How do we make Schwartz Rounds easier to access for new starters?
04 August 2021
Aggie Rice considers whether Schwartz Rounds are inclusive enough for people starting out in their careers.
It’s the first week of August, which means UK junior doctors will be beginning their first jobs after graduating. A huge milestone in any doctor’s career, it is no doubt a time of both excitement and apprehension.
Last year, junior doctors were ushered earlier than usual into front-line roles as the NHS scrambled resources in the face of the huge challenges the Covid19 pandemic presented. This summer, the next cohort of doctors – alongside many other healthcare professions – are entering the workforce for the first time. At a small but growing number of universities, Schwartz Rounds are forming part of the experience of studying for a healthcare degree, (we reported 17 HEIs running Schwartz Rounds for students in our last Impact Report) – helping undergraduates respond to the unique challenges of preparing for careers in health, sharing experiences and hearing from their peers and other professions.
Notable examples include the University of Plymouth, where all trainee Allied Health Professionals (AHPs) undertake Schwartz Rounds; the University of Surrey, which runs Rounds with student nurses, paramedics and midwives; and the University of Liverpool, where students from nine healthcare programmes have been attending inter-professional Schwartz Rounds for the past five years. The University of Liverpool is also leading the ‘Schwartz North’ project, funded by Health Education England North, a project which has enabled healthcare students from across nine universities in the North of England to run Schwartz Rounds.
Earlier this year, Lauren Mathews, from the University of Liverpool Medical School, wrote an excellent article about the experiences of students and staff from across all of the University of Liverpool’s healthcare programmes of participating in Schwartz Rounds together. She highlighted the impact of Rounds not only on individuals’ wellbeing but on their knowledge and understanding of other professional perspectives. Developing this inter-professional approach in healthcare students, it is hoped, may embed these qualities within the future workforce – helping perhaps to avoid some of the siloed thinking that can be a feature of the health and social care workforce, and supporting the creation of a more open, compassionate and connected culture within medicine.
It is often the case that newly qualified staff, and perhaps even more so, newly qualified staff of colour, feel isolated, disempowered and unable to seek help for mistakes for fear of judgement or penalisation. Creating a culture of authentic and open storytelling can have a huge impact on this.
As we welcome the new cohort of junior medics, nurses, AHPs and other healthcare professionals into the workforce, it is a good time to consider how easy it is for people in the early stages of their careers to access Schwartz Rounds. Are students who have attended Schwartz Rounds at university able to carry this forward into their working lives? And for the majority who have not encountered Schwartz Rounds before, how easy is it to engage with Rounds amid the intense pressures and challenges of the early stages of a health career?
Availability of Rounds
Michael Zervos, an F3 doctor at Torbay Hospital, studied at UCL Medical School, where Schwartz Rounds are popular with students. In fact, with an interest in psychiatry, Michael trained to be a Schwartz Rounds facilitator while still an undergraduate.
But his experience as a junior doctor has not been the same and he believes organisational culture is a cause of this. Schwartz Rounds play a bigger part in the life of some NHS trusts than others. “At UCLH it was standard that Rounds were part of what happened in the trust and attendance was good. I have since found that this isn’t the case everywhere.”
There are a few reasons for this. First is the obvious issue of availability of Rounds. In England, 148 of the 233 trusts are running Rounds. The corresponding proportions of health boards in other parts of the UK, and of trusts in the Republic of Ireland, are lower. There is still a way to go before Schwartz Rounds are universally available.
For Jared Murphy, an F1 doctor who attended the University of Liverpool’s Schwartz Rounds during his training, the absence of Schwartz Rounds at his new trust led him and his colleagues to come together privately to talk through issues together.
“I haven’t had the opportunity to participate in formal Schwartz Rounds this year as a foundation year 1 doctor, but my colleagues and I have taken forward some principles from those Schwartz Rounds we have been part of previously to have our own discussions. We have typically done this when we’ve had a particularly tough or trying experience and have brought out our feelings about the event, it helped us to normalise how we were feeling. I think that to normalise how you are feeling about something can be so valuable.”
This story illustrates the demand among junior doctors for properly facilitated conversations to process the intense experiences of their early careers – a need that isn’t being met in many cases. The full benefit of Schwartz Rounds is of course built on the emotional safety of the Rounds, enabled by trained facilitation. It is striking that people who understand the value of Rounds, from attending them whilst at university, should not then be able to engage with Rounds upon entering the workplace.
Even where Rounds are available, they rarely sit comfortably within the working day of many junior medics.
The shift-based nature of a lot of work in hospitals, combined with the regular timing of Rounds, already precludes many people from attending. This was a key driver for the development of ‘pop-up’ Rounds a few years ago. But for healthcare staff early in their careers, it may not be possible to take a lunch break at a regular time and attend a Round. Pressure of work, having relatively little autonomy as a junior member of the team, and the reality that some things just take longer when you’re new, all play a part. “We might be grabbing a sandwich during a few free minutes at 3pm, not taking an hour at 1pm,” says Michael.
Jared agrees. “I think workload is a significant barrier to participation, and a difficult one to overcome. I imagine from my own experiences that this may be a common barrier as well, and that solutions could be tricky.”
Another issue, for the many early-career medics who have not previously encountered Schwartz Rounds, is awareness of the benefits of Rounds. As Michael points out, junior doctors may not naturally gravitate towards them.
“Young doctors tend to be quite driven people and may well not see Schwartz Rounds as being a good use of their time if they are not familiar with the concept. That time could be spent doing other things deemed more valuable, such as activities directly linked to yearly appraisal and the annual review of competency progression (ARCP). It’s really important for junior doctors to have a hook in and an advocate for Schwartz Rounds fairly early on, so that they can see how they run, and benefit from them over the course of their career.”
Covid, of course, has also made a difference as Schwartz Rounds have moved online. With online Rounds there is no longer a need for participants to be in the same room, but they do still need a private space to log in – which is not always easy to provide within a busy ward or department.
Improving accessibility and inclusivity
It is important for the Schwartz Community to recognise these barriers to engaging with Rounds for people in the early stages of their career. Is there more we can do to make Rounds accessible and inclusive for junior colleagues?
From the experiences of students taking part, we can see the clear benefits of exposure to the Schwartz Round process and regular reflective practice during pre-registration training. As new people join the workforce, their need for the support that Schwartz Rounds can bring is greater than ever. Our challenge as a community is to find ways to provide this for junior colleagues.
With thanks to Laura Golding and Lauren Mathews for support with this article.