Doctors in training who may be experiencing mental health difficulties are being encouraged to seek support.

The early stages of a medical career are particularly challenging.

Not only is this a time of continued training and examination in a highly demanding profession, but doctors in training are also building their personal lives alongside their careers.

As such, experiencing poor mental health at the beginning of one’s professional path might be particularly consequential for their long term prospects.

Comparisons of doctors at different career stages suggest that doctors in training experience higher levels of psychological distress compared with more senior doctors (here).

Experiences of psychological distress among our more junior colleagues are related to long working hours, career anxiety, educational debt, and low professional efficacy.

During the coronavirus disease 2019 (COVID-19) pandemic, doctors in training were at risk of experiencing additional distress due to potential exposure to the novel virus, limited resources, increased witnessing of death, and fatigue from high workloads. They also found that the pandemic disrupted their training, examinations, and other aspects of their professional development.

The mental health of doctors in training: what are the lessons we can learn from COVID-19? - Featured Image
Doctors in training were at risk of experiencing additional distress during the COVID-19 pandemic. Evgeniy pavlovski/Shutterstock

Hearing from doctors in training

During the early stages of the COVID-19 pandemic, we were interested in getting to know how Australian doctors in training were fairing and whether COVID-19-specific concerns were affecting their mental health and functioning across social and work domains.

For our study, we recruited 222 junior medical officers (mostly registrars, interns and residents) working in New South Wales between June and August 2020 to help us answer these questions.

Their responses to psychometric measures indicated that:

  • 14% of participating doctors in training had moderate-to-severe levels of general anxiety;
  • 6% had moderate-to-severe levels of depression; and
  • 12% reported at least moderately severe problems in maintaining usual levels of work and social functioning.

When it came to seeking help, half of doctors in training with more severe depressive symptoms had sought support in the previous month and about one-third of doctors in training with elevated general anxiety symptoms had sought support.

Although this is a good start, only 40% of doctors in training indicated being willing to seek support from a mental health professional should they have a personal or emotional problem.

We believe that this speaks to some of the barriers doctors face when seeking mental health support and the pervasiveness of mental health stigma, particularly among those in the medical profession.

Safety from COVID-19 as a mental health factor

Importantly, the study participants raised specific concerns about COVID-19, which were not merely a facet of generalised anxiety or persistent worry, but rather an additional stressor.

Their concerns for their family and friends during the earlier phase of the pandemic added further stress.

Think of our more junior colleagues

As Australia moves into our next stage of the COVID-19 pandemic, it is timely to pause and consider the ongoing impacts of this difficult time on doctors in training and their mental health.

In May, the latest data from the Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC‐HA) Cohort study were published.

These provided mixed messages.

On the one hand, there was evidence that some of the acute psychological distress felt by many health care workers was beginning to reduce by mid-2022.

However, the data also showed the long-term impacts of the cumulative stress felt by health care workers, such as fatigue and burnout, and more than half of respondents reported that they had considered leaving their occupation.

A promising approach to help junior doctors reach out and that could help debunk mental health stigma lies in faculty-level conversations driven by senior staff.

A study conducted in the United States found that senior physicians’ role modelling and disclosures of mental health problems had a destigmatising effect on junior doctors and encouraged utilisation of mental health care resources.

In the absence of having a trusted senior physician to speak to, listening to the ABC interview with Dr Mark Cross, a consultant psychiatrist, about his own experiences with anxiety may serve a similar function.

A call for action 

The evidence of the impact of accumulated stressors on doctors in training demands action from Government and leadership levels.

The key actions required are those that address the causes of the stress: inadequate funding for system-level adjustments that could alleviate work stressors if implemented, poor junior doctor supervision resulting from a mentoring system that often does not adequately account for supervision time, and unsafe work hours.

Alongside such interventions, consideration is also needed around how doctors in training can be empowered to seek help early, before mental health problems become entrenched.

Confidential support to junior physicians is available through various avenues.

For example, Doctors4Doctors established a confidential, free, and 24/7 available mental health support service. Qualified psychologists and counsellors are responding to calls made to 1300 374 377 and are familiar with junior doctors’ concerns.

In the midst of the acute phase of the COVID-19 pandemic, we worked together with doctors in training and the New South Wales Ministry of Health to develop a new smartphone application (app) for doctors in training.

Together, we called the app “Shift”, a combination of i) remaining unobtrusive about what the app is about, sadly necessary given the ongoing stigma around mental ill health; ii) incorporating the idea of cognitive behavioural therapy of shifting thoughts and behaviours to find back to good mental health; and iii) a nod to what needs to be done on the systems level (eg, optimise shift rostering).

Early results of testing of the Shift app were positive, and we are now refining the app in preparation for a nationwide randomised controlled trial later this year.

This will be the largest ever trial of such an intervention for doctors in training conducted anywhere in the world and we hope it will allow Australia to take an international lead in how we can protect the mental health of the next generation of doctors.

If you are a doctor in training anywhere in Australia and would like to take part come October 2023, watch out for the trial on social media, your doctors’ associations, or visit the Shift website, where you will find the study link once the trial has commenced.

Dr Samineh Sanatkar is a postdoctoral fellow within the Black Dog Institute’s Workplace Mental Health Research Program. She is the lead researcher on the Shift app project to support the mental health and wellbeing of doctors in training.

Professor Samuel Harvey is the Executive Director of the Black Dog Institute. He is a leading academic psychiatrist with international standing in clinical and population mental health research and is the Shift app project’s chief scientist.

The research described in this article was funded by the New South Wales Ministry of Health and by the National Health and Medical Research Council’s Investigator Grant awarded to Professor Harvey.

The Black Dog Institute owns the intellectual property for the Shift app, however, the app does not currently produce any income, app users are not asked to pay any fees for downloading or using the app, and the authors do not receive any financial gain from this intellectual property.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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