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6 Embedding wellbeing support in foundation induction
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  1. Huma Naqvi1,
  2. Michael Blaber
  1. 1Education Team, Sandwell and West Birmingham NHS Trust

Abstract

Context Work with a diverse environment in a district general Teaching Hospital in the UK. The organisation is known for being an excellent environment for learning, well-being and teaching of junior doctors. It has two sites, one in Sandwell (Sandwell General Hospital) and the other in West Birmingham (City Hospital).

I have worked as the Foundation Program Director for Foundation Year 1 doctors for the past 4 years and also have a keen interest in well-being. I have taken an active role more since the COVID pandemic to focus on well-being of junior doctors and been part of a well-being team involved in making the working environment more amenable and healthy. The well-being team is led by the Junior Doctors well-being lead and we in turn have developed a strong working relationship to endeavour that the support foundation Doctors have is robust and consistent.

Issue/Challenge The specific challenge was around addressing the needs of the Foundation Year 1 doctors and to develop a process to ensure they could have a means/approach to have time to address well-being in a focused manner. This led to development of 1:1 well-being meetings with each trainee with the Foundation program Director and the well-being lead. This involved arranging 10-15 mins appointments in an environment away from the working areas and ensuring It was a confidential and safe space. The whole purpose is to see how the trainee was doing in their day to day work and ensuring they were able to approach with any queries and concerns if they wished to. Meetings were arranged mid Sept to early October and across sites to ensure easy accessibility. Trainees were met face to face to ensure that the contact was felt to be more human and personable.

Assessment of issue and analysis of its causes

The size of the challenge was dominated by the number of trainees. It’s on average we have around 65-70 trainees to meet. However with identifying time aside in the allocated times, this was an achievable task to allocate all trainees a slot or work around the time to allocate alternative time slots. This meant dedicating afternoons over a 2-3 week period.

Educational supervisors were informed of the meetings in advance to ensure trainees were released for their time slot and again confidentiality was prioritised to ensure the trainees didn’t feel intimidated and forced into meeting.

Feedback was then sought from the trainee group to assess if the meetings were helpful and how to improve upon the format.

Impact A feedback survey was sent out following on the meetings and a good response rate (50%) from trainees identifying their views about the well-being meetings.

Majority of trainees identified the meetings as very useful and found the environment to be very supportive Witt regards to their well-being. Feedback comments on the meeting format; ‘a lovely idea, felt very comfortable’

‘A month in was a good time to check in’ ‘nice to meet up and chat’

Overall the meetings were received very well. It was suggested by trainees to arrange one per rotation, this was going to be challenged mainly by time and availability.

For ongoing meetings, it has been consistently well received for the past two years and will continue in this format. We will be guided by survey/feedback responses to ensure the process works consistently well.

Intervention The main outcomes from this work has been to assess wellbeing but also key in identifying any trainees who are struggling and particularly those who have struggled to engage with other senior colleagues to share any concerns. This in turn has resulted in further 1:1 meetings with these trainees (this has been 3 in the past training year 2021-2022) and appropriate signposting and guidance to helpful resources (including occupational health and the Professional Support and Wellbeng Unit) has further supported trainees to guide them through the year. Overall the positive outcomes have been all three trainees achieving the needed competencies to complete their FY1 year successfully. This work has shown focused meetings with the right stakeholders achieves satisfying outcomes for those in training and those particularly struggling in training.

The format of meetings can be easily reproducible at differing training levels or across trusts.

Involvement of stakeholders, such as patients, carers or family members:

Overall no direct involvement with patients but indirectly if there are concerns which in turn would affect patient safety, appropriate measures have been taken as and when needed. No patient safety concerns came about as a result of these meetings.

Key Messages The main message is about investing time and focus in trainees at the infancy of their career matters and this time can be invested well to ensure that their well-being is addressed at an earlier stage to ensure that should any concerns are highlighted, they can be addressed.

This in turn as improved outcomes in relation to unplanned sickness or time out of training. Ensuring that appropriate platforms of support are highlighted have helped in this respect.

It also helps your trainees in identifying those who are going to help when needed and having appropriate signposting at this stage has helped them considerably in processing well.

Lessons learnt Lessons include that you need to be accessible but ensuring that trainees also understand there are other means of support outside this remit. This means ensuring that all knowledge is shared and this would be helpful in identifying resources prior to meetings so they’re aware of support mechanisms at hand.

It’s important to also understand that not all trainees will be open to sharing concerns so early on in a meeting so identifying we can be approached at a later stage is also important.

Constraints is time and this isn’t always easily accessible to trainees who struggle out of hours. Ensuring appropriate mentorship through peers is an important consideration at this point.

Measurement of improvement Survey feedback via the trainee group is important to ensure the meetings are delivering what the trainee needs. Through feedback and changes, ensuring that follow on meetings have been adjusted as per suggested changes and this will be assessed through the process of QI and establishing a PDSA cycle. Work is ongoing through to ensure the next feedback meetings are planned in a similar format as last year, as the overall feedback has been hugely positive on a whole

Strategy for improvement Next meetings/check in planned Late Sept/early Oct. Feedback to be sought from meetings.

Planned further 1:1 meetings with well-being leads for those trainees identified as in need for further support. Follow up meetings will be done as per their choice/consent and involvement of educational supervisors if indicated.

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