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Your Training Counts

Results of the National Trainee Survey, 2014 - Health and Wellbeing

Your Training Counts, the annual national trainee experience survey, is designed and delivered by the Medical Council, which aims to inform and support the continuous improvement of the quality of postgraduate medical training in Ireland.

This report looks in detail at the health and wellbeing of trainee doctors. Follow the survey on Twitter.

Find out more about what changes have been made since the 2014 survey.

View interactive charts on:

88%

rated their general health as being good or better

6-in-10

rated their quality of life as being good or better

21%

reported low scores on a rapid assessment of wellbeing tool 

3-in-10 

who experienced bullying also reported poorer health and wellbeing 

+60 hours

those who worked longer hours reported poorer general health and quality of life

1-in-5

rated their quality of life as poor or very poor

More Information

Trainee General Health
  • Over 8-in-10 (88%) of trainees rated their general health as at least good; and 2-in-10 (23%) rated their health as ‘excellent’.
  • Most trainees shared a good experience of general health: rating did not vary with significance based on age, whether they were a direct entry or graduate entry medical student, whether they qualified with their basic medical qualification in Ireland or elsewhere, their stage of training or the type of site where they were training.
  • Trainee reported experience of ‘bullying’ and ‘undermining’ was linked with self-rated general health: compared with trainees who did not report bullying or undermining, trainees who reported these experiences also rated their general health more poorly.
  • Trainee reported ‘hours worked per week’ was also linked with self-rated general health: trainees who reported a greater number of hours worked per week also rated their general health more poorly.
Trainee Quality of Life
  • Views from doctors in training on their quality of life were less positive than their views on general health: 6-in-10 trainees (62%) rated their quality of life as being at least good; 2-in-10 (21%) rated it as ‘neither good nor poor’ and 2-in-10 (18%) rated it as ‘poor’ or ‘very poor’.
  • There was also greater variation in trainees’ views of their quality of life than their self-rated health: the type of site in which trainees were located, their stage of training, their age, and the whether they gained their Basic Medical Qualification in Ireland or elsewhere were all significantly associated with quality of life ratings.
  • Trainees in larger hospitals were significantly more likely to rate their quality of life as less than good (43%) compared to trainees in GP practices (22%).
  • Trainees who reported that they experienced ‘bullying’ or ‘undermining’ also rated their quality of life more poorly than those who did not report these experiences.
  • Furthermore, the experience of working a greater number of hours per week was also associated with a more poorly rated quality of life.
  • Finally, trainee views on their quality of life were linked with their views of the clinical learning environment (D-RECT score): trainees rating their quality of life poorly also had poor views of the clinical learning environment.
Trainee Mental Health and Wellbeing
  • We invited trainees to rate their mental health and wellbeing using the Short Depression-Happiness Scale (SDHS), a rapid assessment of mental health and wellbeing which provides a score on a scale of 0-18: higher scores indicating better mental health and wellbeing. The instrument is a valid and reliable measure of mental health and wellbeing but is not designed to diagnose mental health problems. However, a score of 9 or less (i.e. midpoint on the scale or lower) helps distinguish respondents whose mental health and wellbeing may be causing them some difficulty and for who some support might be helpful.
  • Overall, SDHS ratings show that many trainees’ enjoy good mental wellbeing. The mean SDHS score among trainees was 12.5 (95% CI 12.3 – 12.7).
  • However, 2-in-10 (21%) trainees reported SDHS scores of 9 or less indicating that their mental health and wellbeing may be causing them some difficulty.
  • Similar mental health and wellbeing was enjoyed by trainees with different characteristics. There were no significant variations in SDHS scores based on gender, whether or not the trainee gained their Basic Medical Qualification in Ireland or overseas, whether they were a direct entry or graduate entry medical student, their age, or their stage of training.
  • However, SDHS scores were linked with trainee reported experience of bullying and undermining: trainees that reported experience of bullying and undermining also reported lower SDHS scores.
  • SDHS scores were also linked with trainee reported hours worked in an average week: trainees that reported working a greater number of hours also reported lower SDHS scores.
  • Finally, SDHS scores were linked with views of the clinical learning environment. Trainees who reported lower SDHS scores also reported poorer views of the clinical learning environment.

