Factors affecting job satisfaction and commitment among medical interns in Malawi: a cross-sectional study

'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda

OBJECTIVE

Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors' internship experiences in Kenya and Uganda.

METHODS

Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data.

FINDINGS

Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being 'treated like we are nobody'.

CONCLUSION

We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors' well-being and provide standardised supervision, support systems and conducive learning environments.

Occupational Well-Being of Multidisciplinary PHC Teams: Barriers/Facilitators and Negotiations to Improve Working Conditions

Well-being at work is one of the factors determining healthy work conditions and is perceived by workers as a positive psychological state. In this study, the concept of well-being at work was used together with occupational functionality (i.e., current health state, current work environment, and barriers/facilitators to implementing well-being at work), occupational risk perception, and proactivity/negotiations held by workers to improve working conditions. In this context, the objectives were to identify the socio-demographic and occupational characteristics independently associated with levels of well-being at work of the multidisciplinary PHC health team; detect barriers or facilitators resulting from the attitudes of colleagues, community members, and managers that influence the well-being at work of the multidisciplinary health team; and identify with whom and what reasons led health workers to become proactive and negotiate improved working conditions. This cross-sectional study addressed 338 health workers from the multidisciplinary teams of PHC outpatient services in the extreme south of Brazil. Multivariate linear regression models were adopted to analyze data. The results show various independent associations with levels of well-being at work. Nursing workers (technicians and nurses) more frequently expressed job commitment and job satisfaction. Difficulties in solving problems and performing work routines, and co-workers' attitudes directly influence the well-being of the PHC team members. Risk perception (physical and chemical) also influences well-being. Negotiations in which PHC managers engaged to improve working conditions appeared as a significant predictor of job commitment, job satisfaction, and job involvement. The results reveal that well-being at work is an important indicator of the potential of workers' proactivity in negotiating improved working conditions.

Transitional challenges faced by medical intern doctors (IDs) in Vanuatu: a qualitative study

The transition from being a medical student to a fully qualified registered doctor is a challenging time in the lives of intern doctors (IDs). Throughout those challenging times they face many challenges which significantly impact their professional lives as well as their transitional experience. This study aimed to identify the transitional challenges experienced by IDs in Vanuatu. This qualitative study was conducted using a phenomenological approach whereby data collection is done through semi-structured in-depth interviews. Ethical approval was obtained before the commencement of this study. Twenty-seven participants were IDs of Vila Central Hospital and Northern Provincial Hospital in Vanuatu who were either current IDs and had worked for more than 6 months or had completed internship within the past 2 years. The willing IDs were consented on paper before they participated in the interview. The interview data was then transcribed verbatim and interpreted thematically. The participating IDs in the study were between the ages of 27 and 36 years old. Twenty two were current interns while the remaining five had recently completed their internship and now working as registered doctors. Three subthemes were identified as challenges through thematic analysis in this study; intern's welfare not met; different medical training institution; and transitional shock. Those subthemes were later categorized. The study findings have identified that intern's welfare needs improvement along with diverse training medical schools, and the transitional internship encounters were significant challenges experienced by IDs. There is indeed a need for healthcare providers, medical leaders, and relevant stakeholders to recognize and address these challenges.