scholarly journals Exploring preference for, and uptake of, rural medical internships, a key issue for supporting rural training pathways

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Matthew R. McGrail ◽  
Belinda G. O’Sullivan ◽  
Deborah J. Russell ◽  
Muntasirur Rahman
Keyword(s):  
Medical Training ◽  
Junior Doctors ◽  
Domestic Students ◽  
Rural Location ◽  
Medical Graduates ◽  
Care Access ◽  
Rural Workforce ◽  
Published Evidence ◽  
Career Intent ◽  
International Graduates

Abstract Background Improved medical care access for rural populations continues to be a major concern. There remains little published evidence about postgraduate rural pathways of junior doctors, which may have strong implications for a long-term skilled rural workforce. This exploratory study describes and compares preferences for, and uptake of, rural internships by new domestic and international graduates of Victorian medical schools during a period of rural internship position expansion. Methods We used administrative data of all new Victorian medical graduates’ location preference and accepted location of internship positions for 2013–16. Associations between preferred internship location and accepted internship position were explored including by rurality and year. Moreover, data were stratified between ‘domestic graduates’ (Australian and New Zealand citizens or permanent residents) and ‘international graduates’ (temporary residents who graduated from an Australian university). Results Across 2013–16, there were 4562 applicants who filled 3130 internship positions (46% oversubscribed). Domestic graduates filled most (69.7%, 457/656) rural internship positions, but significantly less than metropolitan positions (92.2%, p < 0.001). Only 20.1% (551/2737) included a rural location in their top five preferences, less than for international graduates (34.4%, p < 0.001). A greater proportion of rural compared with metropolitan interns accepted a position not in their top five preferences (36.1% versus 7.4%, p < 0.001). The proportion nominating a rural location in their preference list increased across 2013–2016. Conclusions The preferences for, and uptake of, rural internship positions by domestic graduates is sub-optimal for growing a rural workforce from local graduates. Current actions that have increased the number of rural positions are unlikely to be sufficient as a stand-alone intervention, thus regional areas must rely on international graduates. Strategies are needed to increase the attractiveness of rural internships for domestic students so that more graduates from rural undergraduate medical training are retained rurally. Further research could explore whether the uptake of rural internships is facilitated by aligning these positions with protected opportunities to continue vocational training in regionally-based or metropolitan fellowships. Increased understanding is needed of the factors impacting work location decisions of junior doctors, particularly those with some rural career intent.

scholarly journals The validity of the Annual Review of Competence Progression: a qualitative interview study of the perceptions of junior doctors and their trainers

2017 ◽  
Vol 110 (3) ◽  
pp. 110-117 ◽  
Author(s):  
Rowena Viney ◽  
Antonia Rich ◽  
Sarah Needleman ◽  
Ann Griffin ◽  
Katherine Woolf
Keyword(s):  
Assessment Tool ◽  
Medical Training ◽  
Annual Review ◽  
Junior Doctors ◽  
Postgraduate Medical Training ◽  
Medical Graduates ◽  
Qualitative Interview Study ◽  
Negative Perceptions ◽  
Positive Experiences ◽  
Graduate Trainees

Objective To investigate trainee doctors’ and trainers’ perceptions of the validity of the Annual Review of Competence Progression (ARCP) using Messick’s conceptualisation of construct validity. Design Qualitative semi-structured focus groups and interviews with trainees and trainers. Setting Postgraduate medical training in London, Kent Surrey and Sussex, Yorkshire and Humber, and Wales in November/December 2015. Part of a larger study about the fairness of postgraduate medical training. Participants Ninety-six trainees and 41 trainers, comprising UK and international medical graduates from Foundation, General Practice, Medicine, Obstetrics and Gynaecology, Psychiatry, Radiology, and Surgery, at all levels of training. Main outcome measures Trainee and trainer perceptions of the validity of the ARCP as an assessment tool. Results Participants recognised the need for assessment, but were generally dissatisfied with ARCPs, especially UK graduate trainees. Participants criticised the perceived tick-box nature of ARCPs as measuring clerical rather than clinical ability, and which they found detrimental to learning. Trainees described being able to populate their e-portfolios with just positive feedback; they also experienced difficulty getting assessments signed off by supervisors. ARCPs were perceived as poor at identifying struggling trainees and/or as discouraging excellence by focussing on minimal competency. Positive experiences of ARCPs arose when trainees could discuss their progress with interested supervisors. Conclusions Trainee and trainer criticisms of ARCPs can be conceptualised as evidence that ARCPs lack validity as an assessment tool. Ongoing reforms to workplace-based assessments could address negative perceptions of the ‘tick-box’ elements, encourage constructive input from seniors and allow trainees to demonstrate excellence as well as minimal competency, while keeping patients safe.

