Assessment of basic surgical trainees: can we do more?

Introduction: Changes to surgical training and reduction of junior doctors'' working hours has resulted in trainees spending less time in surgical specialties before becoming eligible to apply for specialist registrar posts. A high quality basic surgical training programme is needed to improve the competence of trainees during their shortened period, an essential part of which is to conduct a formal assessment at the end of each training post and regular appraisals during their period of training. Aims: To analyse the existing practice with regard to conducting assessment and appraisals for basic surgical trainees in the South East Wales region. Methods: A questionnaire was sent to all the basic surgical trainees in the South East Wales region. Results: A total of 52 questionnaires were sent out and 44 (84%) were returned. Four candidates were in the first post of their rotation, and were therefore excluded from the study. Nine of the 40 trainees (23%) did not have an assessment in one or more of their posts. There are 17 senior house officer posts available in general surgery in the rotation. Of the 31 "six month" episodes spent in these 17 posts, 27 (87%) underwent an assessment, 12 of the 17 (70%) episodes in trauma and orthopaedics (12 available posts) were assessed, and 31 of the 35 (88%) episodes in accident and emergency (eight available posts) underwent an assessment. Twenty eight of the 40 trainees (70%) did not undergo regular appraisals during the majority of their posts. Only 30%–50% of episodes spent in general surgery, orthopaedics, and accident and emergency underwent appraisals. The majority of the episodes spent in the other surgical specialties (12 posts available in total) had formal assessment and regular appraisals except for urology in which two of seven episodes underwent assessment and one underwent an appraisal. Twelve candidates (30%) expressed the view that operative experience and technical skills must form part of their assessment. Eight trainees (20%) felt that they needed more help from tutors with regard to career advice, preparation of curriculum vitae, and interview techniques for specialist registrar posts. Eight trainees mentioned that they had discussed unsatisfactory posts with their tutors but were not aware of any changes made to these posts. Conclusions: This study has shown that the formal assessment of basic surgical trainees at the end of each training post has to improve further. The existing practice of conducting regular appraisals for the trainees is grossly inadequate. There appears to be a need for formulating guidelines for conducting such appraisals, which would help to improve practice in the future.     

Career attainment - chance or choice. Survey of career experience of doctors graduating in Scottish medical schools in 1962.

A survey was carried out of the career experience of the doctors who graduated from Scottish medical schools in 1962. Few of those in general practice in the UK had undergone the minimum period of vocational training now considered necessary for new entrants to practice. Of those in the hospital and specialist services, 53% were consultants. There was a tendency for early career decisions to be made, leading to an increasing number of doctors obtaining postgraduate training almost exclusively in one specialty. Many married women doctors were underemployed. A quarter of the doctors were living overseas, including those of the nonBritish nationals who had returned to their country of origin.     

Training for rural practice in Australia 1990

There is a shortage of general practitioners in rural Australia. Several recent State and federal government reports have highlighted the difficulties of rural practice. One of the reasons commonly cited for the shortage of country doctors is the lack of appropriate training in Australia's medical schools and the Family Medicine Programme. This survey of the heads of departments of community medicine/general practice of Australia's 10 medical schools and of the State directors of the Family Medicine Programme documents the present efforts to train doctors for rural general practice. A 100% response was achieved. The responses indicate much interest and effort from the Family Medicine Programme in developing rural training schemes. Though the community medicine/general practice departments demonstrate considerable interest and innovation, they are hampered by lack of resources and negative attitudes of some specialist colleagues. Overall, the main impediments are: lack of "affirmative action" admissions policies to recruit rural students; insufficient curricular time for teaching the principles of general practice; students' lack of confidence in the procedural aspects of rural practice; lack of appropriate training posts in anaesthetics; lack of appropriate general practice training posts at regional hospitals; and lack of financial resources. Some suggestions are given to improve training for rural practice in Australia.     

Junior hospital doctors' views on their training in the UK.

To ascertain the views of senior house officers and registrars on the educational and training component of their posts, a questionnaire was sent to all full-time doctors working in training posts in general and/or geriatric medicine at three district general and three teaching hospitals. Completed questionnaires were received from 64 (61%) of 105 doctors who were contacted. Most had a careers counsellor or tutor, although less than two-thirds thought they had benefited from this arrangement. The majority of doctors attended at least two medical tutorials or meetings per week; most wanted to attend more but were unable to because of other work commitments. Supervision by more senior staff on the ward was deemed by most to be satisfactory, but less so in out-patient clinics. Overall, one-third of doctors thought that training was inadequate and three-quarters wanted a greater amount of formal education. The majority of junior doctors'' time was spent on routine work and most considered :training'' constituted less than 10% of their working time. Doctors in training require more sessions designated as educational, with protected time to attend these.     

