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Nicola is a psychiatry registrar at Toowoomba Hospital in Queensland, completing a Master of Public Health and a Graduate Certificate in Clinical Education. She shares her experience and views on tackling junior doctor burnout and suicide.
What drew you to psychiatry in a regional setting?
Psychiatry appealed to me because there is a lot of complexity and emerging knowledge which is exciting. You also get to spend a lot of time with your patients, which I find really satisfying.
I wanted a broad exposure to medicine, so it was definitely worth moving to the countryside. It’s certainly very different in terms of trying to co-ordinate care and what is available. There is a lot of liaising, but hopefully it means patients can access care closer to home.
Tell us about being awarded 2018 Queensland Junior Doctor of the Year by the Queensland Prevocational Medical Association?
I received a page to call the Medical Education Unit to clarify some details on my CV when I found out I’d won the award for commitment to education and training in the junior doctor space. I’d been very involved in education and training through the Queensland Prevocational Education Medical Committee, AMA Queensland Council of Doctors in Training and the Junior Medical Officer Forum Queensland, which I think led the unit to nominate me. I was quite humbled as there are a lot of junior doctors who are really committed in that space.
How did you find supportive mentors?
I went through formal mentoring programs run at the hospital or the college, and some were local mentoring programs set up for interns among our registrar cohort. Some of my mentors were people I thought I could learn something from, like work-life balance, that mystical beast, or aspects of the job I wanted to improve upon – in those cases, I just approached people.
Finding mentors close to where I was in my training has been very helpful. I’ve also had mentors that have done more creative things with their careers and gone into education or administrative roles, which I don’t usually see in my clinical work.
What factors do you think contribute to burnout?
I have experienced burnout in the past and many of my colleagues would say the same thing. Changing roles, for example, stepping up from resident to registrar, were challenging periods for me due to the change in responsibility and expectations.
Long hours are also a factor. I’ve been very fortunate and if I’ve had any issues, I’ve felt comfortable enough to speak up. Unfortunately, that’s not the case for a lot of doctors. There is a lot of fear that speaking up will be interpreted as a personal weakness. This can discourage trainees from seeking help and taking time off to recover, which creates a vicious cycle.
How should junior doctor burnout and suicide be tackled?
It’s a really complex problem, so the solutions are not going to be simple and it needs multiple approaches. Individual risk factors are definitely a component, but addressing those factors isn’t sufficient to create a healthy environment for junior doctors to train in. We need to look at creating tangible change at a systems level and how medical culture influences burnout and suicides.
How can supervisors better support trainees’ mental health and wellbeing?
Making sure trainees can have discussions around their mental health and wellbeing is important, particularly during COVID-19. That may not be within their direct line of supervision, but through peer support groups or mentors. There has also been so much uncertainty for trainees around exams and obtaining adequate clinical time, so it’s important to understand the impact of that. Many doctors in training have planned their lives around when they will sit exams and finish their training, so it can be quite stressful.
In terms of supervisors, I have found building team morale through a sense of ‘we’re all in this together,’ was helpful. Knowing my supervisors also felt a bit uncertain and were concerned about how things were going, was reassuring and helped me discuss my concerns.
As Chair of the AMA Council of Doctors in Training Wellbeing Special Interest Group, what issues are being championed?
We are looking at projects we can use to amplify our voices to change some of the awareness around doctors’ wellbeing and burnout and suicide, into action. It’s important we have a seat at the table in those discussions and ensure any campaigns or interventions have the best possible outcomes for junior doctors.
We are looking at the ‘Every Doctor, Every Setting’ national framework, which aims to direct coordinated action on the mental health of doctors and medical students, to guide our work this year. The Medical Board of Australia’s 2020 Medical Training Survey results highlighted that bullying and harassment is a massive issue for doctors and adversely impacts wellbeing, so we also hope to do some work in that space.
What coping strategies have you used throughout your training?
Having a life outside of medicine has been a big one – so for me, that’s playing the cello with the Queensland Medical Orchestra, walking my dog and bushwalking. I’ve also joined an online Balint group which has helped me process and reflect on some of my cases.
There is a lot of fear that speaking up will be interpreted as a personal weakness. This can discourage trainees from seeking help and taking time off to recover, which creates a vicious cycle.
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