A system for maintaining the educational and training standards of junior doctors

The development of junior doctors' competence is complex because the hospital environment in which doctors work places many demands on them. The need for quality education and training and personal development may be in direct conflict with the service commitments required from hospitals. This paper describes the methods by which the Postgraduate Medical Council of New South Wales, Australia, addresses the needs of junior doctors in the state in order to improve the quality of their education. Key elements of the Council's function include the provision of hospital clinical supervisors who oversee junior doctor education and training, and central involvement in supplying the junior doctor workforce to all state hospitals who must meet defined accreditation standards. This paper also provides data on evaluation of those methods and some educational outcomes.     

Are junior doctors taught to use problem lists?

One hundred junior doctors were asked to complete a questionnaire about the training they had received in the use of problem lists. A questionnaire was sent about the training in the use of problems lists at their medical school to the Deans at all 27 British medical schools. Of the 100 junior doctors, 57 reported that problem lists 'had hardly been mentioned' at their medical school. In contrast only one of the 24 Deans who responded thought that problems lists were 'likely to be hardly mentioned' at his medical school. After graduation only 35 junior doctors had worked for a consultant who had demanded the use of problem lists and only 17 of these had worked for more than one such consultant. Most junior doctors have received little training in the use of problem lists as undergraduates and even fewer as postgraduates. Few consultants demand the use of problem lists.     

Knowledge of junior doctors regarding the New Deal

Junior doctors' knowledge of the content and local implementation of the New Deal for junior doctors was surveyed in one English region. Data were analysed from 254 replies (response rate 60%); a majority (86%) knew that the initiative was intended to reduce their working hours, but detailed knowledge was lacking. Less than half could identify the correct limits on contracted hours for full or partial shift working patterns, while 73% knew that they should not be contracted for more than 72 hours per week for an on-call pattern, the most common and traditional pattern worked. Only 20% knew that hours actually worked should not exceed 56 per week. Only 13 of 114 doctors who believed their posts conformed to the New Deal knew the correct hours limits. Only 11% knew any member of the hospital local implementation group for the New Deal. The results of the survey indicate that junior doctors are not well informed about the details of the New Deal, or its local implementation-four years into the New Deal, this situation needs to be improved, especially as junior doctors are now to be asked to validate the progress of the initiative.     

Progression of junior doctors into higher specialist training

OBJECTIVES: To report on the transition of junior doctors into higher specialist training in the UK, following the Calman reforms and recent initiatives to promote training in general practice. Design and setting Postal questionnaire survey carried out in the UK. PARTICIPANTS: All graduates of 1996 from UK medical schools were surveyed in 2002. MAIN OUTCOME MEASURES: Outcome measures were considered to be details of applications, outcomes of applications, intentions to apply for specialist training, and career plans with regard to such issues as flexible training and work. RESULTS: Of 2312 responders, 39% had applied for specialist registrar (SpR) training and 35% for general practice (GP) training. Of applicants for SpR training, 68% were successful; 24% failed, almost all of whom intended to reapply, many after gaining research experience; 4% awaited a decision, and 4% had had another outcome (e.g. they withdrew their application). A sixth of responders intended to apply but had not yet done so. Of applicants for GP training, 95% had been successful. A further 2% intended to apply but had not yet done so. Responders viewed flexible and part-time training and work opportunities, and information about available posts, as being more widely available in general practice than in hospital practice. Half of the responders did not agree that their postgraduate training had been of a high standard. CONCLUSIONS: Progression into GP training seemed to have been a smoother and less protracted process than that into SpR training. Delayed applications for SpR training were common, and many of those who had applied had not been accepted. The use of research experience to strengthen a re-application was common.     

Measuring the hospital experiences of junior doctors

The development of an appraisal questionnaire which measures junior doctors' opinions about their hospital experiences is described. The first section of the questionnaire consists of seven reliable subscales which measure opinions about teaching and learning, registrar teaching, consultant teaching, staff support, workload, administration and overall experiences during a period of attachment or term. The second part of the survey contains 11 reliable questions about the hours spent on service and education during the term. The responses to this measure of 257 randomly selected Australian junior doctors are described. The questionnaire may be used to contrast the experiences of junior doctors in different types of terms, different hospitals or varying levels of training. The data generated from the instrument can provide useful information about hospitals, such as the work practices of junior staff and the effectiveness of educational programs.     

