Thriving under pressure: occupational stress and the performance, development and wellbeing of doctors in training (12/21)

Occupational stress is linked with 7 of the 10 commonest causes of death, and accounts for 37% of work-related ill health and 45% of lost working days. Chronic or repeated stress exposure alters the physiological response to acute stressors and may cause ill health through persisting changes in autonomic, immune, cardiovascular or psychological function. Occupational stress is particularly endemic in healthcare, and is associated with poor long-term career and health outcomes. Workforce development and productivity is central to the NHS England Long Term Plan, including commitments to expand the medical workforce and ensure that support is available to manage the complex and often highly stressful nature of delivering healthcare.

Although stress is typically seen as undesirable, it is noticeable that not all doctors falter under the stress they encounter. Indeed, some thrive. This programme of research aims to understand variability in response to stress from a psychophysiological perspective, and how such variability influences the performance, development and wellbeing of doctors in postgraduate training. It thereby aligns with UKRI cross-council research priorities and requires an interdisciplinary approach across psychology, physiology, education and health research.

The intended research programme comprises three studies. The first will use a cross-sectional design to examine whether psychophysiological responses to stress are associated with performance and wellbeing in doctors in the early stages of training after graduation from medical school. Stress responses will be assessed using subjective self-report items and objective physiological measurements, for example using impedance- or electro-cardiography, salivary cortisol and alpha amylase. Performance will be assessed using standard workplace assessment items. Wellbeing will be monitored with validated measures such as the WHO5 index.

The second study will use a longitudinal design to monitor stress responses in doctors in training over time, using the same measures as in study 1. Stress response trends will be evaluated for associations with wellbeing, performance in the workplace and professional development. Professional development will be assessed by subjective self-report and by the outcome of routine progress monitoring in postgraduate training, for example through the Annual Review of Competence Progression. Thriving can be defined as a joint experience of success and development. This study will explore relationships between stress responses and thriving.

Depending on the findings of studies one and two, a third study will investigate the effects of an intervention designed to optimise psychophysiological responses to stress for performance, development and wellbeing in doctors in training. Specifically, this intervention will aim to alter the way postgraduate trainees view stress and associated physiological arousal, and measure the effect on subsequent stress responses, workplace assessment performance, professional development and thriving.

A better understanding of occupational stress in medical trainees offers the potential to prospectively identify learners who might benefit from targeted early support, and to facilitate the development of evidence-based interventions to equip doctors with the capabilities required to thrive under pressure. Therefore, the findings of this PhD may help safeguard the productivity and wellbeing of the future healthcare workforce and, ultimately, improve patient safety.