Trainee Work Engagement 
  • Engagement is a positive, fulfilling, work-related state of mind characterised by vigour, dedication and absorption; energetic engagement with work is important for the individual, and in the case of medicine, is important for patient care. Engagement may be protective against burnout and provides a strength-based approach to understanding how trainees manage with work and training. We invited trainees to share views on their engagement with work using a 9-item version of the Utrecht Work Engagement Scale (UWES), which is a validated and reliable instrument for measuring engagement with work that has been used previously with doctors in training.
  • Many trainees reported views which indicated that they are well engaged with their work and had high UWES scores.
  • Other indices of trainee health and wellbeing were linked with engagement – trainees who reported better health and wellbeing also tended to report greater engagement with work.
  • Increasing trainee age and later stage of training were, in general, linked with greater trainee reported engagement with work. Trainees who qualified outside Ireland reported greater engagement than trainees who qualified in Ireland.
  • Trainee reported experience of bullying and undermining was linked with work engagement; trainees reporting more frequent experience of bullying and undermining also reported lower engagement.
  • There was no strong or significant link between hours worked and work engagement.
  • Work engagement and views of the clinical learning environment were linked; trainees reporting greater work engagement also reported more positive views of the clinical learning environment.
Trainee Utilisation of Support Services
  • 3-in-10 (29%) of trainees felt that they needed to access some sort of support service to assist them with their health and wellbeing needs.
  • Many trainees reporting poor health and wellbeing did not feel a need to access support services; for example, 4-in-10 (43%) of trainees that reported lower mental health and wellbeing scores (SDHS scores of 9 or less) did not feel a need to access support services.
  • Compared with male trainees (21%), more female trainees (35%) felt that they needed to access some sort of support service to assist them with their health and wellbeing needs.
  • A need to access some sort of support service to assist them with their health and wellbeing needs was also more common among trainees who reported an experience of bullying or undermining behaviour. Among trainees who reported frequently experiencing bullying and undermining, almost 5-in-10 also felt a need to access some sort of support service.
  • Despite a felt need, over 8-in-10 (86%) of trainees did not make contact with support services.
  • Compared with older trainees, younger trainees less commonly reported making contact with support services despite reporting that they felt they needed support.
  • Of those trainees who did contact support services, over 6-in-10 (62%) found them to be 'quite' or 'very' useful; 2-in-10 (19%) did not find them useful.
Findings 
  • Generally good self-reported health is an important positive finding.
  • Furthermore, it is a testament to the dedication of trainees that they generally report good engagement with their work. It is important to acknowledge and better understand the strengths which many trainees bring to their experience of working and training.
  • However, a small but significant minority are clearly struggling to maintain good quality of life and mental health and wellbeing.
  • The linkages between indices of trainee health and wellbeing and key features of the clinical environment point to the importance of focusing on the settings where trainees work and learn.
  • Hospitals appear to present particular challenges to maintaining good health and wellbeing. Unsurprising, but importantly, this report finds a strong, significant and consistent link between the experience of bullying and undermining and poorer health and wellbeing among trainees.
  • Linkages between hours worked and trainee reported health and wellbeing are evident. Your Training Counts will provide an important framework to monitor how trainees experience European Working Time Directive implementation: if and how their experience of the clinical learning environment changes; if and how their health and wellbeing changes.
  • There are shared responsibilities for everyone involved in medical education and training in responding to what we have heard from trainees.
  • There is a role for organisations that design and deliver curricula to ensure that self-awareness, self-care, and skills to navigate stressors in the clinical environment are fostered to help trainees maintain good health and wellbeing are promoted.
  • But a wider response involving policy-makers and healthcare organisations is required to ensure that the clinical environments where trainees work and learn are designed and managed to prevent unnecessary challenges for trainee health and wellbeing so problems are prevented.
  • The Medical Council will continue to raise awareness of doctors’ health and wellbeing in the interests of good professional practice for safe, effective and compassionate patient care.
Statistical Annex
  • 545 trainees reported that they work over 60 hours per week.
  • Of the 195 trainees who reported frequent bullying, 51 stated that their general health is less than good.
  • 198 trainees between 30-34 years stated that their quality of life is less than good.
  • 716 of trainees who graduated outside of Ireland report that their quality of life is good or better.
  • Of the 184 trainees who reported frequent bullying, only 90 trainees reported the need to access support services.
  • View the full statistical annex for the report.
Health and Wellbeing Interactive Chart