scholarly journals The Level of Confidence, Readiness and its Associated Factors Among Medical Graduates Prior to House Officer (HO) Training

2019 ◽  
pp. 41
Author(s):  
Aneesa Abdul Rashid ◽  
Sazlina Shariff Ghazali ◽  
Iliana Mohamad ◽  
Dalila Roslan ◽  
Husna Musa ◽  
...  
Keyword(s):  
Medical Training ◽  
Clinical Skills ◽  
Junior Doctors ◽  
Cross Sectional ◽  
Medical Graduates ◽  
Adequate Knowledge ◽  
Level Of Confidence ◽  
Preparatory Course ◽  
Training Company ◽  
The Impact

Introduction: House officers are reported to feel less confident in working, especially in the initial part of their training. Among the factors that make them feel unprepared are in terms of adequate knowledge, clinical skills and dealing with workload. The impact of less confident house officers (HO) can lead to detrimental effects.Objectives: This study aims to look into the confidence and readiness levels of medical graduates prior to starting a HO preparatory course and factors associate.Methods: This is a cross sectional questionnaire study done among medical graduates between April – September 2018. This is part of a bigger study looking into the effectiveness of this course, which was initially organised under the Islamic Medical Association of Malaysia (IMAM) and later privatized to Medicorp (a medical training company for junior doctors). 238 participants who fulfilled the inclusion and exclusion criteria, completed the adapted IMU Competency survey pre and post the course. Their level of confidence and readiness to work was scored out of a Likert scale of 1 to 5. The higher the score, the higher the confidence or readiness to work.Results: We found significant association of confidence levels pre-course with ethnic it y (p=0.038). The scores were 2.0 (IQR=2.0), 2.0 (IQR=2.0), 3.0 (IQR=1.0), 2.5 (IQR=1.25) for Malay, Chinese, Indian and others respectively. We report significant associations with level of confidence (p=0.03) and readiness (p=0.08) not only prior, but levels of confidence (p<0.001) and readiness (p<0.001) after the course in association with place of study. Significant association was found for levels of confidence (p=0.048) and readiness (p=0.07) according to gender for scores post-course which were both 3.0 (IQR=1.0) and 4.0 (IQR=1.0) for females and males respectively.Conclusion: Confidence level to start work were higher for the Indian ethnicity before the HOpreparatory- course. Confidence and readiness levels were higher in male after the course, and locally graduated participants pre and post course.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 41

scholarly journals European List of Essential Medicines for Medical Education: a protocol for a modified Delphi study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045635
Author(s):  
Erik Donker ◽  
David Brinkman ◽  
Milan Richir ◽  
Paraskevi Papaioannidou ◽  
Robert Likic ◽  
...  
Keyword(s):  
Medical Education ◽  
Delphi Study ◽  
Medical Training ◽  
Medical Center ◽  
European Countries ◽  
Essential Medicines ◽  
Ethical Review ◽  
Junior Doctors ◽  
Direct Supervision ◽  
Modified Delphi

IntroductionJunior doctors are responsible for a substantial number of prescribing errors, and final-year medical students lack sufficient prescribing knowledge and skills just before they graduate. Various national and international projects have been initiated to reform the teaching of clinical pharmacology and therapeutics (CP&T) during undergraduate medical training. However, there is as yet no list of commonly prescribed and available medicines that European doctors should be able to independently prescribe safely and effectively without direct supervision. Such a list could form the basis for a European Prescribing Exam and would harmonise European CP&T education. Therefore, the aim of this study is to reach consensus on a list of widely prescribed medicines, available in most European countries, that European junior doctors should be able to independently prescribe safely and effectively without direct supervision: the European List of Essential Medicines for Medical Education.Methods and analysisThis modified Delphi study will recruit European CP&T teachers (expert group). Two Delphi rounds will be carried out to enable a list to be drawn up of medicines that are available in ≥80% of European countries, which are considered standard prescribing practice, and which junior doctors should be able to prescribe safely and effectively without supervision.Ethics and disseminationThe study has been approved by the Medical Ethics Review Committee of VU University Medical Center (no. 2020.335) and by the Ethical Review Board of the Netherlands Association for Medical Education (approved project no. NVMO‐ERB 2020.4.8). The European List of Essential Medicines for Medical Education will be presented at national and international conferences and will be submitted to international peer-reviewed journals. It will also be used to develop and implement the European Prescribing Exam.

