使用直接从初级医生那里收集的证据来确定导致英国初级医生劳动力保留危机的因素,并为解决这一问题的变革提出建议。
综合审查。
对OvidMedline和HMIC进行了搜索,以查找2016年1月至2021年4月之间发布的证据。相关国家组织的出版物补充了这一点。
与英国初级医生保留有关的英文论文,包括直接从初级医生那里收集的健康或满意度数据。只关注大流行的论文,一个医学专业特有的因素,干预措施的评估,或没有因果关系证据的数值数据被排除。审查文件被排除在外。
数据由FKL提取并编码在NVivo上,然后进行了主题分析。
包括47篇论文,由学术(定性、定量,混合和评论)和灰色文学。确定的关键主题是工作条件,支持和关系,学习和发展,缺乏灵活性的总体主题。这些因素的结果是医生感觉不到价值,缺乏自主性,工作与生活的平衡很差,并提供受损的病人护理。这导致需要中断医疗培训。
这篇综述基于有关工作环境的相关文献的发现,隔离,污名,和对自治的渴望,并强调了学习和培训方面的其他问题,灵活性,感觉有价值,和病人护理。它继续提出了解决英国初级医生保留率低的建议,强调复杂的问题需要基于证据的解决方案和自下而上的方法,其中初级医生在干预措施的规划过程中被视为核心利益相关者。
To determine the factors contributing to the junior doctor workforce retention crisis in the UK using evidence collected directly from junior doctors, and to develop recommendations for changes to address the issue.
Integrative
review.
Searches were conducted on Ovid Medline and HMIC to locate evidence published between January 2016 and April 2021. This was supplemented by publications from relevant national organisations.
English-language papers relating to UK junior doctor retention, well-being or satisfaction which contained data collected directly from junior doctors were included. Papers focusing solely on the pandemic, factors specific to one medical specialty, evaluation of interventions, or numerical data with no evidence relating to causation were excluded.
Review papers were excluded.
Data were extracted and coded on NVivo by FKL, then thematic analysis was conducted.
47 papers were included, consisting of academic (qualitative, quantitative, mixed and commentary) and grey literature. Key themes identified were working conditions, support and relationships, and learning and development, with an overarching theme of lack of flexibility. The outcomes of these factors are doctors not feeling valued, lacking autonomy, having a poor work-life balance, and providing compromised patient care. This results in need for a break from medical training.
This
review builds on findings of related literature regarding working environments, isolation, stigma, and desire for autonomy, and highlights additional issues around learning and training, flexibility, feeling valued, and patient care. It goes on to present recommendations for tackling poor retention of UK junior doctors, highlighting that the complex problem requires evidence-based solutions and a bottom-up approach in which junior doctors are regarded as core stakeholders during the planning of interventions.