Reason for using WeCaRE: took the opportunity for using WeCaRE as it seemed to be a framework that actually worked for clinical staff and fatigue and burnout in the specialty was felt to contribute to its high attrition rate.

Core steering group: two ED SpRs (one with a junior rota co-ordinator role and one Chief Resident), one junior grade doctor, one ICM SpR rotating through (and Chief Resident), one consultant (overall rota responsibilities)

Timeline: 6 month cycle - the core group meeting and planning in October 2021 and formulated action plans based on proposals from doctors in training in February 2022 and enacted them by March 2022.

Change ideas tested:

1) Adding a new shift type which started at ~5pm which relieved the pressure of the day-time and backshift teams who felt most tired and stressed by workload at this point in the day when the department was at its busiest point. This resulted in improved productivity and staff well-being. There were benefits for the night shift too who had less of a backlog to address when starting their shift.

2) Building ten minutes into the departmental handover to enable well-being check-ins and an educational opportunity after recognising that although handovers were safe, they added little additional value to the training experience. Handovers could be used to flag to the rest of the team specific educational outcomes/procedures certain trainees were seeking that day to allow tailoring of educational opportunity, or sometimes 5 minutes of this extra time could be used for a quick teaching point and contribute to formal teaching opportunities in the department.

3) Raising awareness of the wellbeing resources/initiatives in NHS Lothian as doctors in training indicated they were not aware of the available options. This also supported the Consultant Well-being lead of the department.

What worked well:

• staff really benefited from the what matters to you questions and valued being listened to and their concerns taken seriously. 31 doctors took part in the surveys and 27 in the focus group discussions. It was clear that although workload was high, the DiTs often reported working in the department as very rewarding.

• support from MED fellow team to help guide through the cycle and sign-post to useful resources

• fewer DiT ( 71% from 88%) reported the out-of-hours workload feeling “too intense”

• considerably more (64%) DiT were aware of the wellbeing resources and had found them useful

• more DiT (32% from 13%) reported finding the quality of teaching in the department as “excellent”

• reduction in reported symptoms of burnout amongst DiTs (from 1/3 of trainees to 1/4 reporting one or more symptom)

• strength of data to drive change and a wealth of options to collect information and generate ideas (e.g. jamboards)

• reassuring for doctors in training to see the support from senior clinicians in undertaking this work and helping to adopt proposed changes

What was challenging:

• some issues in the department were divisive and not unanimous across all groups and the steering group had to be careful to seek consensus

Work presented as a poster at the NES Medical Education Conference and oral presentation at Scottish RCEM Conference.