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Background Newly-qualified doctors in the United Kingdom experience a great deal of stress and have poor wellbeing when compared to more senior counterparts. A number of interventions have been put in place to boost healthcare professionals’ wellbeing, but little is known about interventions aimed to improve the wellbeing of newly-qualified doctors in the United Kingdom. This study aims to systematically review current evidence of interventions which improved the wellbeing of newly-qualified junior doctors in the United Kingdom. Methods Five key electronic databases were searched. Subsequently, reference scanning and citation search was performed. Studies were included if they were conducted from the commencement of the Foundation Programme in 2004, until 2019. In addition, studies had to be performed on junior doctors: working in the United Kingdom and within their first five years post-qualification and have a quantitative outcome. Studies which did not meet these criteria were excluded. Quality was assessed using the modified Newcastle-Ottawa scale. Bias was not formally assessed using a standardised tool. Results Seven papers met the inclusion criteria and identified three main types of interventions: mentorship, mindfulness and clinical preparation interventions. The majority of included studies reported a positive result from the performed intervention, suggesting these to be beneficial in improving junior doctor wellbeing, and thereby reducing anxiety and stress levels. However, most of the studies used small sample sizes. Conclusions This review reveals that there is dearth of evidence on the effectiveness of intervention to improve the wellbeing of newly-qualified doctors in the United Kingdom. Most of the identified interventions focused on relieving stress and anxiety inherent within newly-qualified doctors’ training programmes. However, wellbeing interventions need to take into cognisance all the factors which impact on wellbeing, particularly job-related factors. We recommend that future researchers implement large-scale holistic interventions using appropriate research methods. Systematic review registration: PROSPERO CRD42019127341.

Interacting social and ecological processes shape productivity and sustainability of island small-scale fisheries (SSF). Understanding limits to productivity through historical catches help frame future expectations and management strategies, but SSF are dispersed and unaccounted, so long-term standardized data are largely absent for such analyses. We analysed 40 years of trade statistics of a SSF product that enter international markets (sea cucumber) from 14 Pacific Island Countries and Territories (PICT) against response variables to test predictors of fishery production: (i) scale, (ii) productivity and (iii) socio-economics. Combined production in PICT peaked over 20 years ago, driven by exploitation trends in Melanesia that accounted for 90% of all production since 1971. The size of island fisheries (as measured by total exports), and the duration and magnitude of fishery booms were most influenced by ungovernable environmental variables, in particular land area. The large and high islands of Melanesia sustained larger booms over longer periods than atoll nations. We hypothesize that land area is a proxy for land-based nutrient availability and habitat diversity, and therefore the productivity of the shallow water areas where SSF are operating. PICT need to tailor management based on the intrinsic productivity of shallow inshore habitats:harvests from atoll nations will need to be smaller per unit area than at the high islands. Particularly countries with low productivity fisheries must consider the crucial economic "safety nets" that export SSF make up for dispersed island populations and incorporate them into broader development and island resilience strategies. K E Y W O R D Sbeche-de-mer, governance, invertebrate, management, markets, trepang

Objectives University Hospitals Birmingham's (UHB) Foundation Doctors should log clinical incidents via the Trust's incident reporting system. Anecdotal reports suggest under-reporting is commonplace. It is therefore important to identify the proportion of Foundation Year 1 (FY1s) who witnessed but did not report incidents and identify and weigh perceived barriers to reporting. We can then suggest strategies to address these barriers and repeat our data collection. Methodology We performed an analysis of anonymised data from the Trust's Datix Incident Reporting system alongside an anonymised survey to determine the proportion of FY1s witnessing reportable clinical incidents, and the proportion successfully reporting an incident in the 2017/18 academic year. The survey also gathered data on FY1 perceptions of barriers to reporting. We went on to discuss our results with UHB management and suggested several strategies to improve reporting, prior to repeating data collection for the 2019–20 academic year. Results 36.4% FY1 doctors surveyed in 2017–18 reported witnessing at least one clinical incident that they did not report. 37.0% FY1 doctors surveyed in 2019–20 reported the same. Respondents felt time taken to complete forms and system complexity were the key barriers to reporting. Conclusion Results show that over a third of FY1s at UHB had witnessed but not reported at least one clinical incident each year. The evidence-based strategies suggested to the trust in 2018 and 2020 included FY1 education on incident reporting, early senior clinician involvement in the reporting pathway, and a streamlined reporting system integrated with existing infrastructure. These have not been implemented.