Martin Amy, Jamieson Susan
Yorkshire and Humber School of Public Health, Leeds, UK; Leeds Institute of Medical Education, University of Leeds, Leeds, UK.
School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.
Lancet. 2023 Nov;402 Suppl 1:S68. doi: 10.1016/S0140-6736(23)02084-6.
The term "Shielding" was introduced in the UK during the COVID-19 pandemic to protect approximately 4 million people at highest risk from infection. Shielding was characterised by extreme isolation and applied to those with certain illnesses, disabilities, and during pregnancy. For the estimated 1300 high-risk doctors, shielding meant abrupt departure from the clinical environment. We aimed to understand the impact of shielding on junior doctors (JDs) by interviewing them and their consultants.
This qualitative study used individual semi-structured interviews and reflexive thematic analysis. Virtual interviews were conducted between Sept 2, and Nov 30, 2022, using an interview guide, including open questions around impacts on training, career, and health. 11 JDs and 2 consultants were recruited via Scotland-wide purposive and snowball sampling. Written informed consent was obtained. 12 of 13 participants were women. Eight JDs were shielding because of health issues, and three because of pregnancy. Participant specialties included primary care, secondary care, and foundation and specialty training. Interview transcripts were coded by the lead author and the second author acted as a critical friend.
Despite making important contributions working from home, most JDs (73%, eight of 11) felt that their work was undervalued during shielding. They felt forgotten, feeling they had to "pester" supervisors to be allocated work. All participants reported inadequate support at Occupational Health and workplace levels, including limited supervision or information about training impacts. Negative attitudes towards JDs were experienced by 82% (nine of 11) of JDs, including being denied reasonable adjustments and threatened with dismissal if not following shielding advice. Consultants described supervisory challenges including not receiving guidance or resources and ongoing issues supporting disabled and pregnant JDs beyond the pandemic.
These findings offer novel qualitative insight into the impacts of shielding on JDs in Scotland. Findings indicated that support infrastructure was not fit for purpose. Given the significant number of JDs that take prolonged leave from the clinical environment, and the JDs working with disabilities and during pregnancy, these findings are of ongoing concern. Although the sample size was small and the study was set in a specific region, these findings suggest there is potential to improve support infrastructure and move towards a more inclusive clinical environment that recognises, celebrates, and benefits from the value of a diverse workforce.
Scottish Medical Education Research Consortium.
“防护”一词在英国新冠疫情期间被提出，旨在保护约400万感染风险最高的人群。防护的特点是极度隔离，适用于患有某些疾病、残疾以及孕期的人群。对于估计1300名高风险医生而言，防护意味着突然离开临床环境。我们旨在通过采访初级医生（JDs）及其顾问来了解防护对他们的影响。
本定性研究采用个人半结构化访谈和反思性主题分析。2022年9月2日至11月30日期间进行了虚拟访谈，使用了一份访谈指南，包括围绕对培训、职业和健康影响的开放性问题。通过全苏格兰的目的抽样和滚雪球抽样招募了11名初级医生和2名顾问。获得了书面知情同意。13名参与者中有12名是女性。8名初级医生因健康问题进行防护，3名因怀孕进行防护。参与者的专业包括初级保健、二级保健以及基础和专科培训。访谈记录由第一作者编码，第二作者担任关键审校人。
尽管在家工作做出了重要贡献，但大多数初级医生（73%，11名中的8名）认为他们在防护期间的工作被低估。他们感到被遗忘，觉得必须“纠缠”上级才能获得工作安排。所有参与者都报告在职业健康和工作场所层面缺乏支持，包括监督有限或缺乏关于培训影响的信息。82%（11名中的9名）的初级医生经历了对他们的负面态度，包括被拒绝合理调整，以及如果不遵循防护建议就受到解雇威胁。顾问们描述了监督方面的挑战，包括未收到指导或资源，以及在疫情之后为残疾和怀孕的初级医生提供支持方面仍存在问题。
这些发现为防护对苏格兰初级医生的影响提供了新的定性见解。结果表明支持体系不适用。鉴于大量初级医生长期离开临床环境，以及残疾和怀孕的初级医生仍在工作，这些发现一直令人担忧。尽管样本量小且研究是在特定地区进行的，但这些发现表明有改善支持体系的潜力，并朝着一个更具包容性的临床环境迈进，该环境认可、赞扬并受益于多元化劳动力的价值。
苏格兰医学教育研究联盟。
