College of Medicine and Health, University of Exeter, Exeter, UK
College of Medicine and Health, University of Exeter, Exeter, UK.
BMJ Open. 2022 Mar 28;12(3):e059397. doi: 10.1136/bmjopen-2021-059397.
To determine the factors contributing to the junior doctor workforce retention crisis in the UK using evidence collected directly from junior doctors, and to develop recommendations for changes to address the issue.
Integrative review.
Searches were conducted on Ovid Medline and HMIC to locate evidence published between January 2016 and April 2021. This was supplemented by publications from relevant national organisations.
English-language papers relating to UK junior doctor retention, well-being or satisfaction which contained data collected directly from junior doctors were included. Papers focusing solely on the pandemic, factors specific to one medical specialty, evaluation of interventions, or numerical data with no evidence relating to causation were excluded. Review papers were excluded.
Data were extracted and coded on NVivo by FKL, then thematic analysis was conducted.
47 papers were included, consisting of academic (qualitative, quantitative, mixed and commentary) and grey literature. Key themes identified were working conditions, support and relationships, and learning and development, with an overarching theme of lack of flexibility. The outcomes of these factors are doctors not feeling valued, lacking autonomy, having a poor work-life balance, and providing compromised patient care. This results in need for a break from medical training.
This review builds on findings of related literature regarding working environments, isolation, stigma, and desire for autonomy, and highlights additional issues around learning and training, flexibility, feeling valued, and patient care. It goes on to present recommendations for tackling poor retention of UK junior doctors, highlighting that the complex problem requires evidence-based solutions and a bottom-up approach in which junior doctors are regarded as core stakeholders during the planning of interventions.
使用直接从初级医生收集的证据，确定导致英国初级医生劳动力保留危机的因素，并制定解决该问题的建议。
综合回顾。
在 Ovid Medline 和 HMIC 上进行搜索，以找到 2016 年 1 月至 2021 年 4 月期间发表的证据。这一搜索结果通过相关国家组织的出版物进行了补充。
纳入的英文文献与英国初级医生保留、福利或满意度相关，其中包含直接从初级医生收集的数据。仅关注大流行、某一医学专业特定因素、干预措施评估或无因果关系证据的数值数据的文献，以及评论性文献被排除在外。
FKL 在 NVivo 上提取和编码数据，然后进行主题分析。
共纳入 47 篇论文，包括学术（定性、定量、混合和评论）和灰色文献。确定的关键主题包括工作条件、支持和关系以及学习和发展，其主要主题是缺乏灵活性。这些因素的结果是医生感到不受重视、缺乏自主权、工作生活失衡以及提供有缺陷的患者护理。这导致他们需要从医学培训中休息一下。
本综述在有关工作环境、孤立、污名化和自主愿望的相关文献发现的基础上进一步扩展，并强调了学习和培训、灵活性、价值感和患者护理方面的其他问题。它接着提出了解决英国初级医生保留率低的建议，强调了这个复杂的问题需要基于证据的解决方案和自下而上的方法，在规划干预措施时应将初级医生视为核心利益相关者。
