team, Director of medical education, Champion of the project of these 17 participating NHS Trusts (see the project website). In particular, I would like to thank people behind the scene include Mrs Yasmin Godhania for valuable advice with regard to NHS Ethics and set up all the Research Sites for the project, Ms Anna Oliver who design the website with passion and care.