Critical study to explore health and wellbeing in doctors in training

Feb 17, 2016

Dr Sue Abhary has been awarded a grant-in-aid under Avant’s Doctor in Training Research Scholarship Program 2015 to lead the first pilot qualitative study to analyse personal and workplace enablers and stressors among registrars in speciality training programs. The study aims to provide key qualitative data to inform the development of evidence-based health care strategies to improve support for young doctors and patient care.  

Advocating for young doctors informed by personal experience  

A registrar herself, Dr Abhary’s personal frustrations in medicine and training ignited a passion to explore the health and wellbeing of doctors in training.

“I decided to leave the profession for a while and travelled overseas for a year and kind of found myself,” she says.

During her sabbatical, Dr Abhary, 35, (pictured) developed a passion for mountaineering and has fond memories of helping a Women’s Shelter in Iran to organise mountaineering trips.

“I helped the shelter raise funds to do mountaineering trips because the women are either homeless or they have come out of abusive homes and can’t afford education or the equipment,” she says. “I realised the power and satisfaction in helping disadvantaged people live their dreams and there is nothing more empowering than conquering a mighty mountain!”

Upon returning to Australia, Dr Abhary decided to pursue a career in medical administration and use her extensive background in quantitative and qualitative research after completing a clinical PhD. In addition to her roles as an Australia Medical Association (AMA) Victoria Board Director and AMA Victoria Doctors in Training representative to the AMA Victoria Council, to advocate for her fellow doctors in training.

Unique stressors faced by young doctors in the spotlight   

Dr Abhary, who is currently undertaking a Medical Administration Fellowship with The Royal Australasian College of Medical Administrators at Monash Health, Melbourne, says the results of the 2013 Beyondblue National Mental Health Survey of Doctors and Medical Students precipitated the pilot study.

“The survey revealed some pretty shocking statistics and found that Australian doctors reported significantly higher rates of psychological distress, anxiety, attempted suicide and suicidal thoughts compared with other professionals and the rest of the Australian population,” she says.   

“Importantly, there is a lack of data regarding these issues for registrars in speciality training, who face additional unique stressors associated with training demands, exams, college and speciality related factors and first on-call.”

Dr Abhary, who also holds a Graduate Certificate in Health Management from the University of New South Wales, Sydney, says research conducted by the AMA found 69% of residents and registrars reported burnout and 71% voiced concern about their own health.

In 2015, the importance of safeguarding the health and wellbeing of junior doctors was widely recognised after the deaths of three registrars and an intern in Victoria, as well as extensive media coverage of bullying and harassment in speciality training, particularly in surgical training programs.  

However, Dr Abhary is quick to point out that AMA Bullying and Harassment Survey data showed rates of bullying and harassment were similar across all specialties.

“Bullying and harassment is rampant and not just unique to surgery,” she says. “The surgeons were unlucky, but it was fortunate for the rest of us as at least it highlighted this issue in medicine and the Royal Australasian College of Surgeons had to do something about it and put some solutions forward.”

Qualitative data a key step in developing targeted support   

Dr Abhary anticipates that the research will provide critical qualitative data to create more targeted evidence-based health care strategies to assist junior doctors to successfully complete their training.  

“We have a reasonable amount of survey data and many health care strategies have been created, but the critical step in the qualitative research hasn’t been undertaken at all in Australia,” she says.  

The study aims to interview 20 specialist registrars across medicine and surgery to elucidate workplace and personal factors that may contribute to psychological stress or enable successful completion of training.   

To date, Dr Abhary has conducted six confidential interviews with registrars across a range of specialities including surgery, physician training, emergency medicine, ICU and obstetrics and gynaecology.

“We are delving into the impact of a variety of workplace factors, for example, hours and whether you are being paid overtime, workload, being on-call, supervision that’s available, college support, exams, bullying and harassment, absenteeism and private versus public training,” she says.  

The study will also explore personal factors including relationships and family life, work-life balance, financial impacts, major life events and mental and physical health issues. As well as analysing registrar use, awareness and perceptions of support programs.   

Preliminary results highlight key trends  

Early results have mirrored previous results showing registrars in speciality training programs experience significant forms of stress.  

“Between 60 to 70% of registrars are experiencing serious stressors within their workplace and training, which is having a significant impact on their personal lives,” Dr Abhary says. “Exams, poor supervision, on-call and bullying harassment and relationship strains have been repeatedly highlighted as major sources of stress.” 

“Bullying and harassment is definitely rife and they don’t feel that there are any appropriate services to be able to report these issues without recrimination, leading to them suffering in silence,” she says. “The majority are completely unaware of the support services that are available and there is only a minority utilising any support services.”

Lack of transparency is also an issue for doctors in training in terms of clear pathways to securing a place on a training program or finding a job once they have completed their training program, she adds.

Scholarship funding a win for doctors  

Dr Abhary is extremely grateful for the Avant scholarship and describes it as a win for doctors’ voices to be heard. “Avant has supported me in my plight to have our doctors in training heard in order use the results to push for a fairer system, better working and training conditions, more support services and ultimately better patient safety,” she says.

Due out in late 2016, Dr Abhary will present the research to Avant to support Avant’s advocacy on the prevention of bullying and harassment for doctors. She will also share the results with the AMA and The Royal Australian College of Medical Administrators and use her roles within these organisations to drive awareness and the necessary changes within the health sector.    

“Australia’s health care system is multi-faceted and complex. There is a long way to finding solutions for fairer training and working conditions and the support systems necessary. Research like this brings this one step closer to making it happen”

In the future, Dr Abhary is aiming for the pilot study to be used as a platform to expand the scope of the research to include medical students, interns, resident medical officers and consultants.

Learn more  

Read Avant’s submission to the Royal Australian College of Surgeons (RACS) – Expert Advisory Group Issues paper on discrimination, bullying and harassment on our submissions page

For advice and information on maintaining your health and wellbeing, visit Avant’s Health and Wellbeing website or the Doctors’ Health Advisory Service in your state or territory.

You can also access Avant’s Personal Support Program free on 1300 360 364 which provides a range of support options for members who are suffering health issues, including a confidential counselling service.

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