Trainee doctors' experiences of learning and well-being while working in intensive care during the COVID-19 pandemic: a qualitative study using appreciative inquiry

Abstract

Objectives: Concern about trainee work-related well-being has been raised in recent years and is the subject of several reviews, reports and research studies. This study aimed to understand the experiences of trainees working in a large intensive care unit during the first surge of the COVID-19 pandemic from an educational and operational perspective in order to highlight what worked and what could be improved.

Design: A qualitative study using peer-to-peer semistructured interviews, developed using appreciative inquiry methodology, was conducted during July 2020. Responses were analysed using a thematic analysis technique.

Setting: A large, tertiary intensive care unit in the UK.

Participants: All trainees in anaesthesia and intensive care working on the intensive care unit during the first surge were invited to participate.

Results: Forty interviews were conducted and four over-arching themes were identified. These were: feeling safe and supported; physical demands; the emotional burden of caring; and a sense of fulfilment, value and personal development. Positive aspects of the organisational response to the pandemic included communication, personal protective equipment supply, team working and well-being support. Suggestions for improvement focused on rest facilities, rota patterns and hierarchies, creating opportunities for reflection and ensuring continued educational and training opportunities despite operational demands.

Conclusions: Trainees described opportunities for learning and fulfilment, as well as challenges, in working through a pandemic. Trainees described their needs and how well these were met during the pandemic. Ideas for improvement most frequently related to basic needs including safety and fatigue, but suggestions also related to supporting learning and development. The appreciative inquiry methodology of the project facilitated effective reflection on positive aspects of trainee experiences.

Keywords: COVID-19; adult anaesthesia; adult intensive & critical care; education & training (see medical education & training).

Figure 1

(A) Pre-COVID-19 intensive care unit staffing levels. (B) Intensive care unit staffing levels during the COVID-19 pandemic.

Figure 2

Flow diagram of participant numbers. ICU, intensive care unit.

Figure 3

Frequency of suggestions for improvement according to Maslow’s hierarchy of needs (dark grey box=hierarchy, with box size proportional to frequency of theme; light grey box=examples of topics within the theme). PPE, personal protective equipment.