Career choices at the end of the pre-registration year of doctors who qualified in the united kingdom in 1996

OBJECTIVE: To report the career intentions one year after qualification of doctors who qualified in the United Kingdom (UK) in 1996, and to compare their intentions with those of 1993 qualifiers at the same stage. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1996. MAIN OUTCOME MEASURES: Choices of eventual career expressed one year after qualifying. RESULTS: We report on detailed choices of long-term careers for all specialties. Only 20% of 1996 respondents chose general practice compared with 25.8% of 1993 respondents. The percentage choosing general practice fell more sharply among women, from 34.0% to 25.2%, than among men, from 17.5% to 14.1%. Choices for surgical specialties rose from 16.9% of 1993 respondents to 21. 4% of 1996 respondents. The percentage choosing the surgical specialties rose among women, from 7.8% to 11.6%, compared with a rise among men from 26.1% to 32.2%. The percentage of respondents who definitely or probably intended to pursue a long-term career in the UK was 77.7% compared with 75.7% of 1993 respondents. Most of the home-based respondents who had doubts about practising in the United Kingdom were considering practising abroad. Only 1% made an explicit first choice for a non-medical career. However, in all, 9. 4% said that there was a possibility that they might leave medicine. CONCLUSION: The substantial decline in intentions to enter general practice among newly qualified doctors, seen in the 1993 qualifiers, is continued in the 1996 qualifiers. A shortfall in recruitment of UK-trained doctors to general practice is the likely outcome. The rise in choices for the surgical specialties, particularly among women, may herald a renewed interest in hospital specialist training following the Calman changes. It is worrying that almost a quarter of respondents indicated some doubts about pursuing a medical career in the UK.     

Doctors' views about their first postgraduate year in UK medical practice: House officers in 2003

Aim To report house officers' views in 2003 of their first postgraduate year, and to compare their responses with those of house officers 2 and 3 years previously. Methods Postal questionnaires to all house officers in 2003 who graduated from UK medical schools in 2002. Results The response rate was 65.3% (2778/4257). The house officers of 2003 enjoyed the year more than those of 2000–1. A total of 78% of respondents in 2003 scored 7–10 in reply to the question ‘How much have you enjoyed the house officer year overall?’, scored from 0 (no enjoyment) to 10 (enjoyed it greatly), compared with 70% of 2000–1 house officers. They were more satisfied with leisure time available to them (51% scoring 6–10 in 2003; 35% in 2000–1). There were significant improvements in almost every aspect of doctors' experience. Hospital medical posts were rated more highly than surgical posts, and general practice posts higher still. Overall, 38% of respondents regarded their training as having been of a high standard, and 37% felt that they received constructive feedback on their performance. Differences between men and women in their views about their jobs were small. Discussion The house officers of 2003 reported more positively on their experiences than did those of 2000–1. Although a substantial percentage were negative about specific aspects of clinical support and training, particularly in surgical posts, almost all the responses covering training and clinical support moved in a favourable direction over time.     

Views of doctors in training on the importance and availability of career advice in UK medicine

OBJECTIVES: To determine whether doctors in their first year after qualification wanted career advice, and, if so, whether they thought they had been able to obtain useful advice, and whether older doctors thought that adequate career advice had been available to them. METHODS: We carried out a postal questionnaire survey of all UK medical graduates of 1988, 1993, 1996, 1999 and 2002, and a 25% random sample of the graduates of 2000. RESULTS: The response rate was 67.4% (24 261/35 976 mailed questionnaires). Of doctors in the first postgraduate year, 95% agreed that: 'It is important to be given career advice at this stage of training.' A total of 38% disagreed with the statement: 'I have been able to obtain useful career advice since graduation.' Of more experienced doctors surveyed between 3 and 11 years after graduation, 34% agreed that: 'Making career choices has been made more difficult by inadequate career advice.' CONCLUSIONS: The great majority of junior doctors want career advice after qualification. It cannot be assumed that they are able to seek it out for themselves satisfactorily. Career advice needs to be planned into postgraduate work and training.     

