Dominic Arnold: Junior doctor changeovers need a steadier start

The current sink or swim approach to junior doctors starting new rotations serves neither doctors nor patients, says Dominic Arnold

It’s August, that time of year when many junior doctors are migrating to pastures new. It means saying farewell to the team you have often spent more time with than your partner, closest friends, or children these past few months, and taking another plunge into the deep end of a new speciality, or at the very least a new department, with all the new characters and systems that this entails. 

The knowledge and skills you’ve spent the past few months developing and honing may be of little use in this new field. You’ve finally got good at those ABGs, however that’s not going to be much use in community psychiatry. The OCTs you’ve got used to interpreting in ophthalmology won’t help in A&E. During these upheavals, it has become clear to me that we need to become better not only at recognising the impact that these transitions have, but at supporting doctors’ adjustments through them.

Starting a new rotation is like the first day at a new school (with likely even less choice than you had back then), where you know no one and feel more than out of your depth. The difference being that at this school, you’re not only trying to learn a new discipline, you’re also putting it into practice on the immediate nights you’ve been rota-ed onto with sometimes threadbare staffing. While these processes can clearly be formative, enabling doctors to develop wide ranging experiences and knowledge that help us to care holistically for our patients, it’s not a stretch to see how they can also be challenging and stressful. 

The maxim “what doesn’t kill you makes you stronger” is oft quoted, but whether this thrust into the deep end approach is constructive or damaging to trainees is debatable. The desire to just get one’s head down and power through such times is strong, but would giving doctors a more measured familiarisation of departments and teams help with this transition? And would easing doctors through this transition not only help reduce burnout but also improve patient care? It is a very human desire to want to belong, but every four to 12 months we ask our junior doctors to start again in their fundamental working relationships—something which cannot fail to have an impact on both the doctors themselves and the teams they join. 

We know from the latest GMC survey just how many doctors in training feel highly burnt out—nearly 25% at present—and these periods only contribute to this. As junior doctors we evidently have the ability to improve things on the ground, but it can also feel like you’ve hardly got your feet under the table before you’re whisked away again, making it hard to begin to think about departmental changes that could improve such transitions. It shouldn’t be entirely down to the individual struggling in such a period to try to address what are systemic issues and their predictable consequences. 

I know that during these times of transition, I must have heightened awareness of the importance of looking after myself, although finding the time can often be a challenge. But there must be a broader acknowledgement of the strains this changeover period creates, and a system wide attempt to adapt these pressure points. Is it helpful to patients, wards, or doctors themselves to start on nights? Is it constructive for doctors’ short and long term development? 

The induction to new departments should be more than the current tick sheet and “get on with it” approach that it can often be. Corporate induction should be about more than presenting your certificates and a hand washing test. A more measured, formalised, and steady start would be a huge help to doctors and their new teams alike—something that can only be done through better rota design, which acknowledges these migrations for the upheavals that they can be and thus mitigates them.

In the meantime, as I’m facing my own move this month, I’ll continue to say thank you for the patience of my new team, my old colleagues, and my patients.

Dominic Arnold is a GP trainee in North Cumbria.

Competing interests: None declared