How to improve the wellbeing of junior doctors: building the evidence

Mentoring programs can be valuable tools for safeguarding the health and job satisfaction of medical interns

A stressful and demanding internship year has traditionally been regarded as a rite of passage for doctors in Australia. A heavy workload, long hours, new job performance anxieties, a hierarchical work environment, looming applications for specialist training programs: all place considerable stress on junior doctors, who experience high rates of fatigue, burnout and depression.1 With increasing focus on their mental health, support programs for interns, including mentoring, have been recommended by national professional bodies.2

In this issue of the MJA, Chanchlani and colleagues3 report the results of original research in which they evaluated the impact of a peer mentoring program for medical interns at the Royal Perth Hospital, the first randomised controlled trial in this area. In the study, 53 interns who volunteered their participation were randomised 1:1 to receiving or not receiving a peer mentor. Based on the preferences expressed by participants in an unpublished pilot study, mentee–mentor pairs were matched by sex and career preferences; psychosocial wellbeing and job satisfaction were qualitatively assessed after 12 months. Participating interns who had been allocated mentors reported that the program had had a positive impact; specifically, that it had assisted them navigate the complex health system and enhanced their sense of community in the workplace.

The randomised design of the study reduced the effects of obvious potential confounders, including the variability of participant backgrounds, rotations, and other support structures, as well as of mentor training and experience. No quantifiable endpoints, such as personal leave or sick days taken, were examined, but doing so could be useful for hospital administrators; nor were levels of burnout, fatigue and depression measured. A follow-up period longer than 12 months would probably be needed for assessing these important outcomes. It would also be useful to learn the participants’ views on the subjective benefit of the program several years after participating in the mentoring program, and to determine whether it influenced their career choice, resilience throughout training, or job satisfaction.

It is worth noting that one-third of the intern cohort at the hospital did not opt to be part of the study. Information about those who did not participate could be enlightening, as it is possible that a critical selection bias was introduced by the opt-in nature of the program. Those who opted out may have benefited from mentoring, but were unwilling to ask for help. Further, only limited information about the experiences of the control group (no mentors) was reported, making comparison of the two groups difficult.

Although the study had a number of limitations, it did provide some important insights. The effectiveness of mentoring programs is well established in the fields of psychology and teaching, where research has highlighted the importance of mentor selection and preparation.4,5 The pilot program for the study by Chanchlani and her co-authors found that interns reported greater benefit when the mentor was only one or two years their senior. This finding is perhaps explained by junior doctors having more recently managed the same problems faced by interns, so that they are better placed to provide relevant guidance on work-related and career progression matters. This insight breaks with the traditional model of older consultants acting as mentors, and signposts a direction for future research. It also raises questions about whether consultant doctors are provided with adequate training and support for assisting their junior staff.

Despite some limitations, the results of this study are positive and have provided evidence for the value of intern mentoring programs. Clearly, however, more research is needed, particularly long term follow-up of participants. Nonetheless, the framework and program outlined by Chanchlani and her colleagues could be profitably adopted by postgraduate medical education organisations around Australia to support their interns as they begin their medical careers.