Exploring intrawork break taking in doctors before and during the Covid-19 pandemic

Abstract

Burnout in doctors is a longstanding, prevalent public health issue. The Covid-19 pandemic posed an additional threat to doctors’ wellbeing, particularly for those who began careers at the pandemic onset. Intrawork rest breaks could be a helpful means of improving doctors’ wellbeing. This project explored break taking in UK doctors before and during the pandemic.

Systematic review of literature on the effectiveness of breaks for doctors’ wellbeing and/or job performance found a widespread lack of evidence, in quantity and quality, and identified a need for further exploratory research. A longitudinal mixed methods design sought to fill this evidence gap. Quantitative surveys preceded explanatory follow-up semi-structured interviews in two phases (pre-pandemic and post-pandemic outbreak).

In a pre-pandemic survey of doctors of all grades (N=250), repeated twice during the pandemic with newly-qualified foundation doctors (July/August 2020 N=78; November 2020 N=58), most participants perceived breaks as important to wellbeing but were unable to take breaks daily or weekly. Workload and staffing levels were most commonly cited barriers, and lack of break facilities the least cited barrier. Interventions most likely to facilitate breaks were those that reduced workload and/or granted permission. Interventions most often implemented by NHS trusts (e.g. facility improvements, reminders) were ranked least likely to make a difference.

In pre-pandemic follow-up interviews (N=21) participants described a range of structural, procedural, and individual factors that interact to affect break practices, and interventions that could attenuate these effects. Interviews with doctors of all training grades at the pandemic onset (N=12) and foundation year doctors one year later (N=9) explored factors affecting break practice and work experiences under pandemic conditions, and potential areas for intervention. Compared with pre-pandemic narratives, individuals described having more passive roles, which focused on coping with, rather than changing, the considerable disruption to structures and procedures under pandemic conditions. Integration of findings across studies and chronological phases resulted in a proposed conceptual model of break taking in doctors.

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Identifiers

ORCID for Aimee Nicole O'Neill: orcid.org/0000-0002-5358-6944

ORCID for Julia Sinclair: orcid.org/0000-0002-1905-2025

ORCID for David Baldwin: orcid.org/0000-0003-3343-0907

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