The Eatwell Guide (EWG) is “a policy tool to define government recommendations on eating healthily and achieving a balanced diet”, where a third of the diet should come from starchy foods and the remaining portion from fruits and vegetables, protein-rich foods, dairy and other foods [1]. Both quality and quantity of carbohydrates are critical in a healthy diet, with studies highlighting a stronger link between carbohydrate type and disease risk than total intake [2,3]. To promote improved carbohydrate consumption, it is crucial to understand current carbohydrate-rich food patterns and the socio-demographic factors that influence these dietary patterns.

This research aimed to identify distinctive dietary carbohydrate patterns in a representative sample of UK adults, and assess their adherence to EWG recommendations, and their associations with sociodemographic factors.

Data from a 4-day food diary of 2,757 adults (19-85 years old) in the National Diet and Nutrition Survey wave 9-11 [4] was analysed. Statistical clustering was used to classify individuals according to consumption of starchy-based meals (i.e., potatoes, bread, rice, pasta, and other starchy carbohydrates). The obtained dietary carbohydrate patterns were assessed for adherence to nine EWG food and nutrient recommendations (fruits and vegetables, oily fish, other fish, red and processed meat, fibre, salt, free sugars, saturated fats, and total fat) [5,6] by age and sex. Finally, multivariable logistic regression was used to examine the associations between sociodemographic factors and dietary carbohydrate patterns.

Four dietary carbohydrate patterns were identified: “White Bread and Fried Potatoes” (24%), “Whole Grains” (9%), “Pasta, Rice, and Other Cereals” (19%), and “Varied Carbohydrate Sources” (48%). Starchy carbohydrate intakes ranged from 189g in the “Varied Carbohydrate Sources” pattern to 251g in the “Pasta, Rice, and Other Cereals” pattern. The “Varied Carbohydrate Sources” had the highest proportion (55%) of individuals adhering to 3-4 guidelines; the “White Bread and Fried Potatoes” had the largest share (37%) of individuals with very low adherence. Overall, the most commonly unmet recommendations included dietary fibre (8%), oily fish (20%), and fruits and vegetables (27%), with individuals in the “White Bread and Fried Potatoes” pattern reporting the lowest mean intake for fibre (17.9g), oily fish (5.9g) and fruits and vegetables (243.1g), and highest mean intake for red and processed meat (71.0g), salt (5.6g), free sugars (54.5g), saturated fat (27.2g), and total fat (74.4g). Socio-demographic factors—including sex, age, ethnicity, income, and household size showed significant associations (p <0.01) with dietary carbohydrate patterns and EWG adherence. The “White Bread and Fried Potatoes” pattern was more prevalent in young adult males from lower socioeconomic backgrounds.

Starchy carbohydrate consumption patterns are associated with adherence to EWG recommendations and are influenced by sociodemographic factors. Targeted dietary strategies focusing on the different carbohydrate consumption groups can contribute to meeting food and nutrient recommendations.

Aims: Raising concerns is an important duty for those working in medicine, which can have a broad impact on factors including safety, training, and wellbeing. This project aims to explore resident doctors’ experiences of raising concerns in psychiatry, including establishing awareness of available processes, and identifying barriers to utilising these. This work has been conducted as part of a wider Quality Improvement Project, aiming to improve resident doctor awareness and engagement with the process of raising concerns by overcoming identified barriers.

Methods: Resident doctors of various grades working in psychiatry within a six month period were invited to attend focus groups to gather information about their perspectives of raising concerns. Thematic analysis of focus group discussion was conducted. Quantitative data was obtained from an online survey which was sent to all resident doctors working in the trust for anonymous completion.

Results: 19 resident doctors attended focus groups. Thematic analysis of this content demonstrated five key themes with additional subthemes:

Repercussions (impact on career + feedback, wellbeing, reputation).

Futility.

Uncertainty (culture, acceptability, process).

Division (hierarchy, staff groups).

Variability (receptiveness, response, supervisor relationship).

25 resident doctors responded to the survey: 52% felt unfamiliar with the process for raising concerns; 5 respondents had raised a concern within the trust; 9 had experienced concerns that they had wanted to raise but could not.

Most concerns related to training (56%), supervision from seniors (31%), patient safety (25%), bullying/harassment (19%), and resident doctor wellbeing (13%). 16% of respondents felt that a barrier to raising a concern was related to race, sexuality, gender, or any other protected characteristic. 57% felt they were not taken seriously when they had raised a concern. 71% felt they had not received adequate feedback after raising a concern.

Conclusion: Resident doctors are experiencing a range of concerns, but many find that barriers prevent them from raising these. These barriers generally relate to uncertainty regarding the process, futility of raising concerns based on previous experiences, and fear of repercussions. This data suggests that there are issues resident doctors are experiencing that are going unreported, relating to their own training experiences as well as patient safety concerns. Focus group data has allowed us to have a better understanding of the barriers resident doctors face when raising concerns. Subsequently, we are working alongside resident doctors and key stakeholders using Quality Improvement methodology to trial the implementation of several change ideas to streamline the process of raising concerns.