Views of junior doctors about their work: survey of qualifiers of 1993 and 1996 from United Kingdom medical schools

OBJECTIVE: To investigate the views of junior doctors about their work. DESIGN: Postal questionnaire surveys. SETTING: United Kingdom. SUBJECTS: Doctors who graduated from medical schools in the United Kingdom in 1996, surveyed at the end of their preregistration year (2926 respondents), and graduates of 1993 surveyed 3 years after qualification (2541 respondents). RESULTS: Almost 70% of the 1996 qualifiers felt that they worked excessive hours and 80% felt that they undertook too many routine non-clinical duties. Only 24% agreed that their postgraduate training was of a high standard and 22% felt they were being asked to perform clinical tasks with inadequate training. A total of 70% were dissatisfied with arrangements for cover for absent doctors. Senior doctors and nurses were regarded as supportive by most respondents, but hospital management was not. Although 65% were satisfied with their future prospects, only 36% had been able to obtain useful careers advice. Job enjoyment was reasonably high, with two-thirds scoring 6 or more on a scale from 1 (not enjoying at all) to 10 (greatly enjoying), but 70% of respondents felt that they had insufficient time for family and social activities. A briefer questionnaire sent to the 1993 qualifiers in 1996 showed similar results. CONCLUSIONS: More needs to be done to ensure that junior doctors are trained appropriately for the tasks they undertake, to ensure that they regard their training highly, to reduce excessive non-clinical work, and to provide reasonable working hours and cover.     

Career patterns of women medical graduates 1974–84

A postal questionnaire was carried out in 1984 to determine the career pattern of United Kingdom women medical graduates of 1974. The response rate was 57%. The median age was 33 and 82% were married. Eighty-nine per cent were employed in a vast range of specialties; most of those not working at the time of the survey planned to return to work within 6 months. Many expressed a need for more career advice at all stages, and for more training in the community-based specialties.     

Working patterns and the quality of training of medical house officers: evaluating the effect of the `new deal'

The `new deal' on junior doctors' hours of work has led to the widespread introduction of working patterns such as full shifts and partial shifts in the United Kingdom. The impact of these changes on the training of medical staff is unclear. The subjects of the current study were 36 pre-registration medical house officers working shift rotas and on-call rotas at a teaching hospital in the north of England. They were studied over a 12-month period using a self-report questionnaire seeking their views on the quality of their training experience and their satisfaction with the in-service training they received. Nursing staff, consultant and medical student opinion was also sought. Partial-shift and full-shift systems led to reduced hours of work when compared to on-call rotas (mean hours: partial shift 65·0; full shift 59·8; on-call 72·7), but they were associated with significantly lower training experience and training satisfaction scores for the house officers than were on-call systems (P < 0·01). Shift systems were unpopular among consultants and medical students but not nursing staff. Despite reducing excessive hours of work, shifts may be detrimental to the training of medical house officers. The further imposition of shift working should be suspended until such time as the impact of new working patterns on the training of medical staff has been determined.     

Academic careers in general practice and primary care

In the past 10 years, significant developments in general practice teaching and research have led to the considerable growth of academic general practice as a discipline. This paper reviews issues relating to these developments, particularly career pathways and training aspects. The need to extend these advances to the broadening arena of primary health care has given further impetus for the development of academic careers. General practice will need to work closely with secondary care, community health, and social services to develop primary health care in its broadest sense, and an evidence base, generated by relevant research and evaluation, must underpin all of this. Structural and funding changes to undergraduate education, postgraduate training and primary care research have created a range of opportunities for general practice clinicians to define career pathways, not formerly available, within multiprofessional and multidisciplinary departments and groups. Education for future general practice and primary care must underpin developments as much as a research base. Relevant masters' degrees and diplomas are now widely available, and extended vocational training and higher professional education will enable general practitioners in their formative years to consider academic opportunities.     

