The Foundation Programme is the postgraduate medical training that UK medical graduates undertake after finishing medical school and prior to choosing a speciality training. It marks the move from medical school into employment as a medical professional. Whilst this is often an exciting and rewarding time, it is also a key transitional time which brings with it feelings of uncertainty, anxiety and unpreparedness. This period is reported as the most stressful in a junior doctor’s career. Resilience training has the potential to improve physician wellness by alleviating distress. The Westminster REFRAME workshop is a half day, intensive resilience-training event for Foundation Year 1 (FY1) doctors, which is designed to help them cope better with the personal and professional challenges of this demanding, transitional time. The workshop has been presented to FY1s at Guy’s and St Thomas’ Hospital since 2014, and this evaluation report, using a newly designed evaluation strategy to enhance questionnaire completion rates, presents findings for the 2016/7 cohort of doctors.
All FY1 doctors at Guy’s and St Thomas’ Hospital were asked to attend the course, and 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 scales. Participants were also 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 sought participants’ experiences and perceptions of the workshop and any changes made as a result of attending.
• Of the 52 FY1 doctors attending a Westminster REFRAME resilience workshop 49 completed baseline and post-workshop questionnaires, and 43 completed a follow-up questionnaire.
• Participant ratings of different aspects of the workshop overall presented a positive impression of participants’ experiences of the day. Many responses rated various aspects of the workshop with the maximum scores of 4 and 5.
• Two-thirds of participants said that the workshop was useful, with 21% unsure how useful the workshop had been and 11% reporting not finding it useful. Eighty-one percent of participants felt that topics covered were useful for their work. Over three-quarters of participants said that they intended to use some of the techniques they had learnt on the workshop.
• Participants particularly liked learning tips and practical solutions to reduce stress and improve well-being and resilience; and reported wanting to have even more of this in the workshop.
• Participants also valued sharing experiences of work stress with peers, having time to reflect on stress and coping, and learning about stress and resilience.
• Eighty-five percent of participants reported that they intended to do at least one thing differently as a result of attending the workshop; 76% of those who completed a follow-up questionnaire had actually done something differently. Changes made included using breathing techniques learnt in the workshop, meditation, taking more breaks/time out, adopting a different mental approach to stress/stressful situations, increased reflection on stressful situations, and accepting help.
• Changes resulted in participants reporting that they were managing stress more effectively, had improved focus/concentration, were able to think more clearly under stress, and had an improved work/life balance.
• Just over half of participants felt that their patients had benefited from their attending resilience training, because the workshop had enabled them to carry out their jobs more effectively and/or communicate better with patients.
• Participants reported high levels of stress at baseline.
• Comparisons between baseline and 2 month follow-up questionnaires revealed stress levels and well-being ratings improved, but that this change was not statistically significant.
• The Westminster REFRAME website intended to support FY1s to make changes was not used by participants. The main reasons for not doing so included not being aware that it existed, lack of time, and ‘forgot about it’.
• The new evaluation strategy (e.g. new evaluation procedures, making participating in the evaluation mandatory, improved questionnaires) improved the questionnaire completion rate and provided more contextual data about how participants were experiencing the workshop.
“Encouraged open discussion around issues of resilience. It was also nice to know that other people experience the same levels of stress, find out ways to deal with it.” P11
“Very much enjoyed breathing exercise and practising mindfulness techniques – found it very relaxing.” P20
“Great tips on how to manage the many common challenges of being a Dr in the NHS today.” P15
“The technique of slow breathing has helped me to calm down several times when I was under severe stress.” P32
“Very busy days with more jobs than time - expected to be in attendance on ward a lot, difficult to take time for breaks.” P20
“Introduced some calm into hectic days, clear my mind and focus on most important tasks.” P20
The Westminster REFRAME workshop was generally well received by FY1 doctors. The workshop was able to instigate at least some behaviour change amongst a number of participants, who reported managing their well-being and stress differently as a result of attending the course. However, these changes did not translate into statistically significant changes in stress and well-being outcome measures.
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 improved the questionnaire completion rate and provided more reliable data on the workshop’s impact. Inclusion of a stress outcome measure was useful, as it identified this group’s high perceived levels of stress. The stronger qualitative element of the evaluation was helpful in providing data on how participants were making use of what they had learnt on the course.