1. 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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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!

10. 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%)

11. 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.
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