Stability and change in career choices of junior doctors: postal questionnaire surveys of the United Kingdom qualifiers of 1993

OBJECTIVE: To report on stability and change in career choices of doctors, between 1 and 3 years after qualification. DESIGN: Postal questionnaire surveys. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the United Kingdom in 1993. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 and 3 years after qualifying. RESULTS: The overall pattern of career choices at year 3 differed a little from that at year 1. For example, choices for general practice increased from 26% to 29%, choices for medical specialties fell from 22% to 18%, and for surgical specialties they fell from 17% to 14%. However, because changes of choice between specialties tended to 'cancel out', the aggregated data masked much larger changes when considered at the level of individual doctors. Overall, 74% of respondents retained their year 1 career choice in year 3 (78% of men, 70% of women). Of doctors who chose a hospital specialty in year 1, 71% chose the same specialty in year 3, 18% had switched choice to another hospital specialty, and 9% had switched choice to general practice. The percentage who changed choice from hospital specialties to general practice between years 1 and 3 was lower in the 1993 cohort than in all previous cohorts. Of those whose year 1 choice of long-term career was general practice, 89% retained that choice in year 3 and 11% switched to other branches of medicine. Even by year 3, less than half of all respondents (and a smaller percentage of women than men) signified that their long-term choice of specialty was definite. In year 3, 78% of all respondents, and 79% of doctors from homes in the United Kingdom, intended definitely or probably to practise medicine in the United Kingdom for the foreseeable future, which represented little change from the figures in year 1. CONCLUSIONS: About a quarter of doctors change their career choice between years 1 and 3 after qualification, and less than half regard their choice in year 3 as definite. Flexibility is therefore needed, well beyond the first post-qualification year, to accommodate changes of choice. Where training opportunities in a hospital specialty are limited, doctors are now inclining, more than in the past, to switch to an alternative hospital specialty rather than to general practice.     

" 'Just think of TB and Asians', that's all I ever hear": medical learners' views about training to work in an ethnically diverse society

The case for being able to respond effectively to cultural and ethnic diversity in health care is attracting increasing debate in medical education. However research exploring the perspectives of learners is lacking. AIMS: We sought medical learners' perceptions and their perceived training needs in relation to cultural and ethnic diversity in health care. METHODS: A series of nine focus group interviews was conducted with 55 medical learners, including undergraduate students in a UK medical school and a group of postgraduate general practitioners in training. Interview data were analysed using qualitative methods. RESULTS: Participants had a broad but superficial awareness of multicultural issues. This focused upon "difference" with students emphasizing their need to acquire knowledge of different beliefs and practices. Current teaching was perceived as inadequate and limited largely to ethnic patterns of disease. Most felt a need for greater training. They regarded development of particular communication skills, such as working with interpreters as helpful. Beyond avoiding stereotyping, learners rarely identified reflecting upon their attitudes or the issue of racism as important. Students anticipated a range of potential problems for further training, but sought learning that was relevant, practically oriented and stimulating. CONCLUSIONS: The study points to learners' experience of inadequate training but suggests a willingness to learn more. The possible predominance of a "difference" perspective might drive a narrow focus upon learning cultural knowledge at the expense of promoting a balance with self-reflection upon attitudes and developing generic skills. Educators might heed learners' views about how they should be taught successfully.     

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 Study

Summary. The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the 'Junior Physician 88' study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977–1986 in Finland (   n = 5208  ). After randomization, a postal questionnaire was sent to one half (   n = 2631  ) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team-work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.     

Anaesthetics: career choices and experiences

At the pre-registration stage, about 4% of doctors who qualified in 1974 and about 5% of 1977 qualifiers gave anaesthetics as a first choice of career. Over the few years after qualifying, both cohorts showed a net gain in career preferences for anaesthetics. The progress of those choosing anaesthetics is described, and also the career paths of those becoming senior registrars in the specialty. Postgraduate qualifications, non-anaesthetic and overseas experience are analysed. Discussion deals with breadth of experience, women doctors and manpower implications.     