The educational component of senior house officer posts: differences in the perceptions of consultants and junior doctors.

The aims of this study were to elicit general practitioner (GP) trainee''s perceptions of the educational structure of their hospital posts, to compare them with those of consultants who had GP trainees as senior house officers (SHOs) in their departments and to examine the use of educational objectives in the hospital component of vocational training for general practice. A confidential postal questionnaire was sent to all the GP trainees (165 doctors) in the hospital component of their vocational training schemes (VTS) for general practice in Trent Region and all the consultants (161 doctors) in Trent who had GP trainees in their SHO posts on that date. Responses were received from 136 trainees (82%) and 134 consultants (83%). Educational objectives were stated as existing in the SHO post by 31 trainees (23%) and by 62 consultants (46%). Of those doctors who said that objectives existed, 19 of the trainees (61%) and 40 of the consultants (65%) said that the objectives were useful. Only nine (29%) of the trainees who stated that educational objectives existed felt that they were being put into practice by senior staff, compared with 41 (66%) of consultants who had made that statement. Of all respondents, 113 trainees (87%) and 100 consultants (77%) agreed or strongly agreed that the use of educational objectives would be beneficial to the trainees. Only 10 (7%) of trainees said that they received no teaching in their current posts. Forty trainees (32%) and 88 consultants (67%) said that teaching took place in protected time. Both groups cited consultants as the member of staff giving the most teaching. Ninety-six consultants (73%) replied that it was possible for GP trainees to obtain study leave, but 102 trainees (75%) either had experienced difficulties in obtaining study leave or had not attempted to obtain study leave. Trainees and consultants differed appreciably in their perceptions of the amount of assessment and feedback which was provided for GP trainees. The use of educational objectives in the hospital component of vocational training was felt to be beneficial by both consultants and GP trainees. Consultants were more likely than trainees to report the use of educational objectives, protected teaching time, GP-orientated teaching, ability of trainees to attend VTS half-day release and the provision of assessment and feedback to trainees.     

Addressing general practice workforce shortages: policy options

There is an ongoing shortage of general practitioners in Australia, accompanied by a decline in the popularity of general practice as a career choice. Many factors influence the career choice of junior doctors and medical students, including role models, the quality of clinical attachments during training, remuneration, and flexibility of training and working hours. Evidence-based strategies that could increase the number of doctors choosing general practice as a career include longer and higher-quality general practice attachments during medical school and the early postgraduate years, and emphasising the positive aspects of general practice, such as flexibility. General practice would become a more attractive choice if remuneration was in line with hospital specialties.     

Adding flexibility to physician training

Demographic changes among junior doctors are driving demand for increased flexibility in advanced physician training, but flexible training posts are lacking. Suitable flexible training models include flexible full-time, job-share and part-time positions. Major barriers to establishing flexible training positions include difficulty in finding job-share partners, lack of funding for creating supernumerary positions, and concern over equivalence of educational quality compared with full-time training. Pilot flexible training positions should be introduced across the medical specialties and educational outcomes examined prospectively.     

Practice patterns and family life--a survey of Melbourne medical graduates

To investigate sex differences in the professional achievements and personal life-styles of graduates, a questionnaire survey was conducted. The sample comprised surviving female medical graduates of the University of Melbourne and an equal number of male medical graduates who were matched by year of graduation. The final response rate was 70% (1764 subjects returned questionnaires) and was representative for both age and sex. This article describes the practice patterns and family lives of graduates. Considerable sex-related differences were found in the professional achievements and personal life-styles of the surveyed medical graduates. Women's professional careers tended to be more circumscribed than were those of male colleagues. Women were less involved in areas outside clinical practice such as teaching or lecturing, committees, medical administration, and research and its publication. Female doctors earned significantly (P less than 0.0001) less than did male doctors and were more likely to work as employees, locums or in sessional employment (P less than 0.0001). Women were more involved in all aspects of household activities, especially during midlife (40-60 years of age)--the peak career years for male doctors. The career underachievement of female doctors is likely to continue unless considerable changes are made to current postgraduate training schemes and career structures.     

