Letters to the Editor

Are you burnt-out or are you merely frustrated?

Could this modern phenomenon known as ‘burn-out’ relate to a form of frustration? Which, if understood and resolved, could stop the high attrition rates seen in NHS staff. Burn-out is thought to result from long-term unresolved job stress.¹ However, my preliminary data, on adult-learning (AL) in dental professionals, suggests a need to rethink the current interventions and strategies.

Understanding what knowledge is and how to use it may turn out to be AL.² Dentists can choose from three approaches and this may be contributing to a three-way conflict in general practice, leading to ‘frustration’, known as ‘burn-out’. To explore this phenomenon, this letter discusses, in context, the background literature; next, proposes the reasons for frustration, and considers the implications of this study's findings.

Adult-learning seems to go beyond the mere transfer of new knowledge, found in pedagogy, and could be associated with dental professionals starting to deconstruct their existing knowledge and starting to use it, instead.³

Knowledge is accepted as being made up of three elements⁴ and each element may be associated with a method of justifying (Figure 1).² If dentists, potentially, are ALs and prefer one way of using knowledge over another, there could be a three-way conflict. Could this explain why some individuals are getting frustrated?

My personal experience is that propositional justification, known as truth or EBD, is taking precedence in primary care. Truth alone is not knowledge and it is not absolute.² Hence, I believe that this is leading to job-related stress and should be renamed job-related frustration, specifically associated with interactions with patients and colleagues.

To follow, I believe that dentists start off ‘using’ their preferred approach of justifying, but those around them may be using one of the other two approaches, such as patients and colleagues, causing potential conflict. Formal teaching on this, understanding the nature of knowledge, does not usually begin until Masters and PhD level, and it is often incomplete.⁵ Interestingly, to compound the problem, candidates being taught this do not often return to the frontline primary care setting to share this learning with colleagues. Put simply, we need all three elements for knowledge, and ‘truth’ should not take precedence.

So, I believe that CPD must change and start to incorporate AL, which is set in epistemology and not pedagogy principles. We must either start teaching the nature of knowledge in CPD or restricting anyone in leadership, supervisory or educational roles in the NHS to those who have had thorough training on this subject, as I believe that this is the only way to reduce workplace frustration and staff attrition.

To conclude, as an educational supervisor, I am concerned that this dominance of thinking related to only the truth domain is at the detriment of knowledge, which requires all three in equal measures. Hence, thinkers who do not naturally prefer using just ‘truth’ as a method of justifying, like me, are finding themselves isolated and misunderstood on the frontline. CPD must start to address this problem of AL and ensure that all supervisors understand this concept, known as epistemology, or I am afraid that workplace burn-out will continue to increase as the trend continues to follow this one type of thinking at the detriment of knowledge on the frontline.

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