Depressive symptoms in junior doctors: a follow-up study on work-related determinants

Purpose

The study investigates the long-term effects of accumulated working conditions on depressive symptoms in junior doctors. Drawing on the Job Demand-Control-Support model, this study aims to identify personal and job-related determinants for self-reported depression in junior doctors—a professional group that is vulnerable to depression.

Methods

We conducted a prospective cohort study with measures of work characteristics and depressive symptoms over three time-points among hospital doctors during postgraduate specialty training in Germany. Participants were 415 junior doctors with full-time contract (47.5% women; mean age, 30.5?years). The outcome was depressive symptoms assessed with the Spielberger State-Depression Scale. Odds ratios (OR) were computed to analyse the cumulative effect of initial depressive symptoms scores, demographic variables, and working characteristics across T1 and T2 on subsequent depressive symptoms at T3.

Results

The percentage of junior doctors reporting depressive symptoms scores above a critical value varied between 12.0% at T1, 10.4% at T2, and 13.3% at T3; N?=?34 doctors (8.19%) were classified as incident cases during the observation period. Elevated depressive symptoms at T3 were positively predicted by depressive symptoms scores across T1 and T2 (OR: 1.37; 95% confidence interval: 1.25–1.50) and negatively by professional tenure (0.54; 0.31–0.96), free weekends (0.52; 0.28–0.97), and job autonomy (0.35; 0.18–0.65).

Conclusions

After controlling for demographic and working time influences, findings suggest that junior doctors’ perceived job autonomy is negatively associated with future depressive symptoms. Enhancing job control emerges as a promising strategy to lower the risk of depression during first years of professional practice.     

Views of junior doctors on the specialist registrar (SpR) training scheme: qualitative study of UK medical graduates

OBJECTIVE: To report junior doctors' views on specialist registrar (SpR) training. DESIGN: In 1999, as part of ongoing studies of doctors' careers, we surveyed all doctors who had qualified from UK medical schools in 1993. Structured questions about recipients' careers were accompanied by a form inviting free text comments. Comments about the SpR scheme were extracted for analysis. RESULTS: Doctors commented that there were insufficient national training numbers (NTNs) for those who wanted them, and that more than the minimum entry requirements seemed necessary for shortlisting. Strengthening curricula vitae through research and published work could prolong the duration of training and did not guarantee success. Specialist registrar training was considered by some respondents to be narrow and inflexible, with service work taking priority over training needs. As a result, some respondents feared they would not be competent to practise as consultants. There was a perceived shortage of consultant vacancies and 6 months was considered insufficient time for obtaining a suitable post. DISCUSSION: It is inevitable that doctors may not necessarily be able to pursue their initially chosen career paths. Trainers need to provide realistic advice about career opportunities. Provision of information about NTN availability and formal career counselling could help to prevent delays in career progression. The shortened and more structured programme of training has reduced its flexibility in some doctors' experience. Improvements in educational content will need greater input from consultants, which may require an increase in consultant posts. Time will tell whether concerns about competence to practise as consultants and consultant post availability will be justified.     

社区医生工作满意度的影响因素调查

目的调查分析影响社区医生工作满意度的因素,提出相应的对策,为稳定基层医疗队伍提供理论参考。方法研究者对15名在社区医疗机构工作的医生进行访谈,了解导致他们工作满意度较低的原因,同时查找文献了解相关领域的最新研究结果,提出应对策略。结果影响社区医疗机构医生工作满意度的因素为福利待遇、职业发展、职业风险、工作环境、社会地位,其中福利待遇是最重要的因素。结论社区医生工作满意度低导致了社区专业人才流失严重,卫生行政管理部门应在福利待遇、职业发展、工作环境等方面给予政策支持,激发他们对社区医疗工作的热爱与激情。     

Do junior doctors feel they are prepared for hospital practice? A study of graduates from traditional and non-traditional medical schools

A valid and reliable questionnaire was developed which assesses eight subscales relating to key areas of medical hospital-based work. This was used to evaluate junior doctors' perceptions of the adequacy of their undergraduate medical training to prepare them for hospital practice. Data from 139 (60%) first-year doctors (interns) showed that graduates from the problem-based medical school rated their undergraduate preparation more highly than traditional medical school graduates in preparing them for practice in the areas of interpersonal skills, confidence, collaboration with other health care workers, preventive care, holistic care and self-directed learning. These findings persisted when ratings were adjusted for the effects of age and gender. There were no differences between the intern groups for patient management and understanding science. This research suggests that educational experiences in different undergraduate medical courses are important in preparing doctors for their early working life.     