Female doctors in Victoria, 1977

A survey of medical manpower in Victoria in 1977 revealed that 17% of registered medical practitioners were female and that the proportion of females was much higher among younger graduates. Seventy-eight per cent of female doctors were currently working in Victoria, compared with 82% of male doctors; 3.8% were "not working temporarily" compared with 0.6% of male doctors; and 3.9% were "retired" compared with 1.9% of male doctors. Female doctors accounted for only 8% of specialists in private practive, compared with 15% of general practitioners, more than 20% of salaried staff members of hospitals and other semigovernment and government bodies, and 40% of the staff members of community health centres. Thirty-eight per cent of female doctors were working part time. The need for part-time training programmes and part-time work, and the difficulties of female graduates becoming specialists are discussed. The implications of increasing proportions of female doctors entering the medical work force during the next decade, and the lower average working hours of female doctors compared with those of males, are considered in relation to the increasing supply of medical manpower in Australia.     

野战外科教学在基层军医住院医师规范化培训中的应用

基层军医参加住院医师规范化培训尚处于试点阶段,其执业背景与培训目标同地方住院医师相比存在很大的不同,需要探索符合基层军医岗位特点的执业医师规范化培训方法。本研究从基层部队的实际需求出发,紧贴军事医学环境,通过住院医师规范化培训与野战外科教学方法的紧密融合,使基层军医在住院医师规范化培训的临床实践过程中达到野战外科考核目...     

Twenty-five years of medical graduates in Papua New Guinea

1989 is the 25th anniversary of the first doctors trained in Papua New Guinea at the Papuan Medical College (PMC). By the end of 1970 PMC had produced 44 doctors. The following year it became the Medical Faculty of the University of Papua New Guinea (UPNG), which had graduated 318 doctors by February 1989. National doctors now make up approximately two-thirds of the total number of doctors in the country. The largest category of national doctors includes those working with the Health Department, but not at headquarters or specialist medical officer (SMO) level. Private practitioners constitute the second largest category, with almost one-fifth of fully registered national doctors. While postgraduate training programs have been established for clinical and public health specialists, vocational training for general practitioners has been mainly ignored. Private practitioners represent a considerable, and growing, manpower resource in urban areas, and ways need to be found to utilize their services in the public sector. 20% of national private practitioners have the M. Med. degree and 24% of those with the M. Med. are currently in private practice. Medical graduates from PMC and UPNG have a good record in postgraduate education: 37 have passed the M. Med., 62 have obtained a postgraduate medical diploma from UPNG and many have obtained overseas postgraduate diplomas and degrees. It is projected that 80% of SMOs will be national doctors within five years. An increased intake of national medical students into the Medical Faculty is needed now if most doctors in the country are to be nationals by the year 2000.     

Career Preferences of First-year Students at Canadian Medical Schools, 1966-67 to 1968-69

The principal findings of this study of the career preferences of first-year Canadian medical students were:

Over 70% of the first-year students expressed a preference for specialty practice, with only 20% oriented towards practice as a family practitioner.

There were considerable differences between the medical schools in the proportion of medical students preferring general practice, ranging from less than 10% at McGill to nearly 33% at Queen's.

Nearly one-third of the students stated that they preferred primarily salaried practice. These students were largely those who preferred specialty practice or a career in an area such as public health or research.

Nearly 70% of the students looked for a career with part-time teaching, while 8% preferred a full-time teaching career.

Only 1% preferred a full-time research career although 90% expected to have at least some research involvement.

Students from smaller communities were more likely to express a preference for general practice than those from large urban areas.

Men and women had similar practice preferences in terms of general practice and clinical specialty, but significantly more women than men preferred a career in salaried practice. Significantly fewer women expressed a preference for major involvement in either teaching or research.

     

Future models of general practice training in Australia

Current proposals for significant primary health care reform in Australia create a timely opportunity to reflect on the education and training requirements of future general practitioners. Australian general practice will become increasingly team-based, with growing emphasis on coordinated care, chronic disease management, and disease prevention and self-management, while maintaining its focus on delivering high-quality, patient-centred care. This will require cost-effective application of new technologies and information management systems within new models of delivering health care. Future models of general practice training must respond to these new ways of working to ensure general practice remains an attractive career choice and training programs graduate doctors who are equipped to meet the health needs of Australians. This article discusses potential development of new general practice vocational training models in Australia. This includes hospital rotations that are more directly integrated with general practice placements and have greater emphasis on the needs of the future general practice workforce; and an extension of the training program to 4 years with a final year tailored to future career plans including development of expertise in practice management, specific clinical disciplines or academic skills.     

