Myanna Duncan Doctoral Researcher Work & Health Research Centre Loughborough University

Perspectives: Who am I? B.Sc. (Hons.) Psychology M.Sc. Occupational Psychology Ph.D Applied Psychology Research interests: extended working hours, shift working and their associated impact on health and wellbeing Doctoral research: occupational health and wellbeing of junior doctors’ under EWTD 4 phase mixed-methods research design working in collaboration with EMHWD

Assessing Junior Doctors’ Perspectives Doctoral research objectives –Assess juniors’ views on the EWTD –Impact on training, education, quality of working life –Explore perceived impact of the reduction of out-of-hours work –Feedback findings to key stakeholders in order to facilitate development of future rotas and working schedules Foundation Year 1 & 2 Doctors Data collection August 2007 – October 2008 Sampled 3 junior doctor cohorts in EMHWD

Assessing Perspectives: Research Phases Phase 1: Semi-structured interviews: 36 participants –Foundation Year 2 Doctors. August – December 2007 Phase 2: Web-based survey. 423 respondents –June – October Validated & bespoke measures Phase 3: Focus groups: 23 participants – 5 groups –October 2008 Phase 4: Expert Panel: scheduled for May 2009 –Further details towards end of presentation

Perspectives: The Junior Doctors Unable to present full details of research today Time constraints! Questions I aim to address today: –What does EWTD mean to Junior Doctors? –How has EWTD impacted on Junior Doctors’ work-life balance? Presenting data from research phase 1 (interviews)

The Junior Doctors’ Perspectives: Phase 1 data Interview schedule developed in consultation with the literature, discussions with key stakeholders and from pilot interviews Schedule included working schedules/experiences, followed by a combination of structured and open-ended questions pertaining to the research objectives Nature of interview method allowed for a flexible exploration of topics & emergent themes Invitation to participate in project sent to all Foundation Year 2 doctors working in EMHWD August 2007

The Junior Doctors’ Perspectives: Phase 1 data 36 interviews conducted: 21 females & 15 males 9% of total sample Participants self-selecting Age range years (mean 24.2 years) 19 telephone & 17 face-to-face interviews Interviews duration minutes (mean 45 minutes) No incentive offered for participation Data coding by 2 independent researchers

The Junior Doctors’ Perspectives: Findings Participants largely recognised the need for regulation on working hours Did not wish to return to the ‘old days’ Many acknowledged positive impact EWTD has had on general health & wellbeing However, the majority of participants regarded the 48 hour limit as too stringent Frustration reported at way in which Directive has been implemented insofar as rota design Particular value placed on out-of-hours shifts

Theme 1: Importance of regulated working hours ‘ I think I’m in favour of a time directive. I think the past has shown that doctors were working ridiculously long hours and it was affecting them and the care and safety of their patients’ (Pp 18) ‘ I am personally in favour of it (EWTD) having worked in hospitals and knowing the value of on-calls but knowing you need to get the balance between being able to work safely and work happily and being able to work happily is quite important to me’ (Pp 17)

Theme 2: ‘Excessive’ regulation ‘ I can understand that they want to limit hours but I think they’re setting the limit too low. I don’t really think any of us went into medicine expecting to work a 48 hour week and that’s not why we went into medicine, we did that because we want to work the hours to get the experience’ (Pp 24) ‘My biggest concern is that this (48 hours) is going to push the burden up to our senior colleagues. Because Trusts are cutting the hours of the junior doctors and not letting them opt out then the burden will move up the profession’ (Pp 21)

Theme 3: EWTD & rota design ‘They’re taking out on-calls which means you’re going to get to a more senior level and do on-calls for the first time and be expected to be at the level people are at the moment when they get there having done years and years of on-calls’ (Pp 4) ‘I had 8 months of Monday to Friday 9 to 5, and other people had all their jobs banded. There’s just such variation and at the end of your house year. Some people will run the ward on their own whilst some people felt so unconfident at dealing with any sick patient because you had no experience’ (Pp 19)

Research Limitations Findings are from a single Deanery May therefore offer limited generalisability to other Deaneries Relatively small sample of self-selecting participants Acknowledge this shortcoming, the data does appear to reflect a broad range of working experiences and views regarding the EWTD Phase 1 data presented > 1 year old Is however reflective of phase 2 and 3 data

Perspectives: Take home message Regulation on working hours typically welcomed Junior doctors’ largely acknowledge improved quality of working life and work-life balance under EWTD However, August 2009 presents many challenges as Trusts endeavour to with requirements for a 48 hour week This requires careful rota planning Where possible, we would encourage juniors’ involvement in rota planning & suggest that junior doctors may benefit from the opportunity to engage in out-of-hours working Such opportunities may arise with multi-professional Hospital at Night teams

Further details Phase 4: Expert Panel, May 2009 at Loughborough University Panel comprising practitioners, academics, medical professionals, medical HR staffing, occupational health Presenting full details of the 3 research phases Examining research implications for policy and practice If would like further information/to register an interest, further details are available at the registration desk Please feel free to contact me