Abstract
Background and aim; This thesis examines the mental health (MH) trajectory of Foundation Year junior doctors (F1s) in their first year of clinical training and the role of Occupational Health (OH).
There is limited research in this field. A literature review identified that OH is often poorly utilised (Cohen et al, 2016), and no literature examined the role that OH might be able to offer for this year group has not been examined. There is a poor understanding of how best to emotionally support doctors in general, specifically F1s, to sustain their mental well-being, reduce their suicide risk and address any factors that might be associated with these phenomena (Brooks et al, 2011).
Methodology: Thematic Analysis (TA) was the qualitative method used for this research and semi-structured questionnaires. A sample of ten F1s who had self-declared as experiencing or having had health conditions (both MH and with a physical health (PH) condition impacting on MH) were interviewed twice: once at the beginning (T1) and once at the end of their first year (T2). Interview questions explored experiences of the transition year, OH and of screening as an intervention.
Personal reflexivity is an important part of the methodology, and is discussed alongside the findings of a literature review and the analysis of participant interviews.
Analysis: The analysis identified themes across the T1 and T2 interviews. The following themes formed the basis of the T1 interviews:
1. Health seeking behaviour and OH
2. Internal world of doctors
3. External world of doctors -the transition and changes experienced by doctors.
4. Professional guidance, policy and politics.
Key themes from the second (T2) interviews were screening and follow up interviews was found to be valuable .The interviews were found to offer an opportunity for individual reflexivity which the doctors found beneficial and supportive.
Main Results: Those with long standing MH or PH conditions came to accept that it was “part of themselves” and something they needed to manage during this transitional period. One of the most notable findings was the importance of having an approachable and consistent individual who was the point of contact for the F1 who would follow them up if they did not attend or missed a session. F1’s contact with OH, they still reported a tendency to feel that they were wasting someone’s time if their mood was low. The findings of this study suggest that OH has a key role to engage with F1s early in the induction process with regards to screening and to recognise warning signs as well as to make contact at times of risk. The research shows that when screening and follow up is offered to F1s by OH for those with a previously known, or current, mental and physical ill health condition it is valued as a worthwhile intervention
Discussion: This study additionally explored the findings relating to OH specifically through the lens of psychoanalysis. A hypothetical working model was developed, using the work of Steiner (1993) and Jaeggi (2014) in particular, to understand what is happening to F1s as they progressed through the year. This offers a novel contribution to existing literature.
Limitations: This was a time limited study with a small, self-selected sample size. This study could be repeated across a larger population.
Conclusion: This research makes a novel contribution to understanding the challenges in delivering good OH clinical support to F1s in a system where stigma concerning MH issues, still operates. This study indicates that OH has a key opportunity to support F1s early in their clinical year to promote and enhance their health and well-being during the transitional period to Foundation Year Two (F2). Screening as intervention offered this group of F1s the opportunity to build an ongoing relationship with OH to facilitate their continuing well-being in a multitude of ways. These include recognising the importance of the “secure base” OH provides, and allowing for ease of access to a key contact in OH and the opportunity to build a relationship with this contact who might recognise signs of declining well-being and “reach out” if an F1 fails to attend appointments. Other important findings for OH were that these F1s gained insight and acceptance of MH conditions and increasingly drew on the potential of OH to provide a ‘reflexive space’ to support them as they transitioned to F2 and to facilitate work adjustments if necessary. These findings can be used by OH, to support the health and well-being of F1 who have a high prevalence of MH with associated risk factors (Brooks et al, 2011)
Recommendations for future research: further use of clinical diagnostic tools (e.g PHQ9 & GAD7) to monitor HWB of F1 during the screening FU process.
Keywords: Occupational Health, mental and physical health, support, transition, Foundation Year 1 doctors, junior doctors