Early medical career choices and eventual careers

The revised structure of hospital specialist training being introduced in the United Kingdom means that a doctor wanting a career in a hospital specialty will need to be confident that his or her early career choice, made within 3 years of qualification, is realistic. Using data from a longitudinal study of the 1983 cohort of UK medical graduates, the early career choices made by over 2000 doctors were compared with their employment 11 years after qualification. At year 11 65% of the doctors were working within the first choice they had expressed towards the end of their pre-registration year, and 79% were employed in their year 3 first choice. There was, however, important variation within this general picture: lower predictive value was associated with choices made by women; choices for hospital mainstreams rather than for general practice; and choices that were less than definite. The recent drop in popularity of general practice as a career choice of new graduates in the UK, and the steady increase in the proportion of women graduates, mean that the predictive value of the career choices of recent graduates may prove to be lower than that of the 1983 cohort.     

Postgraduate Training Policy paper prepared by the Subcommittee on Postgraduate Training: Permanent Working Group of European Junior Hospital Doctors

The Permanent Working Group of European Junior Hospital Doctors (PWG) represents the interests, in international matters, of trainees from 23 member states. The PWG recognizes the importance of postgraduate training (PGT) in the maintenance of high quality health care delivery, and in this paper presents its current policy on PGT. This replaces its policy previously published in Medical Education 1989, 23 , 339–47. The paper examines the context within which PGT occurs, and calls for an urgent review of its provision and funding. Basic principles, such as PGT existing within a continuum of medical education and the application of a quality assurance-based model, underpin the development of later sections on the structure, process and outcomes of PGT. These recommend the establishment of structured training programmes which should incorporate modern educational practice in the provision and monitoring of PGT. Emphasis is placed on the opportunities for training in the clinical setting and the utilization of a range of educational techniques. Evaluation and guidance by and of clinical supervisors and designated trainers is linked with the responsibilities of the trainee, and is placed within the context of a system of accountability, thus closing the quality assurance cycle. It is recommended that the views of the consumers of PGT, the trainees, are more fully considered in the development of training programmes. Finally, the potential for further harmonization is considered, with cautious advances being proposed.     

''Shadowing'' a manager: an exercise in senior registrar management training

A senior registrar 'shadowed' a district general manager and a unit general manager for one week each as a management training exercise. The three principal participants describe the exercise from their different perspectives. Consequent issues and the value of such 'shadowing' as a mode of training are discussed.     

Education and training in the senior house officer grade: results from a cohort study of United Kingdom medical graduates

INTRODUCTION: This paper shows the findings from a survey of 439 senior house officers undertaken as part of the British Medical Association cohort study of 1995 medical graduates. The aim of the study was to assess the quality of senior house officer training in the United Kingdom. METHOD: In July 1997 a postal questionnaire was sent to a sample of 545 doctors who graduated from medical school in 1995. Responses were received from 515 (95%). Only those doctors who had worked as a senior house officer in the previous 12 months were included in the analysis (n = 439). RESULTS: Encouraging results are that 69% of the senior house officers surveyed had discussed their progress directly with their consultant, and 24% rated their supervision by their consultant as 'excellent'. Of concern are the findings that 47% of respondents did not receive protected teaching time and 16% were unable to take study leave. DISCUSSION: The study revealed wide variability in the quality of training received by senior house officers in the United Kingdom. Whilst some respondents - notably those in general practice, accident and emergency, paediatrics and psychiatry - had enjoyed a high standard of education and training, it was clear that a minority of posts continue to offer little if any educational value to the post holder. The results point to a need for a more systematic approach to maintaining standards in senior house officer training with greater incentives for under-performing trusts.     