The evolution of the general practice workforce in Australia, 1991-2003

OBJECTIVE: To examine changes between 1991 and 2003 in the characteristics of active recognised general practitioners in Australia. DESIGN: We compared self-reported GP characteristics from the 1990-91 Australian Morbidity and Treatment Survey (AMTS) with those from the 1999 and 2003 Bettering the Evaluation and Care of Health (BEACH) surveys, after standardisation for age and sex to the respective sample frames. AMTS and BEACH are cross-sectional, paper-based, national surveys. PARTICIPANTS: Three random samples of 473 (1990-91), 980 (1998-99) and 1008 (2002-03) GPs who had claimed at least 1500 A1 (ie, general practice) Medicare items in the preceding year (in the AMTS) or 375 general practice Medicare items in the preceding 3 months (in the BEACH surveys). MAIN OUTCOME MEASURES: Changes in distribution of GP sex, GP age, number of sessions per week, practice size and location, country of graduation, and postgraduate training. RESULTS: Between 1991 and 2003, the proportion of female GPs rose from 19.3% to 35.2%; GPs aged < 35 years dropped from 22.3% to 10.0%, and those aged >or= 55 years increased from 21.4% to 31.6%. Between 1999 and 2003, the proportion of male GPs working < 6 sessions/week increased from 6.1% to 11.4%, while the proportion working >or= 11 sessions/week fell from 23.8% to 17.1%. Between 1991 and 2003, the proportion of solo practitioners nearly halved (25.5% v 13.7%); the proportion of GPs in practices of >or= 4 partners increased from 34.3% to 59.8%; the proportion of Australian graduates fell from 81.4% to 72.2%; and the proportion of graduates from Asia and Africa increased. Over the same period, the proportion of GPs with Fellowship of the Royal Australian College of General Practitioners more than doubled (17.8% v 36.4%). All of these differences were statistically significant (P < 0.001). CONCLUSION: Changes in characteristics of the practising GP population will affect consultative services and the balance between supply and demand for these services. These changes should be considered in future workforce planning.     

神经外科住院医师规范化培训中临床实践教学策略探讨

住院医师规范化培训是执业行医的起点和必经过程,在医师职业生涯中极为重要。临床实践是住院医师获取临床理论、技能和经验的必需环节,因而其相关教学在住院医师规范化培训中极为关键。基于大型综合医院神经外科高年资医师多年来的临床带教经验,根据住院医师规范化培训的要求,结合神经外科住院医师特点,将培训期分为初、中、末三个阶段,探讨规范化培训各阶段临床实践教学策略。     

Learning opportunities for Australian prevocational hospital doctors: exposure, perceived quality and desired methods of learning

OBJECTIVE: To survey prevocational doctors working in Australian hospitals on aspects of postgraduate learning. PARTICIPANTS AND SETTING: 470 prevocational doctors in 36 health services in Australia, August 2003 to October 2004. DESIGN: Cross-sectional cohort survey with a mix of ordinal multicategory questions and free text. MAIN OUTCOME MEASURES: Perceived preparedness for aspects of clinical practice; perceptions of the quantity and usefulness of current teaching and learning methods and desired future exposure to learning methods. RESULTS: 64% (299/467) of responding doctors felt generally prepared for their job, 91% (425/469) felt prepared for dealing with patients, and 70% (325/467) for dealing with relatives. A minority felt prepared for medicolegal problems (23%, 106/468), clinical emergencies (31%, 146/469), choosing a career (40%, 188/468), or performing procedures (45%, 213/469). Adequate contact with registrars was reported by 90% (418/465) and adequate contact with consultants by 56% (257/466); 20% (94/467) reported exposure to clinical skills training and 11% (38/356) to high-fidelity simulation. Informal registrar contact was described as useful or very useful by 94% (433/463), and high-fidelity simulation by 83% (179/216). Most prevocational doctors would prefer more formal instruction from their registrars (84%, 383/456) and consultants (81%, 362/447); 84% (265/316) want increased exposure to high-fidelity simulation and 81% (283/350) to professional college tutorials. CONCLUSION: Our findings should assist planning and development of training programs for prevocational doctors in Australian hospitals.     

