How does the F3 aid burnout recovery in post-foundation year doctors? - a qualitative study applying organisational behavioural frameworks

Abstract

Summary: This presentation explores clinician burnout in the NHS, focusing on junior doctors and the role of F3 career breaks in burnout recovery. It identifies four themes, discussing how F3 contributes to addressing burnout's clinical features, culminating in a novel framework for promoting enduring burnout recovery in early-stage training: a positive mindset shift. The mindset shift enables better career expectation management and improved work-life boundaries. Organisational recommendations are discussed to enhance support for F3 and its relevance to NHS workforce planning.IntroductionMass clinician burnout in the NHS is an increasingly well-evidenced phenomenon, with adverse work-related stress recently reported to affect 77% of junior doctors. Contrastingly, burnout recovery within this demographic is sparsely considered in the literature despite its role in addressing workforce longevity. F3, a career break taken by junior doctors straight after UK Foundation Training (FT), has risen in incidence, becoming a widely-accepted feature of training pathways (1). Although burnout is indicated as the primary driver in clinicians’ decisions to pursue F3, an organisation-level understanding of if and how clinicians are using F3 for burnout recovery is notably absent. Methods: 12 semi-structured interviews with clinicians returning to training post-F3 were conducted, reaching theoretical saturation. Deductive thematic analysis was performed via NVivo and organisational behavioural theory applied to understand data phenomena. Results: Four dimensions comprising 13 subthemes emerged from the data: post-FT burnout (comprising self-awareness of burnout during FT, established coping mechanisms pre-F3 and burnout drivers in FT), opportunities in F3 (F3 utility, wellness, autonomy and professional development), planning F3 (structure, logistics and expectations) and retrospective perceptions of F3 (positives, downsides and attitudes on return to training). F3 collectively led to burnout recovery via addressing all three clinical features of burnout – emotional exhaustion, depersonalisation, and feelings of personal ineffectiveness at work. Discussion: The autonomy of F3 allows clinicians to engage in self-elected recovery activities, forging the ability to craft healthier relationships with their work. Crucially, this endured post-F3. As such, a mindset shift amongst clinicians towards work that persisted following returning to training was identified. This attitude change allowed clinicians to recalibrate their personal career expectations, and more effectively manage work boundaries allowing re-assertion of passion in their careers post-F3. The evidenced advantages of flexible working like F3 pose additional relevance to NHS workforce strategy planning, and thus 3 organisational-level recommendations to improve support for F3 were evaluated.