Beyond the bubble baths: enhancing medical trainee wellbeing

The path to improved wellbeing in medicine requires a balance of self-care and systemic change, transforming the training environment to address the underlying causes of burnout and advocating for holistic support in the personal and professional growth of medical trainees.

When I say “wellbeing” in the context of medicine, it often conjures up images of individual acts of self-care: a medical student taking a yoga class to manage stress, or a registrar indulging in a relaxing bath to unwind after a demanding schedule. Although these personal practices are essential components of maintaining our health and resilience, the conversation around wellbeing in medical education needs to venture beyond the yoga mats and bubble baths. The essence of fostering true wellbeing lies not just in cultivating personal habits but in driving systemic changes that address the underlying causes of stress and burnout in the medical profession.

The process of medical education is like finding your way through a vast, ever-shifting maze. Students enter with a sense of purpose, eager to discover the paths that lead to clinical expertise. The journey is fraught with dead ends and confusing turns, symbolising the long hours of study, the pressure of exams and the emotional toll of patient care. Self-care acts as a map and compass, essential tools for finding the way through immediate obstacles. However, if the maze is constructed with barriers that obscure the exit, the effectiveness of personal navigation tools is debatable. How far can personal tools take us in a system fraught with barriers to wellbeing?

The prevalence of burnout among medical professionals is alarmingly high. Studies estimate over 50% of doctors, from interns, registrars to consultants, may experience burnout, which comprises emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment. These statistics reflect a global challenge for the medical profession and broad systemic issues within health care systems. The challenges are multifaceted, ranging from excessive workloads and high pressure environments to insufficient mental health support and a culture that often stigmatises seeking help. These factors collectively contribute to a health care environment in which wellbeing is compromised.

Rhetoric that emphasises the importance of self-care is not frivolous; it strives to empower individuals to maintain their physical and mental health amidst the rigorous demands of medical training and practice. Activities such as exercise, mindfulness and adequate rest are proven strategies that help mitigate the effects of stress and prevent burnout. However, these strategies often treat the symptoms rather than the cause. They are akin to applying a bandage to a wound without removing the underlying aetiology of the injury. If the educational and health care systems continue to operate in ways that inherently compromise wellbeing, then no amount of self-care can fully protect individuals from harm.

This is where the drive for systemic change comes into play. Systemic change means re-evaluating and restructuring the environments in which medical education and practice take place. Evidence suggests interventions targeting organisational culture and policies are more effective in reducing burnout and improving wellbeing, than those focusing solely on individual strategies. The recent junior doctor class action in both NSW and Victoria is a poignant example of how unpaid overtime is one such pervasive systemic issue. This underscores the importance of addressing the structural aspects of medical training to foster a more holistic approach to wellbeing, and in turn, facilitate a sustainable medical workforce.

Indeed, the dynamic and complex nature of medical education warrants both personal and systemic approaches to wellbeing. Just as Personal Protective Equipment (PPE) — masks, gloves and gowns — serves as an immediate protective measure for health care workers against potential pathogens, personal self-care acts as a frontline defence against the daily stresses faced by medical trainees. However, relying solely on PPE without addressing the broader infection control and workplace safety policies would be a short-sighted approach to managing health risks in a health care setting. Similarly, focusing only on self-care without seeking to change the systemic factors that contribute to poor wellbeing is an incomplete solution. This dual approach underscores the critical balance between personal responsibility and systemic support to enhance both the immediate wellbeing of individuals but also provides a foundation for a healthier, more sustainable medical education system.

The challenge of systemic change in medicine is formidable, compounded by deeply ingrained traditions, structural barriers and the sheer complexity of the health care system. Several systemic factors contribute to poor wellbeing among medical trainees, including but not limited to, excessive workload, shift work, competitive specialty training programs, insufficient career support, stigma around seeking help for mental health issues and the norm of a punitive approach to mistakes.

Addressing these factors requires a multifaceted approach. For instance, implementing policies that ensure reasonable working hours and promote flexible working arrangements may help alleviate stress. Creating a culture that genuinely values openness and understanding, with protected time for personal care can reduce the stigma around mental health. Moreover, integrating wellbeing education into the curriculum can equip trainees with the skills they need to navigate the nuanced challenges of their profession. Additionally, fostering a supportive community and mentorship programs can provide the necessary emotional and professional support to navigate the complex journey of medical education. These are not mere adjustments but fundamental shifts that acknowledge the importance of wellbeing and actively work to embed it within the fabric of medical education and practice. By focusing on systemic changes, we can create an environment where self-care is not a desperate response to overwhelming stress but a complementary practice within a supportive health-promoting system, which inevitably can bolster retention and reduce burnout. It involves addressing workload, improving access to mental health resources, creating supportive community networks and cultivating a culture in health care services that values and prioritises the wellbeing of our doctors, just as much as the patient outcomes.

Inevitably, these changes are not without barriers. Institutional inertia, budget constraints and resistance to cultural change are significant hurdles. The competitive nature of medical training, combined with traditional views on medical education and practice, often prioritises academic achievement and clinical excellence over personal wellbeing. Overcoming these barriers requires collective action from all stakeholders in the medical education community to adopt a shift in mindset. It calls for leadership committed to wellbeing, investment in mental health resources, and continuous advocacy for a healthier, more balanced approach to medical training. Furthermore, systemic change must also address the broader societal factors that impact the medical wellbeing, such as the social determinants of health and access barriers to health care. The wellbeing of medical trainees is intertwined with the health of the communities they serve, highlighting the need for a holistic approach that considers both individual and societal health.

Fortunately, there is growing awareness of the need for systemic support for medical trainee wellbeing. The National Medical Workforce Strategy articulates improving doctor wellbeing as one of the top three themes. In 2022, an amendment to the Hospital and Health Boards Act 2011 stipulated that health services are responsible for the wellbeing of health care professionals. From 2024, the AMC Prevocational Framework for Medical Training has incorporated new wellbeing standards, which are now on the radar for many specialist medical training colleges, while AIDA advocates for Aboriginal and Torres Strait Islander specialist trainees.

Beyond the occasional events that raise awareness of doctors’ mental health and wellbeing, such as the recent annual Crazy Socks 4 Docs day, there are a number of support services aimed at doctors in training. Administered by Drs4Drs, each state and territory have a doctors’ health service that offers confidential advice and counselling. Accessible to all health care professionals, Hand-n-Hand provides free, confidential peer support and the Black Dog Institute offers resources and telehealth sessions through The Essential Network. Additionally, most hospitals have a junior doctor society and each state has an AMA Committee for Doctors in Training, which continues to advocate for better support from the health care system.

In essence, the path to improved wellbeing in medical education is both complex and challenging. It necessitates a collaborative effort to reshape the training environment to support both the personal and professional growth of doctors in training, where wellbeing is not just woven into the fabric of training but celebrated as a cornerstone of professional excellence and personal fulfillment. Just as the medical profession commits to healing others, it must equally prioritise the nurturing of its own, ensuring that wellbeing is not merely an adjunct to education but the very heartbeat of it. By addressing the systemic factors that contribute to burnout and overcoming the obstacles to reform, the medical profession can cultivate an environment where wellbeing transcends the superficial notions of yoga and bubble baths to become a tangible reality for all.

What would our health care system look like if the wellbeing of medical professionals was prioritised?

Dr Emma Hodge is the medical education and wellbeing registrar at Wide Bay Hospital and Health Service.

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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