Education and the working patterns of junior doctors in the UK: a review of the literature

OBJECTIVE: To identify and review UK research relating to the effects of patterns of work on the education of junior doctors, describe the trends in the research, contextualise the progress of the UK in reducing the number of hours worked by junior doctors alongside that of other countries and identify areas for future research. METHOD: A total of 77 research studies, mostly written after 1995, were identified as relevant from approximately 900 references generated by searching Medline and using a 'snowball' technique. The articles identified were qualitatively reviewed to identify their key research conclusions and/or the main points of argument. These were collated and presented in a qualitative review. RESULTS: Research in the UK is contradictory regarding the effects of working patterns and the views of doctors towards them. Further research is needed to examine in depth the differences in the effects of working patterns on education between hard-pressed and non hard-pressed specialties, hospitals and regions. When viewed in an international context, the UK ranks among a number of countries with similar medical systems that are moving towards reducing the hours worked by doctors in training, all of which are at different points in the process. CONCLUSION: The literature review has helped to identify the popular wisdom surrounding the debate on junior doctors' hours, the progress of the UK when compared to that of other countries and gaps in research. Further research is needed to refine understanding of this area.     

广东省乡镇卫生院医生培训现状分析

目的：了解广东省乡镇卫生院医生培训的现状，为广东省农村卫生人员素质的整体提高提供决策依据。方法；采用现场问卷调查的方法，对全省随机抽样的18家乡镇卫生院的486名医生培训情况进行调查。结果：广东省乡镇卫生院医生有10．2％未参加过任何形式的培训，有67．6％的人认为目前急需的是专业新知识、新技术的培训．有40．6％的乡镇卫生院医生认为经费有限影响其参加培训。结论：广东省乡镇卫生院医生对培训的需求较高．经费有限是影响培训的最主要原因。建议加强政策配套，落实乡镇卫生院医生的在职培训。     

德国医学PhD培养对我国医学研究生教育的启示

与德国医学博士研究生培养模式相比较,我国医学博士研究生培养起步较晚,尚处于探索阶段,亟待完善和发展。本研究从德国现代高等医学人才培养模式的历史发展脉络人手,分析了德国医学PhD教育的特点,从培养目标、入学资格、导师制度等方面,对中德医学博士研究生培养模式进行比较研究,为改革我国医学研究生培养模式提供借鉴和参考。     

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.     

What influences the job satisfaction of staff and associate specialist hospital doctors?

Despite their rising numbers in the National Health Service (NHS), the recruitment, retention, morale and educational needs of staff and associate specialist hospital doctors have traditionally not been the focus of attention. A postal survey of all staff grades and associate specialists in NHS Scotland was conducted to investigate the determinants of their job satisfaction. Doctors in both grades were least satisfied with their pay. They were more satisfied if they were treated as equal members of the clinical team, but less satisfied if their workload adversely affected the quality of patient care. With the exception of female associate specialists, respondents who wished to become a consultant were less satisfied with all aspects of their jobs. Associate specialists who worked more sessions also had lower job satisfaction. Non-white staff grades were less satisfied with their job compared with their white counterparts. It is important that associate specialists and staff grades are promoted to consultant posts, where this is desired. It is also important that job satisfaction is enhanced for doctors who do not desire promotion, thereby improving retention. This could be achieved through improved pay, additional clinical training, more flexible working hours and improved status.     

Does the current use of junior doctors in the United Kingdom affect the quality of medical care?

Current proposals in the U.K. envisage a reduction in both junior staff numbers and the hours which they work. The proponents of change argue that this will improve patient care, although there are also opposing arguments, based mainly on the need to maintain continuity of care and ensure juniors gain sufficient clinical experience. By means of a literature review and interviews with junior doctors, this paper examines the effect of the existing system of hospital medical staffing on quality of care. There is evidence that the existing system reduces the quality of care, principally through mistakes associated with inadequate supervision, and lowered humanity of care due to tiredness. The training value of night-time and weekend work is low, and many doctors find it unsatisfying. In contrast, many doctors value providing continuity of care and a few appreciate the opportunity to gain unsupervised experience. Overall, the disadvantages of the existing system outweight the advantages, and change is required to improve the quality of care. There are, however, several obstacles to change, and there are doubts about the extent to which the current proposals will be implemented.     