Career destinations and views in 1998 of the doctors who qualified in the United Kingdom in 1993

OBJECTIVE: To report career destinations and views in 1998 of doctors who qualified in the United Kingdom (UK) in 1993. DESIGN: Postal questionnaire survey. SETTING: This study took place in the United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1993. MAIN OUTCOME MEASURES: The percentage of doctors in each branch of medicine five years after qualification, and their views on their training and career opportunities. RESULTS: The NHS and universities in the UK employed 88% of respondents (men 90%, women 86%). UK general practice employed 24% of respondents (men 19%, women 28%). There were significant differences (P < 0.01) between the percentages of men and women working in the surgical specialties (men 28%, women 10%), paediatrics (men 8%, women 15%) and obstetrics and gynaecology (men 5%, women 10%). Respondents not in paid employment comprised 1.4% of men and 6.6% of women. 45% of respondents agreed that their postgraduate training was of a high standard, with 26% disagreeing and 29% unsure. 47% of specialist registrars felt their training was too short and 78% were concerned about the availability of consultant posts on completion. CONCLUSIONS: Although loss of doctors from the British workforce through emigration or unemployment is not increasing, our findings confirm a substantial shift away from careers in general practice. The number of home-trained GPs from this generation of doctors will be inadequate to meet service needs. GPs and hospital specialist doctors expressed concerns about quality of training, lack of careers advice, the shortness of specialist registrar training and availability of consultant posts on completion of training.     

Doctors' reasons for rejecting initial choices of specialties as long-term careers

OBJECTIVES: To report on rejected choices of specialty as long-term careers and reasons for rejection. DESIGN: Postal questionnaire survey. SETTING: United Kingdom. PARTICIPANTS: All graduates of 1996 and 1999 from UK medical schools during their first year after qualification. MAIN OUTCOME MEASURES: Any career choice which had been seriously considered and rejected and the reason for its rejection. RESULTS: In all, 33.1% (1871) of respondents named a rejected choice and gave reasons for its rejection. Disproportionately high numbers rejected the surgical specialties, paediatrics and obstetrics and gynaecology (O&G), using the specialty distribution of positive choices as the comparator. Relatively few doctors rejected general practice (GP) after giving it serious consideration. Doctors rejecting the hospital medical and surgical specialties or paediatrics were most likely to specify reasons relating to quality of life. Three-quarters of the graduates of 1999 who rejected O&G did so because of poor career prospects. CONCLUSIONS: Quality of life issues, and concerns about working relationships, are sufficiently influential to persuade many doctors to abandon an initial choice of medical career. It is unlikely that much of the decline in entry to GP is attributable to rejection of GP by doctors who initially chose it. The decline must therefore represent an increase in the number of doctors who had never seriously considered it as a long-term career choice.     

A follow-up of career preferences

Of 146 pre-registration house officers in 1972 who answered an enquiry about career preferences, 111 were written to again in 1974. The enquiry yielded 101 comparisons, out of which 65 doctors retained their original first choice of career, 15 opted for their previous second or third choice and 21 gave a completely new first choice. Reappraisal of abilities, additional experience of the new choice of career and additional knowledge of promotion prospects were the commonest reasons given for change of career choice.     

Gender in medicine: the views of first and fifth year medical students

This study of first and fifth year medical students found a general recognition among male and female students that gender affects future career choices and the ability to reach career goals. Females were seen as being disadvantaged both in terms of career choice and their ability to achieve career goals. These views are less abstract and more based upon the reality of personal experiences in clinical attachments among fifth year students. While both male and female students describe negative experiences of clinical training, female students were more likely to suffer discrimination because of their gender in certain specialties, such as surgery, and to be dissuaded from pursuing a career in that specialty. Despite the general awareness of the effects of gender in medicine this did not appear to have an effect upon personal career choice. However, some female students were considering career choices at an early stage in their career based on accommodating their future desire to have a family life. Over half of all male and female fifth year students reported that having time for their family was an important consideration in choosing a career.