Care Under Pressure

Related Projects

Shared Social Spaces
ASME Board Award 2022

This project is investigating the impact of shared social spaces on wellness and learning of junior doctors. It is led by Dr Ciska Uys, an Anaesthetic registrar undertaking an Academic Clinical Fellowship in Medical Education supervised by Professor Karen Mattick and Dr Daniele Carrieri. 

A significant finding from Care Under Pressure (CUP)1 was that connectedness between colleagues and sense of belonging appear to be one of the most important factors to prevent and reduce mental ill-health. Shared social spaces in which healthcare staff can meet informally are thought to improve connectedness, however these spaces are in decline. Nearly 20% of junior doctors in the UK do not have access to a ‘common room’, according to 2019 data from the British Medical Association.

We have recently published the findings of our scoping review, which identified several ways in which shared social spaces may impact positively, not only on wellness, but also on learning of junior doctors. Four significant common attributes of shared social spaces can be credited with positive impacts on wellness and learning. 1) Informal; fostering connectedness and belonging, trust and teamwork and offering access to informal help and support. 2) Safe; allowing reflection, debrief and raising of concerns. 3) Functional; there is planning of clinical care activity, sense of control and engagement from users and provision of refreshment. 4) Legitimate; regular maintenance and use of shared social spaces affect role modelling, sustainability and wellness culture. However, we found that although the value of spaces such as the coffee room and doctors’ mess is widely talked about, there is currently very little empirical data to inform our understanding. 

Therefore we will collect data in one UK hospital, which will involve mapping of shared social spaces, observation and realist interviews, to allow us to further our understanding of what happens in shared social spaces and how and why this impacts wellness and learning. The findings of this research will provide doctors, other stakeholders and  policy makers with evidence of how shared social spaces are used; when, why and for whom they are significant; and what we need to do to create or preserve spaces that are effective in supporting learning and wellness.                                                                                                                                                                                                                        

Key publication:

Uys C, Carrieri D, Mattick K. Theimpact of shared social spaces on the wellness and learning ofjunior doctors: A scoping review.Med Educ. 2023;57(4):315‐330. doi:10.1111/medu.14946330 

Further information:

Continued support for Devon-wide initiative to support GPs under stress

After a successful pilot, NHS Devon has committed to continue funding an innovative programme to support GPs, aimed identifying and supporting doctors under stress before their health or performance suffers. 

Thanks to this support, GPs will be able to access to a range of new support services, including wellbeing focused coaching, peer support groups and mindfulness training.  Of course, you will still be able to access all the existing services (such as the Practitioner Health Programme and support from the LMC).

In addition, under this new initiative GP appraisers are being encouraged to explore wellbeing with their appraisees, and are being provided with the guidance and resources to do this in a sensitive and supportive way. Please use your appraisal as an opportunity to reflect upon and prioritise your own wellbeing.

We are all increasingly concerned about the wellbeing of our GP colleagues. We know what fantastic work you all do, and the pressure you’re under. It’s completely understandable to feel stressed at this difficult time for the NHS, and it’s ok not to be ok. All we ask is that if you’re not ok, please do something about it: talk to colleagues, seek out the support you need. Help is available. If you’re having a difficult time, we believe that accessing support can make all the difference.

If you would like to know more about this programme, please email vik.mohan@nhs.net

An evaluation of Interim Foundation Programme (FiY1) posts: new doctors’ adaptation to practice during the COVID-19 crisis (2020-21)

This project explores the experience of ‘the class of COVID’ new medical graduates who are starting work in the UK during the COVID-19 crisis. It is led by Newcastle University School of Medical Education, with colleagues from Exeter University, Plymouth University and Queen’s University Belfast. It is supported by the GMC, Medical Schools Council and other stakeholders, and will explore with questionnaires and interviews how starting practice at this unprecedented time affects new doctors. This is the only study with the support of all national bodies responsible for trainee doctors.

For further information see: https://blogs.ncl.ac.uk/2020medicalgraduates/

Key Publications

Burford B, Vance G, Goulding A, Mattick K, Carrieri D, Gale T, Brennan N. (2021). 2020 Medical Graduates: The work and wellbeing of interim Foundation Year 1 (FiY1) doctors’ during COVID-19. GMC report.

Mattick K, Goulding A, Carrieri D, Brennan N, Burford B, Vance G, Dornan T (2023). Constraints and affordances for UK doctors-in-training to exercise agency: a dialogical analysisMedical Education.

Burford B, Mattick K, Carrieri D, Goulding A, Gale T, Brennan N, Vance G. How is transition to medical practice shaped by a novel transitional role? A mixed-methods study. BMJ open. 2023 Aug 1;13(8):e074387. https://bmjopen.bmj.com/content/13/8/e074387.info

‘Thriving Lessons’: Optimising strategies to promote medical students’ wellbeing (2019-21)

Excellent Medical Education Joint Association for the Study of Medical Education/General Medical Council Awards 2019 CPD category

This project aims to develop evidence-based recommendations to optimise current strategies to address mental ill-health and to promote wellbeing for medical students at the College of Medicine and Health (CMH), University of Exeter.

The mental health of medical students and doctors is a pressing concern in the UK and worldwide. Its consequences are far reaching and include dropout, depression, self-harm, suicide, poor academic performance and patient care. This complex problem requires multi-level integrated approaches targeting individual ‘skills’, as well as changes at organisational, professional and cultural levels.

In the UK, regulatory bodies and institutions such as the GMC and HEE have argued for the importance to start early in developing doctors’ wellbeing, self-awareness, and self-care. A growing number of medical schools in the UK are introducing a wide variety of different initiatives to promote wellbeing and tackle mental ill-heath. However, most programme leaders and educators lack guidance and resources to develop these initiatives or to properly incorporate them within education and training programmes.

This project aims to address this gap by undertaking a realist evaluation of the delivery and impacts of the initiatives to support the health and wellbeing of the medical students at the University of Exeter. The main objectives are to: make explicit the implicit theories held by educators who have been involved in the design and delivery of wellbeing curriculum and initiatives to understand their beliefs about the different contexts, mechanisms and outcomes that may be important to promote wellbeing; develop an explanatory account of whether/how these initiatives are working, for whom, under what circumstances and why (not); develop an evidence-based plan to optimise strategies to support medical students’ wellbeing.

This study will be undertaken at the University of Exeter, but some of the findings and the methodology employed may be relevant and transferable to other medical schools.