Return to Work

Your first point of contact is your educational supervisor or training programme director throughout the return-to-work process. Meet with your educational supervisor and/or TPD. Ideally arrange the first meeting prior to finishing work. Then a check in half way through planned leave time and final planning at least six weeks before return to allow adjustment of clinical activity.

In the initial placement you should aim to be in a familiar setting, not too far from home, in a sub-specialty that is not completely new. If you are planning KIT days then it is ideal if they are in the department you will be returning to.

It is probably advisable not to take on extra roles such as rota master or teaching co-ordinator, initially, and try to keep research on a back burner for a few months while you settle in.

In England - if additional guidance and support is required you can contact your local SuppoRTT Champion and the SuppoRTT team.
A SuppoRTT Champion:

• Oversees the return-to-training process;
• Provides you and your supervisors with guidance regarding the relevant policies and available resources.

Their role is to provide leadership within the Trust/School to ensure that the SuppoRTT strategy is fully implemented and results in a high-quality supported return to training for all concerned. Each regional HEE office offers a slightly different 'menu' of support. More details are available here. 

You should also discuss or consider:

Plan with your education supervisor or TPD the level of supervision you wish when you come back, this will be dependant on your level when going on leave, your personality and length of time off – it is therefore highly individual.

The following activities can be avoided if you wish in the first 2-4 weeks with a phase back in after this. This plan should then be made know to all the consultants you may be working with during this time period and the rota master by your TPD or ES.

• Holding the on-call page – initially start shadowing someone if that makes you more comfortable.
• Unsupervised out of hours shifts/ non-resident on call supervising others.
• Lone operating.
• Registrar only clinic – unless with a senior registrar.

While you are breastfeeding, you and your baby have special protection under health and safety law. You must inform your employer in writing that you are breastfeeding. It is advisable to do this before you return to work, so your employer can make the necessary adjustments.

A risk assessment must be carried out for any trainee who is breastfeeding, facilities must be provided where you can rest and you should be supported to find:

• Appropriate break times.
• Adequate refrigerated storage (not shared facility with lunches).
• A private space (a toilet, bathroom or the relatives room are not suitable places to express milk) and where necessary your employer should provide appropriate facilities for you to lie down. These facilities should not be located a significant distance from the ward.

It is not always possible to provide all of this, so be as reasonable as possible and work with your employer to establish reasonable adjustments. Be flexible with your requests. If additional breaks are not possible, for example, then consider using your tea and lunch breaks and taking them at different times.

Guidance for employers and breastfeeding mothers is available from the Health and Safety Executive (England, Scotland and Wales) and at nidirect (Northern Ireland).

The initial return to work is daunting. Not only do you feel like you know nothing about orthopaedics, but you now have a new pressure to be at home. You may not be able to come in as early or stay late. Planning is your friend – discuss your initial activities with your ES/TPD and on the first day a familiar clinic or supervised list is ideal. Layout everything out the night before, treat yourself (a facial, a haircut or a new outfit) to boost your confidence and be prepared to delegate – you can have it all, but you can’t do everything at once! See if your partner can pick the kids up the first day or arrange a clinical activity you know will be finished in plenty of time and get take away for dinner!  

Plan a week or a few days off a month/6 weeks after returning to work to spend time with your family and do something for yourself.

Transitioning from trainee, to at home mum, to working mum is one of the hardest things you will likely do in your training. It is normal to feel overwhelmed or stressed during this time. It can help to open up to trusted colleagues about how you are feeling. You may be surprised and find that most other people have felt this way at some point in their careers and may have felt any or all of the following:

• Low self-confidence – this is natural after a significant break from work.
• Guilt.
• Separation from your child.
• Feeling inadequate at home and work- feeling you are not performing either role as you would aspire to.
• Less connected to work colleagues possibly due to:
  • No longer being willing to stay late or meet after work for socialising.
  • Differing life experience/ new priorities.
  • Being out of the loop while on maternity leave.
• Concern about colleagues perceptions (real or perceived):
  • Less focused.
  • Shift in priorities.
• Concern over managing the workload.
• Less time to study.
• Poorer cognition and/ or focus due to lack of sleep.
• Pressure to leave on time.
• Feeling rusty in theatre.

These feelings are all normal and should lessen with time, however, if they are becoming intrusive or not lifting after several weeks then you should seek help. Post-partum depression and anxiety can be triggered, uncovered or worsened by return to work.

Sources of help:

• GP.
• Occupational health.
• Counselling – free from BMA regardless of membership.
• Educational/ clinical supervisor.
• TPD.
• BOA Wellbeing pages.