Andrew Toffoli

Background Junior doctor training is stressful and associated with significant challenges, including poor mental health and burnout. Mindfulness-based interventions (MBI) are increasingly being offered within junior doctor education programs to support junior doctor wellbeing, with online platforms for delivery attracting interest. Methods This mixed-method randomised waitlist control trial was conducted with junior doctors across two hospitals in Western Australia. The intervention was an 8-week online mindfulness training program, with usual training as control. Outcome measures were changes from baseline to program completion (8 weeks) and then 1-month follow-up for self-reported surveys of trait mindfulness, perceived stress, self-compassion, occupational stress, and work engagement. Intervention and control participants completed surveys at all three time points. Semi-structured interviews and focus groups were conducted with participants at program completion. Results Seventy-two (35 intervention, 37 control) junior doctors were randomised. Seventeen did not complete the baseline measures. Data for the remaining 55 participants (28 Intervention, 27 Control) were retained for analysis. Most intervention participants formally practiced mindfulness 2 to 3 times per week for 5–7 minutes. For the intervention group, perceived stress increased at program completion (-1.4, 95% CI − 2.6, -0.3, p = 0.0151) while work engagement was decreased (-2.9, CI − 5.6, -0.2, p = 0.0355) at final follow-up. There were no significant changes in any of the outcomes for the control group at any follow-up point. Thirteen intervention and 8 control participants undertook semi-structured interviews about their experience. Despite lack of positive quantitative findings, benefits reported regarding the program during interview included: improved self-awareness, emotion regulation, self-compassion and work productivity, as well as professional and personal relationships. Barriers to participation in the program included limited time, work stress, and challenges with elements of the intervention. Conclusion This novel online mindfulness training program was not associated with improvements in measured outcomes including trait mindfulness, perceived stress, self-compassion, occupational stress or work engagement for participating junior doctors. This contrasts with our qualitative findings suggesting that junior doctors experience wellbeing benefits from participating, and with the results of our similar trial in medical students. Organisational factors such as stressful workplaces and time limitations likely minimised the impact of the mindfulness intervention in this group.

Objective: The Australasian College for Emergency Medicine Curriculum Framework contains numerous mentions of point‐of‐care ultrasound (PoCUS). However, obtaining formal PoCUS credentials is often problematic. The Fiona Stanley Hospital ED PoCUS training programme was devised to assist emergency medicine trainees to meet the credentialing requirements of the Australasian College for Emergency Medicine and the Australasian Society for Ultrasound in Medicine.Methods: Six emergency medicine registrars are selected for each 6‐month semester. Successful applicants nominate two modules of Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound and receive dedicated non‐clinical time. For 3 h a week, an emergency physician holding formal PoCUS credentials supervises a pair of trainees while they perform scans on ED patients. During these sessions, trainee logbooks can be reviewed and assessments occur as required by the module.Results: Over an 18‐month period, 18 emergency registrars were involved, averaging eight 3‐h sessions each. All selected the Extended Focused Abdominal Scan for Trauma module, 14 chose Abdominal Aortic Aneurysm and eight chose Basic Echo in Life Support. Overall, 30 (75%) of 40 modules were completed within the trainees' 6‐month semester. Just under half of logged scans were obtained during the supervised sessions. Overall, the average number of scans performed exceeded each module's logbook requirements. Trainees perceived that involvement in the programme benefited their ability to manage patients. There was overwhelming support for the structure of the programme.Conclusions: The Fiona Stanley Hospital ED model is effective in assisting emergency medicine trainees to gain formal PoCUS credentials. As it requires relatively little organisation, time and staffing, it could be adopted in many EDs around Australia and New Zealand.