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Do you think there is a need for provision of more wellbeing support to GP trainees in the region? Would you like to receive training in resilience skills? Would you be willing to engage with mindfulness practice? In what other ways would you like to get support improving your wellbeing and reducing burnout? Do you practise mindfulness in any form? What does the term personal wellbeing mean to you?What strategies or techniques have you used to improve your personal wellbeing or manage stress?Where did you find information about these strategies? Do you think that strategies or techniques for coping with work-related stress should be considered as a part of specialist training?If so, how and when should this be delivered?If not, what alternatives should be provided to help GP trainees deal with stress? What do you understand by the terms 'resilience' and 'mindfulness'?What experience, if any, have you had of training or practice related to these? What would attract you to participate in a programme aimed at increasing mindfulness and resilience?What concerns would you have, if any?What could be done to overcome these? Major themes Minor themes Exemplar quotations Stress and burnout Knowledge and training 'But I don’t know how much it’s been expressed that you, as the doctor, you need to look after yourself.' (Focus Group 2, R7) '… we’ve not been trained to do little more than gather a history that can possibly identify someone’s suicide risk or whether they’re psychotic. Like we just need to figure it out ourselves in terms of our training.' (Focus Group 1, R2)'I wouldn’t have said that I’d had any training on how to cope or how to get through terrible things…' (Focus Group 2, R2) Keeping up appearances '…we have to appear to cope. We have to pretend all the time that we think we know exactly what’s happening or what’s going on and what to do next. “Trust me, I’m your doctor,” …but half the time inside you’re going, “Oh, I can’t remember that,” or, “I don’t know what to do.” But yet we, we cope. What do we do with all that stress? Where does all that mental energy go?' (Focus Group 1, R5) Detaching from work 'My mum, she was GP and she used to tell me, “When you leave the job, leave the work, you just shut the door, so you leave everything in your practice, don’t take it home.” But it’s not easy.' (Focus group 2, R4) Major themes Minor themes Exemplar quotations Support and coping Threshold for seeking help 'You are, you know, you are the doctor… so you keep everything for yourself and that’s, that’s the, the biggest [issue], you know, the threshold to seek help….' (Focus group 1, R6) 'I think there’s a stigmatisation amongst doctors that if you need to take more time, if you need to have some extra support, that, overall, that’s perceived negatively.' (Focus group 2, R2) 'Quite often you get asked, “What do you think is going on then?"... And you make your own diagnosis.' (Focus Group 1, R2) Recognising burnout in the professional culture of medicine 'I found that times where I haven’t been happy, but it’s taken me quite a while to realise that. And actually it wasn’t till kind of about six months nearly down the line, I thought, “Actually, no, things aren’t right and, and this is what’s wrong in life and this is what’s making me unhappy.”' (Focus group 1, R2) 'No one should be going to work and being made to feel, you know, belittled or disrespected. And I think, at times, in medicine, I have certainly experienced it.' (Focus group 2, R2) Maladaptive coping approaches 'They avoid it, they might do some exercise but they might watch loads of Netflix, might not go out, might smoke, might drink, might take drugs.' (Focus group 1, R5) Adaptive coping approaches '…pretty much every day actually, I’ll go home and there’ll be something that’s happened that day that I’ll talk to my wife about who’s not medical … it might help me focus on a bit more of how I felt at the time or how the person felt at the time and that can be really helpful … she’ll often put her non-medical spin on it which I think can be quite good.' (Focus Group, R5) Personal acceptance 'I know, for me, it’s kind of my acceptance of my own limitations, like accepting that I’m not perfect, which took a really long time to learn…' (Focus group 2, R6) Use of mindfulness apps 'I was trying to do things like downloading mindfulness apps and trying to actively do mindfulness. And then I find that, “Oh, I’m not stressed any more, don’t bother with that anymore,” and it just goes out the window.' (Focus group 1, R5) - Table 5. Exemplar quotations from participants: perceived barriers and motivations to practising self-care and attending a mindfulness intervention
Major themes Minor themes Exemplar quotations Barriers Concept of mindfulness 'I find mindfulness an odd concept because it’s probably something that people didn’t think about 20 years ago .' (Focus group 1, R5) 'I might talk about mindfulness or something as a strategy to manage a patient and it wouldn’t be the first time where I’ve seen somebody of an older age roll their eyes, you know, as a response to something that I’d suggested to a patient.' (Focus group 1, R4) Fear of introspection '… there might be people who are on the cusp of being in a really, really bad mental state, who might be that, you know, the swamp underneath, paddling like crazy just to get through. And those people might avoid doing something like this because they think if they just open the box a little bit, it might spill out.' (Focus group 1, R2) Time 'I agree with that, I think it, I think a lot of us are aware of strategies that might help, but it’s about having time to put those into place with busy working lives, home lives.' (Focus group 2, R2) Motivators Desired benefits 'I’m hoping it will improve my mental state, that it will give me more tools to better cope with life, my own life and my patients’ lives and make my kids ... my wife sort of like, she can take care of herself, that’s what I’m hoping.' (Focus group 1, R4) Necessity for mindfulness training when working 'I think it [resilience training] should be more, once you’re actually working in the environment you work in, it would be more useful, but if it’s kind of put [to the test] dealing with, how to deal with complaints, how to ... it’s kind of facing, “That stuff’s going to happen, this is how you deal with it.”' (Focus group 2, R6)
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Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study
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