Factors relating to working hours restriction that have impacted the professional identity of trainees in the last decade

2021 ◽  
Vol 82 (3) ◽  
pp. 1-10
Author(s):  
Soumya Mukherjee ◽  
James Meacock ◽  
Eleanor Kissane ◽  
Debasish Pal
Keyword(s):  
Identity Development ◽  
Professional Identity ◽  
Medical Training ◽  
Working Hours ◽  
Junior Doctors ◽  
Clinical Experiences ◽  
Postgraduate Medical Training ◽  
European Working ◽  
Working Time Directive ◽  
The Impact

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or ‘being a doctor’. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

scholarly journals Quality improvement supervision comparison between training and non training posts

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S196-S196
Author(s):  
Qutub Jamali ◽  
Tarun Khanna ◽  
Gareth Thomas
Keyword(s):  
Patient Care ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Medical Training ◽  
Junior Doctors ◽  
List Type ◽  
Online Questionnaire ◽  
Qualitative And Quantitative ◽  
Training Post ◽  
Method Approach

AimsTo explore the level of supervision between training and non-training posts at LSCFT.Background•Supervision is defined as ‘provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainees' experience of providing safe and appropriate patient care’.•Along with the trainees, doctors working in non-training posts such as staff grade, specialty doctors, trust grade doctors (TJD)and MTI (Medical training initiative) doctors form an integral part of patient care in the NHS.Method•A mixed method approach was adopted with both qualitative and quantitative data collected simultaneously in the form of an online questionnaire.•An anonymous online questionnaire was sent to junior doctors currently in training and non-training posts at LSCFT in 2019 using Meridian software.Result1- Quantitative Data: - Participants included were doctors in training post such as Foundation Doctors (5), Psychiatry Core Trainees (6), GP STs (2) and doctors in non-training post such as TJD (4), Specialty Doctors (2) and MTI doctors (4). Based on the Meridian score, 84% of doctors were satisfied with the supervision. It was found that 72% of doctors received weekly supervisions, 10% monthly (1 TJD, 1 Foundation trainee) and16% bi-monthly (1 MTI, 1 SAS, 2 CTs). The data suggested that there was no difference in the frequency of supervisions between training and non-training posts at LSCFT.2- Qualitative Data: - The feedback was common as there was no major difference between training and non-training doctors. •Positives – WPBAs, discussion on reflections, management of complex cases and medication, personal issues affecting work.•Negatives – Limited discussion on QI, Audit, Research and Psychotherapy.- More specific help, need more support at times.Conclusion1.To prepare a checklist of contents to be discussed during supervision.2.To prepare a timeline chart of supervision.3.Preparing a ‘menu’ of QI projects that junior doctors can sign up to at the start of each post.4.To formulate training packages available to support junior doctors with QI/Audits.

International medical graduates' reflections on facilitators and barriers to undertaking the Australian Medical Council examination

2012 ◽  
Vol 36 (3) ◽  
pp. 296 ◽  
Author(s):  
Pam McGrath ◽  
Saras Henderson ◽  
Hamish A. Holewa ◽  
David Henderson ◽  
John Tamargo
Keyword(s):  
Medical Training ◽  
Study Groups ◽  
International Medical ◽  
International Medical Graduates ◽  
Medical Council ◽  
Or Education ◽  
Program Coordinators ◽  
Australian Health ◽  
Medical Graduates ◽  
Facilitators And Barriers

Objective. In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs’ education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs’ reflections on facilitators and barriers in undertaking the AMC examination. Methods. After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. Conclusion. The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination. What is known about the topic? There is concern expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs education. The Australian work that is available only depicts educational experience of fellowships or education and training strategies after IMGs have passed their AMC examination. What does this paper add? The findings indicate that the process of sitting for the AMC examination is perceived as one of the major difficulties associated with entering and integrating into the Australian health system. The findings indicate a range of practical, financial and resource problems faced by IMGs attempting to sit for the AMC examination. What are the implications for practitioners? The detailed accounts from IMGs about their experience with undertaking the AMC examination will provide up-skilling program coordinators with the information they need to better assist IMGs to prepare for the examination. The provision of appropriate medical training and educational support will contribute to more effective integration of IMGs into the healthcare system.

scholarly journals ASiT backs trainees through upheaval

2007 ◽  
Vol 89 (7) ◽  
pp. 242-243
Author(s):  
Elaine Towell
Keyword(s):  
Surgical Training ◽  
Medical Training ◽  
Junior Doctors ◽  
Security Breach ◽  
High Profile ◽  
Medical Careers ◽  
Recruitment System

There is no doubt that surgical training is going through a period of major upheaval. The implementation of Modernising Medical Careers (MMC) has been steeped in controversy with recent months bringing uncertainty and anger as junior doctors compete for a limited number of training places. The introduction of a new selection and recruitment system, the Medical Training Applications System (MTAS), only served to exacerbate the anger. The system, as well as being involved in a major security breach, also failed to take into account doctors' qualifications and experience and was subsequently dropped, leaving a trail of destruction and high-profile resignations in its wake.

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