Workplace warning signs must be heeded to protect training, GMC says

High quality on-the-job training for doctors in the UK could be at risk if tell-tale warning signs in the workplace go unheeded, the General Medical Council (GMC) warns today (Friday 30 November).

The GMC says poor handovers and inductions, and gaps in rotas, should be seen by employers as indicators of more significant problems that can affect the quality of trainee doctors’ education and development.

The warning comes as the regulator publishes a full review of its latest annual national training surveys, which collate the views and experiences of more than 70,000 doctors in training and senior doctors who act as trainers.

It found that while trainers and training organisations continue to provide high quality medical education, trainees rated their experience as worse when they had poor handovers, inadequate inductions and gaps in rotas.

Charlie Massey, the GMC’s Chief Executive, said:

‘Handovers, inductions and well-organised rotas are indicators of workplaces where teamwork and positive cultures are fostered, and where trainees feel well supported. But where these aspects run less well doctors more commonly report poor experiences.

‘Proportionally more doctors who feel unsupported at work with high workloads tell us they experience exhaustion and burnout. That can erode the quality of their training as well as potentially putting patients at risk. These warning signs must not be ignored.’

Overall around one in six doctors in training said handover arrangements did not always ensure continuity of care between different clinical departments, and one in three said handovers were not used as learning opportunities, which GMC standards say they should be.

Inductions also varied, with more than 4,000 trainees (8.1%) reporting that they didn’t get an explanation of their role and responsibilities at the start of their most recent post.

And over half of doctors in training – almost 53% – told the GMC that they received less than the recommended six weeks’ notice of their rota. Around one in 10 had only a week’s notice or even less.

Charlie Massey added:

‘We know that where these issues exist there are likely to be wider problems as well. An unsupportive environment doesn’t just disrupt training, but can be a sign that inexperienced doctors are working beyond their clinical competence.

‘The majority of doctors in training say they are satisfied with the teaching and supervision they receive, and most trainers enjoy their roles. But we cannot take the continued high quality of medical training for granted. Time for training must be protected; it is too often at the mercy of gaps in rotas and pressures that divert resources elsewhere.

‘All doctors, including those in trainee posts and more senior clinicians who provide their training, need and deserve the necessary support to make sure medical education and training in UK remains first rate.’

The 2018 national training surveys asked doctors about burnout for the first time. Burnout was more prevalent among trainees who disagreed that rotas helped them optimise their education and development; while more trainers reported burnout in posts where they weren’t always able to use the time allocated to them for training.

Doctors in emergency medicine reported the highest rates of burnout. Nearly 74% of emergency medicine trainees rated the intensity of their workload as either ‘heavy’ or ‘very heavy’, and they reported feeling short of sleep while at work more than any other specialty.

Other specialties where trainees reported higher than average workloads and tiredness were surgery, medicine, obstetrics and gynaecology, and paediatrics.

The GMC has commissioned a UK-wide review, led by Dame Denise Coia and Professor Michael West, into the causes of poor wellbeing faced by doctors. The findings will help the regulator to work with others to identify priority areas for improving support and working conditions.

The GMC is also working with professional bodies across the country to improve the effectiveness of processes for doctors who raise concerns about safe working hours.

A copy of Training environments report 2018 is available.