Attrition of Trainees – The national picture SWOT ANNUAL General meeting 20th november 2018 MISS Jessica Preshaw Consultant gynaecologist, north bristol nhs trust Dr rachel ion Consultant obstetrician, north bristol nhs trust

Workforce Challenges Attrition of trainees – what are we doing wrong? Faculty of RCOG Medical educators summit 19th October 2018 Dr Heidi Stelling Leadership and Management Fellow, Health Education England - North East Dr Jo Mountfield Director of Education and Workforce; Honorary Senior Clinical Lecturer, University Hospital Southampton NHS Foundation Trust

The National Attrition Project 6 HEA’s 109 trainees All grades STAGE 2 – FOCUS GROUPS DEVISING THE SOLUTION 30% of doctors entering speciality training in O&G leave before completion All trainees contacted ~ 1800 trainees 512 responses (28%) Representing all training grades and health education offices/deaneries STAGE 1 – THE SURVEY ASSESSING THE PROBLEM

Survey Headline Results of trainees have at some point felt low in mood, depressed or anxious 89% 19% of trainees experience these feelings monthly or more frequently 79% of trainees surveyed had considered leaving Speciality Training at some point 15% of trainees considered leaving Speciality Training monthly or more frequently 4% of trainees would take a stand-alone non-training post in O&G if they left training 1 in 3 trainees are not happy with their current hospital allocation 14% required Formal Talking Therapies 8% required Cognitive Behaviour Therapies 10% required Mediation Trainees Overall

Summary Overview of Focus Group Recommendations 11 Areas for Improvement 5 Overarching Themes

Areas for improvement OVERARCHING THEMES Being valued as an individual Rota Educational supervision Exams Placement organisation ePortfolio Support SUI OOP LTFT Training programme organisation ARCP OVERARCHING THEMES Being valued as an individual Flexibility and predictability Standardisation and transparency in processes to promote fairness Access to quality support Learning focussed training

Two Key Areas 70% 41% 20% would talk to no-one about leaving Dissatisfaction with work-life balance increasing Associated with burnout Access to LTFT Flexibility Role Modelling Factors aw increased mental health concerns Survey Increased generally and focused at: ST2 >3 episodes of sickness >2 attempts at MRCOG Access to formal sources of support Educational Supervisor Focus Groups One of the 11 central domains A factor in 7 out of the remaining 10 41% Only 37% positive about work-life balance Review role and requirements of good Educational Supervision as significant numbers (41.08%) of trainees overall are having fewer than the recommend formal meetings. Reason for leaving Speciality Training: 1. Lack of work-life balance (70.34%) 2. Rota Gaps (47.87%) 3. Intense workload (45.39%) Long working hours (45.17%) Under resourced health service (44.72%) Family (44.04%) 20% would talk to no-one about leaving

Actions on Recommendations Rota Gaps: ST3 level entry Junior Doctors Contract: 1in8 working, adequate breaks, rota deadlines Wessex: trainee SPA to promote flexibility and SDL SEAC: considering HEE ARCP recommendation RCOG: supports new HEE SL policy and exception reporting SEAC: considering options to instigate transparent action of trainee feedback Curriculum review: define competence RCOG ES Task Grp: re-defining the role, approach, allocation, standardisation and training RCOG: support the Gold Guide and are Ix Burnout North East: LTFT Handbook East of England: universal access LTFT Pilot RCOG: support the Gold Guide & transparency locally re. OOP applications RCOG: exam booking issues rectified SEAC: ‘hub’ placements, longer duration, swapping RCOG: national survey and working group INDIGO study: workplace trauma RCOG: checklist great training unit and national RTW Multiple Regions: ‘step-up’ course for ST2 North East: trainee buddy system, litigation sessions RCOG: new curriculum, updated guidance on reflection practice

Don’t reinvent the wheel! Next steps WHAT ARE RCOG DOING WRONG? Improvements in training suggested Links only correlations not causation More research is needed Happy workforce is a better workforce Continue to address wellbeing and welfare of the workforce Collaborative working Shared learning WHAT ARE RCOG DOING RIGHT? Don’t reinvent the wheel!

A final note Top 5 reasons for applying Top 5 reasons for leaving Unique Mix of Medicine and Surgery Variety Rewarding Team Working Job Satisfaction Lack of work life balance (70%) Long working hours (45%) Intense workload (45%) Rota Gaps (47%) Family (44%)

Thank you for listening Acknowledgements With thanks to the trainee participants across the country who made this possible. Jo Mountfield, Supervisor Jason Waugh, Supervisor Adalina Sacco, National Trainee Committee Liason With special thanks to the following trainees for co-ordinating focus groups in their local regions and compiling data. stelling.heidi@gmail.com North, East and Central Thames east midlands Irene Gafson, Katie Cresswell, Jen Elliott Rowena Pykett Wessex (Focus Groups arranged but not attended by sufficient trainees to collect data) South West Rachel Ion, Claire Hein West Midlands Natalie Brown Nowmi Ali Thames Valley Sanyal Patel