UK Doctors Research Articles

Is there a sufficient supply of clinical academics for UK medical schools? A retrospective cohort study

ObjectivesClinical academics lead research to deliver medical advancements while also teaching in medical schools to maintain high-quality medical services. The objective of this project was to determine if there is...

Towards inclusive healthcare: evaluating knowledge, confidence and awareness of LGBTQ + health among Internal Medicine Trainees in London

BackgroundPatients from the lesbian, gay, bisexual, transgender, queer plus (LGBTQ +) community face various health inequalities and report poor healthcare experiences. Little is known about how knowledgeable and confident UK doctors are around LGBTQ + health, and previous research demonstrates that UK medical schools rarely deliver teaching in this area. This research evaluated the level of knowledge, awareness and confidence of LGBTQ + health among Internal Medical Trainees (IMTs) in London.MethodsLondon IMTs were invited to complete an online questionnaire evaluating knowledge, awareness and confidence in LGBTQ + health. Stratified analysis of results by demographics was performed.ResultsThree hundred and fifteen surveys were analysed from 796 eligible trainees (40%). Confidence in caring for LGBTQ + patients was variable. Confidence in discussing gender identity was lower than for sexual orientation. Knowledge of health issues affecting LGBTQ + patients varied. Most participants had never received training on LGBTQ + health at undergraduate (n = 201, 64%) or postgraduate level (n = 252, 80%), but the majority of participants felt that training would be useful (n = 233, 74%). Stratified analysis revealed that IMTs who received previous LGBTQ + teaching at undergraduate or postgraduate level were considerably more confident discussing sexual orientation with patients, compared to those who received no previous teaching.ConclusionsThere is a clear need for education on LGBTQ + health, given the varied levels of knowledge and confidence identified. A significant majority of IMTs in London have never received teaching on LGBTQ + health, although there exists a strong desire for this. LGBTQ + health topics should be integrated into undergraduate and postgraduate training and examinations for IMTs. This would support IMTs in delivering high quality and inclusive care for all patients, particularly those of sexual orientation and gender identity minorities. There are relatively few published studies exploring competency in LGBTQ + health among doctors, and this is the first among UK Internal Medicine Trainees.

Reassessing ‘good’ medical practice and the climate crisis

In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of...

Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review

BackgroundEye emergencies constitute a significant portion of attendances to general Emergency Departments (EDs) in the UK, therefore it is important to assess the confidence of doctors who work in this setting in managing these potentially sight- and life-threatening presentations. This systematic review aims to assess the confidence of UK doctors working in general EDs in managing ophthalmic emergencies.MethodsMEDLINE (Ovid), EMBASE (Ovid), ProQuest Central and Web of Science databases and grey literature were searched from inception to 1 October 2022 for publications that (1) featured doctors working in UK general EDs, (2) assessed doctors’ confidence in managing ophthalmic emergencies, (3) contained original data, (4) were full-text, and (5) written in English. Methodological quality was assessed using the AXIS tool.Results462 articles were screened, and 7 papers included for data extraction, which collectively assessed the confidence of 956 doctors working in EDs in managing ophthalmic emergencies. There was a widespread lack of confidence amongst foundation doctors, which has worsened over time. Most doctors lacked confidence in performing funduscopy and using the slit-lamp, and considered formal ophthalmology training received in EDs to be inadequate.ConclusionsEvidence suggests a lack of confidence amongst foundation doctors in managing ophthalmic emergencies. High-quality evidence investigating the confidence amongst more experienced Emergency Medicine (EM) physicians was lacking. It is important to assess why foundation doctors feel so ill-prepared to manage eye emergencies and develop further ophthalmic training for doctors working in EDs. Further investigation exploring the confidence of EM trainees and consultants is required.

Determining the distance patterns in the movements of future doctors in UK between 2002 and 2015: a retrospective cohort study

ObjectiveTo determine and identify distance patterns in the movements of medical students and junior doctors between their training locations.DesignA retrospective cohort study of UK medical students from 2002 to 2015...

UK doctors’ strikes 2023: not only justified but, arguably, supererogatory

The 2023 doctors’ strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors’...

Sustained benefits of a generalist training programme for UK doctors: a survey-based follow-up study

ObjectivesThe study aimed to conduct a follow-up of all broad-based training (BBT) trainees who participated in the original evaluation completed in 2017. The follow-up study explored the impact of BBT...

