Faculty of Science and Technology, University of Westminster
Abstract
Executive summary
Introduction
Being a doctor is often a highly rewarding career, but it can be a challenging role. The demands of the job can lead doctors to experience high stress levels and burnout, and put them at risk of psychiatric morbidity. Resilience training, by providing insight, self-regulation skills and time for reflection, may have the potential to mitigate distress and improve physician wellness. The Westminster REFRAME workshop is a half day, intensive resilience-training programme, originally designed for FY1 doctors to help them cope and perform safely and competently as professionals. The workshop, in a form now taught by a larger team of trainers, has been adapted for other medical staff. This report presents evaluation findings on the experiences and outcomes of the workshop for doctors at various stages of their career, as well as a small number of other hospital staff.
Methods
Westminster REFRAME workshops were put on for different groups of staff at Guy’s Hospital: speciality training (ST) 1+ doctors, consultants, the Junior doctors leadership group and other members of clinical staff. Generally, different groups were invited to particular workshops and the content was fine tuned slightly to be inclusive when membership was diverse. Workshops’ maximum capacity was 20. All attendees were invited to take part in the evaluation. Questionnaires were used to collect quantitative and qualitative data from participants at three time points: immediately prior the workshop (baseline), immediately after the workshop (post workshop), and two months after the workshop (follow-up). Outcome measures collected included perceived stress and positive well-being. Additionally, participants are asked to rate six statements about the workshop (e.g. ‘the workshop was useful to me’; ‘The ideas and concepts were communicated clearly’). Open-ended questions collected written data regarding participants’ experiences and perceptions of the workshop and any changes they had made as a result of attending.
Key findings
• Of the 68 doctors and health professionals attending a Westminster REFRAME resilience workshop, 63 completed baseline and post-workshop questionnaires, and 47 completed a follow-up questionnaire.
• Participants reported elevated levels of stress at baseline.
• Comparisons between baseline and 2-month follow-up questionnaires revealed a statistically significant improvement in both participant stress levels and well-being ratings.
• Participant ratings of various aspects of the workshop presented a positive overall picture of participants’ experiences of the day: many responses rated different aspects of the workshop with the maximum scores of 4 and 5.
• Ninety percent of participants said that the workshop was useful, with 8% unsure how useful the workshop had been and 2% reporting not finding it useful. Ninety-two percent of participants felt that that topics covered were useful for their work. The majority of participants said that they intended to use some of the techniques they had learnt on the workshop.
• Participants valued having time to explore stress and resilience issues including sharing experiences of work stress with peers, practical demonstrations on stress management, and having time to reflect on stress and coping.
• Participants reported wanting even more on practical solutions to manage stress in the workshop, some would have liked a longer session.
• Ninety percent of participants reported that they intended to do at least one thing differently as a result of attending the workshop; 75% of those who completed a follow-up questionnaire had actually done something differently. Changes made included using breathing techniques learnt on the workshop, meditating, taking more breaks/time out, adopting a different mental approach to stress/stressful situations, increased reflection on stressful situations, improved communication with colleagues, and approaching certain work situations differently.
• Changes resulted in participants reporting that they were calmer at work and home, more effective at work, taking work home with them less, or had more energy.
• Over half of participants felt that their patients had benefited from their attending a resilience training workshop: doctors felt that being more calm and focussed (as a result of resilience techniques) led to improved interactions with patients and more efficient working.
• The Westminster REFRAME website intended to support doctors to make changes, was rarely used by participants. Key reasons for not doing so included not being aware that it existed, lack of time, and having forgotten about it.
• The new evaluation strategy (e.g. new evaluation procedures, reworked questionnaires) improved the questionnaire completion rate and provided more contextual data regarding how participants were experiencing the workshop.
Participant quotes
“Great people – course director (especially [anonymised]) and other consultants on the course. Good to meet and have time with other colleagues. Confirmation that my own speciality is better off than many others. Much less isolated and more team working.”
“Good group size. Lecturers/facilitators experienced, calm and steered. Open/honest/non-judgemental. Experience sharing. V useful techniques and strategies put in clear way.”
“Very practical, important information, useful and good to apply to everyday life.”
“The relationship between my nervous system and thinking demonstrated to me.”
“Better work life balance ensuring I do regular exercise, and don't work at weekends or on holiday.”
“This has allowed me to become more focused. Work is work and personal life is separate. I used to find it very difficult not to take ongoing issues at work home and I think I am managing this better.”
Conclusions
The Westminster REFRAME workshop was generally well received by attending healthcare staff, suggesting that the workshop had been successfully adapted for a wider group of health professionals. Statistically significant improvements in both the stress and well-being scores of participants, along with self-reported behaviour change amongst a number of attendees, suggest that the workshop has the potential to improve staff resilience and well-being. However, findings should now be confirmed with a larger comparative study.
Additional work to support and encourage behaviour change after the workshop may be useful, particularly additional promotion of the resilience website during and after the workshop.
The new evaluation strategy was successful, it improved the questionnaire completion rate providing more reliable data on the workshop. Additionally, the inclusion of a stress measure was useful, as it identified doctors as being vulnerable to high levels of stress. The stronger qualitative element of the evaluation was helpful in providing data on how participants were using the information they had learnt on the course
