A qualitative exploration of stressors in anaesthesia training in the UK and mechanisms to improve resident wellbeing

INTRODUCTION: High levels of stress and burnout have been identified among resident anaesthetists in UK training programmes. Factors involving clinical roles, workplace culture and training are known stressors, but in-depth research investigating how to improve wellbeing is limited.

METHODS: We used a qualitative design in two phases with participants from across the UK. Phase 1 involved semi-structured interviews of resident anaesthetists in the 2nd-5th years of training, and educational stakeholders. Phase 2 involved additional participants in two focus groups, one each for residents and stakeholders. Interviews and focus groups were conducted online, audio-recorded and transcribed for thematic analysis using a framework approach.

RESULTS: We interviewed 52 participants in phase 1, comprising resident anaesthetists from England, Wales and Scotland and key educational stakeholders. A further 11 resident anaesthetists and stakeholders participated in the phase 2 focus groups. We identified four overarching themes contributing to stress: clinical work; non-clinical work; structure of training; and workplace culture. We also identified supportive features at individual, local, regional and national levels. Stress and burnout were commonplace, particularly during demanding periods of training. Balancing non-clinical commitments alongside busy workloads was difficult. Clinically, intensive care medicine and obstetrics generated the most stress. Frequent rotations and long commutes increased stress, impacting on working and family relationships. Curriculum changes, examinations and competition for higher training posts caused stress and poor morale. Proposed mechanisms to improve wellbeing include: peer-to-peer support; request-based rotas; adoption of 'lead employers'; decreasing rotation frequency and commuting distances; access to less than full-time working and professional support; and adapting the structure of training to improve the stability of the resident anaesthetist workforce.

DISCUSSION: Attention to the factors identified as contributing to stress could improve resident anaesthetists' wellbeing through changes to policy and practice at local, regional and national levels, for which we make research-informed recommendations.