One in Four UK Doctors Are Using Artificial Intelligence: Exploring Doctors' Perspectives on AI after the Emergence of Large Language Models

One in Four UK Doctors Are Using Artificial Intelligence: Exploring Doctors' Perspectives on AI after the Emergence of Large Language Models

Roadblocks to reforming UK guidelines on medically unnecessary penile circumcision: inconsistent safeguarding of bodily integrity

Medically unnecessary penile circumcision (MUPC) performed on a non-consenting child has been the subject of increasing critical attention in recent years. This paper provides a behind-the-scenes narrative of the politics of ethical policymaking in the United Kingdom in this area including a discussion about some potential barriers to reform. After a brief overview of ethical guidance for medically unnecessary surgical procedures on children in general and on their genitalia in particular, the paper takes a closer look at three contemporary documents released by UK medical bodies and highlights the unique ethical and safeguarding contradictions in this area. The outcomes of initiatives aimed at engaging constructively with the medical bodies and encouraging wider debate are then described, along with some of the main obstacles to engagement and counter-arguments employed. MUPC is subsequently discussed in a wider societal context, highlighting why serious safeguarding concerns have been raised about what many people believe to be a harmful, preventable practice hiding ‘in plain sight’. The paper ends by calling for UK MUPC guidance to be made consistent with the body of guidance that UK doctors are expected to follow.

Post-acute COVID-19 complications in UK doctors: results of a cross-sectional survey.

As a consequence of their occupation, doctors and other healthcare workers were at higher risk of contracting coronavirus disease 2019 (COVID-19), and more likely to experience severe disease compared to the general population. However, systematic information on post-acute COVID complications in doctors is very limited. This study aimed to determine the symptoms, perceived determinants, health and occupational impact, and consequent needs relating to post-acute COVID complications in UK doctors. An online cross-sectional survey was distributed to UK doctors self-identifying as having Long COVID or other post-acute COVID complications. Of 795 responses, 603 fulfilled the inclusion criteria of being a UK-based medical doctor experiencing one or more post-acute COVID complications. Twenty-eight per cent reported a lack of adequate Respiratory Protective Equipment at the time of contracting COVID-19. Eighteen per cent of eligible respondents reported that they had been unable to return to work since acquiring COVID. Post-acute COVID (Long COVID) in UK doctors is a substantial burden for respondents to our questionnaire. The results indicated that insufficient respiratory protection could have contributed to occupational disease, with COVID-19 being contracted in the workplace, and resultant post-COVID complications. Although it may be too late to address the perceived determinants of inadequate protection for those already suffering with Long COVID, more investment is needed in rehabilitation and support of those afflicted.

Taking a Break? The Growing Trend of FY3: Why More Junior Doctors are Taking Time Out after the Foundation Programme and What They Elect to Do?

There is a growing trend of UK doctors taking time out of clinical training following completion of the Foundation Programme. At a time when NHS services are facing unparalleled demand, considering the reasons why early career clinicians are deciding to delay entry into specialist training is paramount. Here, we describe some of the push and pull factors contributing to the “FY3” year phenomenon as well as the avenues doctors explore. Within the NHS, clinical fellowships can offer more flexibility in terms of rota and location compared to specialty training posts whilst also providing clinical experience and the chance to develop highly sought-after skills in teaching, research, and leadership. Similarly, locum rotas can be negotiated and usually offer significantly enhanced pay. Outside of the NHS, healthcare systems in Australia, New Zealand, and Canada actively seek out UK doctors, incentivising them with better work–life balance, increased pay, and improved working conditions, leading many doctors who had intended to return to the NHS to stay abroad. Doctors are also becoming increasingly aware of their transferable skills and the value they can bring to non-clinical roles in the pharmaceutical industry, management consulting, and medical law. Although the FP was originally introduced to address issues surrounding career progression and poor training experiences, current push factors for taking an “FY3” including increasing competition for specialty training posts, an imbalance towards service provision versus training, and high workload suggest systemic issues within the UK health service are undermining this aim and ultimately leading doctors to take time out of training.

O.2.1-9 Are doctors and nurses engaging in physical activity and its promotion?

Abstract Purpose Healthcare professionals (HCPs) are ideal providers of physical activity (PA) promotion; a large portion of the population have contact with a form of HCP and they are viewed as trusted and respected role models for health advice. Despite this, we have a very limited understanding of HCPs PA counselling practices. The aim of this study was to evaluate PA levels, attitudes towards PA counselling and counselling practices of UK doctors and nurses. Methods The study included two cross-sectional, anonymised, online surveys conducted in 2018/19 (survey 1) and 2019/20 (survey 2). Whether or not participants were achieving the aerobic PA guideline was evaluated using the first 2 questions of the Scot-PASQ survey. Counselling practices were assessed using likert scales to assess the proportion of patients that participants had discussed PA with in the past week and their perceived importance of PA counselling as part of their role. Results 460 doctors and 169 nurses from the UK completed the survey. 78.3% of doctors and 73.4% of nurses met the UK aerobic PA guidelines. Perceived importance of counselling was high but participants were providing PA counselling on average for less than 25% of their patients. PA counselling was more likely in primary care and doctors were marginally more likely than nurses to counsel on PA. Conclusion This cohort of doctors and nurses were active and viewed PA counselling as important. Despite this, PA counselling levels were low especially in secondary care. Efforts should be made to improve knowledge of, and opportunity for, PA counselling in HCPs.