广东省粤东地区全科医生岗位培训现状分析与对策

目的 探讨广东省粤东地区全科医生现状及岗位培训需求,为落实全科医生培训制度及稳定基层卫生人才队伍提供科学的实证依据。 方法 整群抽取2014年广东省粤东地区第4期全科医生岗位培训学员110名,应用问卷调查法,了解该组全科医生的基本情况、工作现状、对岗位培训的认知以及目前执业环境和岗位培训需求等,并对调查结果进行统计和分析。 结果 本组学员的学历职称偏低:大专以下学历占72.73%;初级职称医生占90.90%,其中助理医生占55.45%。学员中95.45%没有接受过全科医学教育培训,37.27%认为培训是因为工作需要。对基层执业环境不满意主要包括:工作条件、工作环境、职称晋升和培训支持,分别占60.00%、42.70%、28.18%和20.90%。专业知识与技能掌握不足主要包括:健康档案管理、辅助检查、妇儿保健、心理治疗、营养健康、康复技术以及伦理和社会问题等,分别占82.73%、83.64%、80.00%、84.55%、85.45%、84.55%和82.73%。 结论 基层全科医生的学历职称偏低、执业环境较差、对岗位培训认知偏差以及专业能力不足等问题较为明显,提示政府部门需进一步加强政策导向,建立健全具有我国特色的全科医生培养长效机制,要合理优化全科医生的执业环境,为基层卫生人才提供获得成就感的职业发展空间,用激励政策留住人才、吸引人才。      

Family medicine training--the international experience

Family medicine is undergoing dramatic transformation around the world. Its organisation, delivery, and funding are changing in profound ways. While the specifics of primary care reform vary, a common emerging strategy involves establishment of primary health care teams that provide improved access, use electronic records, are networked with other teams, and are paid using blended payment schemes. More family doctors are needed in all countries. New approaches beyond the traditional apprenticeships or residency programs will be required to meet global demand. Training of family doctors must change to prepare tomorrow's family physician for a different practice reality. Curricula are more competency-oriented, rather than time-focused. Today's trainees can anticipate a career that includes periodic reassessment of their knowledge base and competency. This article explores these trends and offers some strategies that have proved effective in various parts of the world for training increased numbers of qualified family doctors.     

The acceptability of personal learning plans in vocational training.

Personal learning plans have been advocated as a means of introducing the principles of adult learning into general practice vocational training. The aim of this study was to investigate attitudes amongst general practice trainers and registrars to the introduction and use of personal learning plans. A questionnaire was sent to general practice trainers and registrars in one vocational training scheme prior to the introduction of personal learning plans. Overall, doctors in the training scheme were positive to the idea of personal learning plans. Trainers were significantly more positive towards introducing learning plans than their registrars. Registrars in their final general practice posts were significantly more positive towards the idea of learning plans than their hospital counterparts. Doctors who had completed membership of the Royal College of General Practitioners, usually trainers or final year registrars, were also more positive in their attitude. This pilot study suggests that most trainers and registrars were positive in their attitude towards personal learning plans prior to their introduction in the Lincoln vocational training scheme. The study cautiously suggests a wider use and evaluation of personal learning plans in vocational training.     

云南省全科医生转岗培训学员执业注册意愿及影响因素研究

目的 了解云南省全科医生转岗培训学员执业注册意愿及影响因素,为提高该群体的全科医师注册意愿提出相关建议,为有关部门促进基层全科医生队伍建设提供参考依据。 方法 采取分层整群抽样方法,抽取云南省6个州市参加全科医生转岗培训的300例基层医疗卫生人员为调查对象,采用自行设计的调查问卷和访谈提纲进行现场调查,内容包括一般情况、执业注册意愿、影响因素等,采用一般性统计描述、χ2检验、非条件Logistic回归分析等方法进行数据分析。 结果 参加云南省全科医生转岗培训的学员无职称者占到41.5%;29.8%的转岗培训学员愿意注册为全科医师,选择注册的原因依次为愿成为全科医师、岗位聘任需要、主管行政部门要求等;70.2%的转岗培训学员不愿注册为全科医师,选择不注册的原因依次为达不到全科医师注册条件、其他、对全科医生职业发展没有信心等。非条件Logistic回归分析结果显示,影响全科医生转岗培训学员执业注册意愿的因素有执业资格、在基层医疗卫生工作中遇到国家相关政策落实不到位、工资待遇低、工作条件简陋、住房等生活条件差等。 结论 转岗培训学员执业注册为全科医师的意愿低,需加强全科医生转岗培训学员的职业引导,改善基层全科医生的职业发展和生活环境,进一步健全转岗培训学员遴选机制。