Burnout in UK urology trainees and consultant urologists

Burnout in UK urology trainees and consultant urologists

What is the burnout problem?

Unmanaged chronic stress, arising from a myriad of toxic factors in the workplace, lowers resilience and results in mental health issues of surgical trainees and trained surgeons alike. Symptomatically this ubiquitous occupational phenomenon (2019) is known as burnout and is characterised by physical, mental and emotional exhaustion, loss of empathy, cynicism and depersonalisation. It is also associated with compromised professional performance and increased medical errors and patient complaints. Moderate to high burnout levels have been reported to occur in 50% of urological surgeons (1) about 60% of UK trainees (2).?

?15%?urologists took self-prescription drugs or used alcohol to combat burnout symptoms whilst 8% sought professional help. 60% would have accessed counselling if it had been available. In 2022 70% of trainee FY2’s took a F3 ‘year’ because they were exhausted and were uncertain about future career options. Of these up to 40% appear set to work abroad, at least initially in 2023.

Why is early burnout diagnosis not targeted in the NHS?

The reason behind these very high burnout statistics is that NHS Trusts do not have an agreed policy for diagnosing early burnout or in managing new found cases. Currently, trainees and consultants rely on their own emotional intelligence and self-awareness to identify any impaired emotional status before obtaining a burnout inventory test to assess their score. Even being symptomatic and having a moderate to high level burnout score, there is no consistent NHS Trust management in place. Ideally, NHS Trusts should consider using trained mental health wellbeing guardians whose remit would be to identify and help mitigate the toxic environmental factors responsible for causing the occupational phenomenon.??

What are the toxic environmental work factors?

Although some trainees and surgeons through their personality traits are more susceptible to developing burnout in every case the precipitating cause is toxicity existing in the workplace environment. The chief of these are work overload, work intensity and insufficient resources. The workload is also emotionally charged, patient centred with a mismatch between emotion giving rather than receiving. Trainees and surgeons may find it difficult to align their personal values to those of the NHS Trust in which they work. Trainee’s toxic factors include a crowded learning curriculum, lack of regular teaching and support, low salary, autonomy, recognition, respect, bullying and harassment, poor communication and connection between management and surgical teams. Inflexibility exists in taking leave for educational purposes, rest and recovery. For surgeon’s, administrative load, patient’s expectations, adverse events, dealing with complaints, and the emotional contagion of their work are significant issues.

What coping strategies are important in managing burnout?

For trainees the most immediate action is to personally manage their stressors by discussing them with their educational supervisors, surgical team and immediate managers in order to make remedial changes to the way they work. If they are symptomatic they should take a break from work, and talk to their GP and OH. They should have the opportunity of formal mentoring or other ‘talk therapy’ to help identify any other specific issues for which they may need bespoke solutions. Any extra non-urgent work needs to be temporarily halted.?

Trainees returning to the workplace will need some monitoring of their clinical performance. Home life should be assessed since there may be issues in this domain that require separate consideration. Informal mentoring with family, friends and colleagues is very valuable. Reviewing bad habits with a mentor and setting new ones such as exercise, mindfulness, good sleep hygiene and limited alcohol intake are important. Most trainees adapt very well with the changes they make to recover from a burnout episode and are then capable of avoiding a recurrence through using good habits.

Young consultant surgeons (<45 years) are more at risk of developing burnout than older colleagues. Often there is an acute stressor incident that precipitates their first burnout episode. This usually arises from an adverse event due to surgical error or complication. As?medico-legal ramifications settle the burnout episode typically resolves. Surgeons are most commonly burnout through overwork and emotional exhaustion. They may develop moral injury, compassion fatigue or secondary traumatic stress . As with trainees they need to reduce their work commitments, take a break for rest and recovery, craft changes to their job plan and most importantly talk with a trained mentor, their GP and OH. Self-awareness of their emotional status each evening is an efficient way of identifying early any further episodes. Very high-level burnout episodes are difficult to resolve and usually require temporary leave from work and rarely may trigger a change of professional role.

In the current NHS most trainees and surgeons will be affected by burnout. The question is ‘when’ and ‘to what degree’. Making the NHS environment a safer place to work in seems more logical than trying to increase a trainee or surgeon’s resilience to work in a ‘ flawed and dangerous system.’?

Tim R Terry

Mentor, educationalist, urological surgeon.

#burnout #trainees #surgeons

1. Rates of self-reported ‘burnout’ and causative factors amongst urologists in Ireland and the UK: a comparative cross-sectional study. Fardod O’Kelly. BJUI 2015

2. National Training Survey .GMC 2022.

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