Our national training survey is the largest annual survey of doctors in the UK. Here, Nathan Booth, Education Policy and Research Officer at the GMC, discusses how the survey informs our work, and the rising rates of burnout in 2021.

Every year, trainee doctors across the UK complete the national training survey and give us their views on their training and the environments where they work. Trainers also report their experience of being clinical and educational supervisors.

In 2021 more than 63,000 doctors took part in the survey. That’s around 76% of trainees and 32% of trainers all sharing their experiences. 

This year’s results reflect the unprecedented year that doctors and the wider health services have had, with the data showing that pandemic pressures have impacted trainees’ and trainers’ wellbeing.

However, there were some encouraging results too. Satisfaction with teaching, supervision and overall experience remained very high and, in some cases, above pre-pandemic levels.

So how will we use this data, and what impact does it have on doctors’ workplaces?

How we use the data

The survey helps us to make sure that doctors are getting the training they need, by tracking year-on-year changes in their workplaces. The questions are based on our standards for medical education, so we can identify where these aren’t being met.

Questions are grouped into a set of 19 indicators covering key aspects of the training experience, which allows us to spot any significant differences – positive or negative – across specialties, sites, trusts, and deaneries.

Our Quality Assurance, Monitoring and Improvement team then works with education providers to understand these differences, address any issues or share instances of good practice.

But the vast wealth of data generated in the national training survey also allows us to build insight into the state of medical education in the UK and identify longer term trends. This helps to shape policy development and influences our discussions with education bodies and national governments on topics such as leadership, creating supportive workplaces and wellbeing.

It’s also used in more targeted, detailed analyses, such as our work to tackle differential attainment and in various collaborative research projects using the UK Medical Education Database.

The annual survey cycle

The survey is usually live from late March to early May, although in 2020 and 2021 we held it slightly later in the year, because of the impact of the pandemic on the UK’s health services and patient care. However, from an operational perspective, our team works on the survey all year round.

We begin survey development in autumn. We work with our external advisory group and individual doctors who volunteer to share their feedback. We consider amendments to existing questions or add new ones, and we improve the functionality of our online reporting tool.

Data collection and validation takes up most of the winter months, as we liaise with postgraduate deans and medical royal colleges to update our trainee and trainer census. In January and February, we build and test the survey ahead of its launch. And once the survey has closed in late spring, we clean and quality assure the data, and test our indicators to make sure they remain statistically robust.

The online reporting tool goes live in July, with results available to key education bodies a couple of weeks earlier.  

We also produce two reports – an initial findings summary to accompany the reporting tool, and a chapter in our annual The state of medical education and practice in the UKreport providing a more detailed analysis. There’s also a lot of internal and external requests for ad-hoc data throughout the year.

Tracking burnout

In 2018, we added seven questions to the survey, taken from the Copenhagen Burnout Inventory – an internationally-recognised and statistically-validated tool for the measurement of burnout.

These questions are optional, but most respondents choose to answer them. The questions ask about different experiences that might indicate a doctor is burnt out, such as emotional exhaustion or feeling tired at the thought of another day at work. Respondents’ answers across all seven questions are aggregated to form an indicator, representing high, medium, or low risk of burnout.

From 2018 to 2020, the proportion of trainees at high risk of burnout was 10% each year, but in the 2021 survey this increased to 15%. It may not surprise many people – inside or outside the profession – that the pandemic has so negatively affected doctors’ wellbeing. But we remain clear that addressing burnout is vital, for doctors, for the system, and for patient safety.

We’ve also previously explored which of our other indicators are closely associated with burnout. Workload and supportive environments are particularly significant, and therefore possible drivers or protective factors. And not feeling adequately prepared when starting postgraduate training is also associated with a higher risk of burnout – not just in that first year, but in subsequent training years also.

The survey is vital in helping us spot specific sites and departments that aren’t meeting our standards or that need additional support; if you can’t and don’t measure it, you can’t improve it. It also supports the work we’ve committed to as part of our corporate strategy to help make healthcare environments more supportive, inclusive, and fair.

You can explore the national training survey data via our online reporting tool, or read our 2021 summary report. We will publish more detailed analysis of the findings – alongside other education data – in our The state of medical education and practice in the UK report, which will be published this winter.