Improving wellbeing for Internal Medicine Trainees across London
Introduction
Internal Medicine Trainees (IMTs) are at significant risk of burnout, particularly those working in London. During, and after, the covid pandemic it became clear that IMT wellbeing is a hot issue. An increasing need for support was reflected in feedback and the 2023 GMC survey demonstrated an escalating risk of burnout with 77% of Stage One IMTs in the city at moderate or high risk. There was, however, minimal evidence as to what factors were impacting these doctors’ wellbeing or which interventions should be implemented to improve it.
In response, one of the Regional London IMT Stage One Training Programme Directors (TPD) took an opportunity to bid for funding from the NHS England COVID Recovery fund for IMT Educational and Wellbeing Fellows across London. The aim was to find out what wellbeing means to residents and provide effective interventions to improve it.
Methods
Wellbeing Fellows were recruited to four fixed term posts between 2023-2025 with one fellow working in each sector of the city. This ensured all 830 IMTs in London had access to the Wellbeing Fellows and their work. The fellowships included varying levels of protected time with some roles being full time and some part time. Each Fellow had recently completed IMT and had an interest in education and resident doctor wellbeing. The fellows were supervised and supported by engaged educators, local and regional TPDs. A ‘wellbeing task force’ was set up including TPDs and Wellbeing Fellows.
The Wellbeing Fellow role included involvement in research, providing near peer support to IMTs and the design and implementation of local wellbeing projects. Examples are listed below.
Research
- Wellbeing fellows conducted research to determine key issues impacting IMT wellbeing, guide effective interventions and explore IMTs current experience of wellbeing support.
- Local and regional surveys plus focus groups highlighted areas of specific wellbeing issues to focus bespoke local projects.
Local and regional projects
- A ‘wellbeing directory’ of resources across London to increase accessibility of support.
- Wellbeing cafes’, spaces where doctors can access support and wellbeing activities.
- Development of a rotational passport for staff requiring essential adjustments.
- Training sessions for IMTs and supervisors providing education on key wellbeing topics.
- Working with local hospital wellbeing teams to highlight issues facing rotational doctors.
- A ‘Wellbeing Day’, organised by fellows and TPDs, was attended by around 50 IMTs. Workshops and talks highlighted available support and introduced doctors to evidence-based wellbeing interventions. This provided study-leave approved protected time for doctors to engage with wellbeing activities and support.
- Local ward-based interventions in response to specific feedback on specific wellbeing issues.
Support
- One to One, near-peer support for individual doctors with training and wellbeing issues.
- Single point of access to wellbeing resources, sign posting and escalation of individual and wider issues to the senior team.
Results/outcome
Research conducted by the Wellbeing Fellows has been published in the Future Healthcare Journal. A large-scale study found themes related to poor wellbeing to include culture, helplessness and distrust, individual circumstances, physiological needs/ safety, rotas and work patterns, stress at work, and value. A second piece of research highlighted that existing trust wide wellbeing initiatives are not reaching IMTs, suggesting an unmet wellbeing support need in this group of staff and a role for alternative support.
Collaboration between the Wellbeing Fellow and existing Trust-wide wellbeing, staff support and occupational health teams lead to progression of trust-based projects such as the Reasonable Adjustments rotational passport.
The Wellbeing cafes had low uptake when held during the working day, demonstrating the challenges of providing wellbeing activities for doctors without protected time away from clinical work. When held in the protected time provided by the Wellbeing Day (for which study leave could be used), the Wellbeing Café was very positively received by attendees. This supports the need for protected time for doctors to engage with wellbeing activities.
The Wellbeing Day itself was a successful event with the post-event survey showing an improvement in attendees feeling of value and belonging within the IMT programme. The open engagement with senior clinician regarding wellbeing was a particular highlight for attendees.
Near-peer support was taken up by IMTs with a range of wellbeing challenges from personal through to rota based logistical issues. This support received positive feedback. The need for this provision was supported by the outcomes of the above research.
The TPDs and Fellows are involved in raising the profile of wellbeing nationally including presentations at education meetings, including School of medicine board (London) and Stage One IMT Special Advisory Committee. The team is also developing a national cross-speciality wellbeing network and engaging with RCP Next Generation Project.
Conclusion and next steps
The wellbeing fellow project has had an impact locally, regionally, and nationally. The research undertaken has contributed to a much-needed evidence base highlighting the issues impacting resident doctors and guiding interventions to improve their wellbeing. This research provided the direction and focus of subsequent local and regional wellbeing fellow projects, ensuring interventions are targeted effectively. These interventions have ranged from the individual level (peer support), local level (bespoke local projects for specific issues often focussed on meeting basic needs), to the regional level (wider training programme changes). This approach provides a blueprint for other fellow roles and can be translated to other geographical areas and training programmes.
Through trialling new interventions, the team have discovered and overcome barriers to supporting resident doctor wellbeing. This included modifying ideas such as the ‘wellbeing café’ which was an effective concept but had low engagement due to a lack of protected time for resident doctors to engage. ‘Time’ is a key theme throughout this work. The wellbeing fellows have had specific time available to undertake this wellbeing work and time has been created through the wellbeing training day for IMTs to engage with the topics.
The next steps in the project include the ongoing evolution of the Wellbeing Fellow role with two further fellows’ recruitment through InnovateMD funding. There are plans to access charitable and additional funding with the aim of creating a national fellow role and also to spread the work to IMT Stage Two. A network of wellbeing fellows is in place and a cross-speciality network of clinicians involved and engaged with wellbeing is being created. These networks and fellowship can bring a wealth of expertise to national policy discussions and increase the prominence of resident doctor wellbeing on the national agenda.