Exploring reasons behind UK doctors leaving the medical profession: a series of qualitative interviews with former UK doctors

BackgroundThe retention of doctors is an important issue for the National Health Service; yet evidence suggests that the proportion of doctors wanting to leave UK medicine is increasing. Some of...

Trends and determinants of GPs' work hours in the UK: a quantitative study.

Information on the hours of work of UK doctors is limited, and what exists relies on self-designed questionnaires in England. To understand trends in the annual stock of physicians' hours and their main determinants. A quantitative study in which data were collected from the Quarterly Labour Force Survey (QLFS) between 1998 and 2020, under the End User Licence (EUL), in the UK. Descriptive and linear regression models of labour supply for doctors (pooled), GPs, and hospital doctors. Between 1998 and 2020, while the headcount of doctors grew by 128.79% for hospital doctors and 45.28% for GPs, hours of work dropped by 20.80% for hospital doctors and 25.37% for GPs. Hence, the annual stock of hours grew by 81.20% for hospital doctors but by a modest 8.42% for GPs. Female doctors worked 8.68 fewer hours than males, with GPs reporting the largest reduction (-11.82 hours, 95% confidence interval [CI] = -13.31 to -10.33 and -6.75, 95% CI = -9.32 to -4.19, in the full specification). Family decisions are associated with a fall in doctors' work hours and modest growth in the annual stock of hours. These determinants and overtime are drivers of part-time work. Despite the increase in the headcount of GPs, their hours of work dropped over the study period, generating a more steady and modest growth in their total annual stock of hours compared with hospital doctors. Female GPs work fewer hours than male GPs and are more likely to work part-time due to childbearing, marriage/co-habitation, and overtime work.

Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study.

The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. DERR1-10.2196/40545.

Workplace support for newly qualified doctors and secondary school teachers: A comparative analysis

AbstractDoctors and teachers in their first year of practice face steep learning curves and increased stress, which can induce poor mental health, burnout and attrition. Informal workplace support from colleagues can help smooth transitions and aid professional development. A three‐phase comparative research design was used to explore who provides informal workplace support to early‐career professionals, types of support and influencing factors. Phase 1 was a systematic secondary analysis of interviews and audio diaries from 52 UK doctors in their first year of foundation training (F1s). Phase 2 involved new narrative interviews with 11 newly qualified teachers (NQTs) from English secondary schools. Phase 3 was a comparative analysis to produce a model of workplace support. Given barriers to accessing senior doctors, F1 doctors drew upon nurses, pharmacists, microbiologists, peers/near‐peers and allied healthcare professionals for support. NQTs gained support from allocated mentors and seniors within subject departments, as well as teaching assistants, allied support staff and wider professional networks. Support types for both professions included information and advice on practice, orientation to local settings, collaborative development activities, observation and feedback, and socioemotional support. Influencing factors included variable departmental cultures, limited opportunities for informal contact, sometimes negative inter‐group perceptions and the agentic responses of novices. The resulting workplace model of support could underpin future research and evaluations of support in similar ‘hot‐action’ environments. In medicine and teaching, greater utilisation of near‐peers and allied staff, improved role understanding and communication, increased informal contact and sharing successful strategies across professions could enhance supportive relationships.

“Helping people get back on their feet”—UK doctors in Turkey share their earthquake stories

“Helping people get back on their feet”—UK doctors in Turkey share their earthquake stories

How do endocrinologists and GPs perceive contemporary transgender care?: results from a qualitative study of UK doctors

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

UK Doctors Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study.

Despite strategies to enable Health Care Professionals (HCPs) to give physical activity (PA) advice to patients, this appears to be rarely done in consultations. The aims of the present study were to gain an understanding of doctors’ awareness of current PA guidelines and to explore their opinions on barriers and solutions. A qualitative approach using semi-structured interviews was adopted. This study included 15 doctors currently working in the UK’s National Health Service (NHS). A thematic analysis approach was used to analyse the transcripts. Four themes and twelve sub-themes were deciphered. Intrinsic factors limiting the delivery of PA advice included a lack of knowledge of PA guidelines and PA being an afterthought. Barriers to delivering PA guidance included a lack of PA education, time pressures, and patient engagement. Solutions included staff training, incorporating PA into undergraduate training, and encouraging staff to be physically active. Methods to optimise PA guidance included individualised PA advice, local exercise services and schemes, utilising online and visual resources, and motivational interviewing. This study provides an updated insight into doctors’ opinions on barriers and solutions to discussing PA with patients. It is clear that further work is needed to ensure greater awareness of PA guidelines amongst clinicians.

ATTITUDES, WORK ROLES AND BARRIERS TO NUTRITION CARE - INTERVIEWS WITH AUSTRALIAN AND UK-BASED MEDICAL DOCTORS.

Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Semi-structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model.