Doctors' views of their first year of medical work and postgraduate training in the UK: questionnaire surveys

Objective The first year of postgraduate work for newly qualified doctors in the UK, the pre‐registration year, is spent working intensively in training posts under supervision. Our aim was to report the views of pre‐registration doctors on these posts. Design Questionnaire survey. Subjects All medical graduates of 1999 and a 25% sample of graduates of 2000 from all UK medical schools. Main outcome measures Doctors' views on the pre‐registration house officer (PRHO) year, recorded as ratings in answers to questions and statements about the year. Results In reply to the question ‘How much have you enjoyed the PRHO year overall?’, rated on a scale from 0?10 (0 = no enjoyment; 10 = enjoyed it greatly), 44% of respondents (1341/3068) gave scores of 8–10; in all, 83·2% of respondents gave scores in the upper half of the scale (≥6). However, there were criticisms of specific aspects of working conditions. Only a third agreed that their training during the year had been of a high standard. Posts in medicine were rated more highly than those in surgery for quality of training. Differences in views held by women and men junior doctors were few. However, where differences existed, women were slightly more positive about their work than men. Conclusion Most graduates enjoyed the pre‐registration year but there is still considerable scope for improvement in working conditions and training. Men and women gave similar responses, which suggests that later divergence in their career pathways is not attributable to different views formed about work in their pre‐registration year.     

Work satisfaction of medical doctors in the South African private health sector

PURPOSE: This paper aims to determine the extent of work satisfaction among general practitioners and to examine the variables influencing the different aspects of their work satisfaction. DESIGN/METHODOLOGY/APPROACH: This was a cross-sectional survey of general practitioners in the private sector, conducted throughout South Africa, using a self-administered questionnaire. Univariate statistical models were used to evaluate levels of satisfaction with various facets of work, while inferences about the effect of several independent variables on the work satisfaction facets were drawn from multiple regression models using a stepwise regression procedure. FINDINGS: Doctors were satisfied with the social and personal aspects of their work and dissatisfied with the practice environment pressures and work setting issues. Overall, doctors were dissatisfied with their work and their careers. Being female, working in large groups, having been in practice for 20 years or more, having a high proportion of insured patients and being incentivised to conserve resources were significant predictors of lower overall satisfaction. Clinical freedom, positive perceptions of managed care strategies, remuneration on a fee-for-service basis and working in small groups were predictors of greater overall satisfaction. ORIGINALITY/VALUE: The paper shows that, although doctors were generally dissatisfied, there are opportunities for enhancing work satisfaction and care provision if policymakers, administrators and health care managers work in collaboration with doctors to provide the specific working conditions that health professionals desire.     

Career destinations, job satisfaction and views of the UK medical qualifiers of 1977

OBJECTIVE: To study the career destinations, job satisfaction and views of UK-trained senior doctors. DESIGN: Postal questionnaire. SETTING: All doctors who qualified from all UK medical schools in 1977; and Department of Health employment data. MAIN OUTCOME MEASURES: Career destinations of medical qualifiers from 1977. RESULTS: 72% responded to the questionnaire. Using all available evidence, including that on non-responders, 76% of the cohort, comprising 77% of the men and 74% of the women, were working in the NHS 27 years after qualification. Approximately 18% were in medical jobs either overseas or outside the NHS. Of respondents in the NHS, 89% of men and 51% of women had full-time contracts. NHS doctors rated their job satisfaction highly, with a median score of 19.5 on a scale from 5 (very low satisfaction) to 25 (very high satisfaction). Satisfaction with time off for leisure was much lower, with a median score of 4.6 on a scale from 1 (low) to 10 (high). Of those in the NHS, 67% agreed that they worked longer hours than they thought they should; and 40% agreed that their working conditions were satisfactory. CONCLUSIONS: 27 years after qualification, the percentage of women who were working in the NHS was similar to that of men. Although these senior doctors had high levels of satisfaction with the content of their jobs, they were not so satisfied with their working hours and working conditions. Our results can be used as benchmarks, against which the career pathways and satisfaction levels of more recently qualified doctors can be compared.     

公共卫生医师岗位培训现状与需求问卷调查

为了解现阶段公共卫生医师的岗位培训现状以及培训需求,对1354名在岗的公共卫生专业人员进行了问卷调查。调查结果显示,大多数被调查者认为刚毕业的新入职人员不能完全胜任岗位要求,应当根据岗位胜任力的要求开展公共卫生医师在岗培训,培训内容应按照核心能力要求进行设计,包括预防医学和临床医学知识,应当统一培训教材、考核要求等,达到培训同质化。     

Migration intentions among Portuguese junior doctors: Results from a survey

Migration of health personnel during periods of economic crisis represents a challenge for policymakers in origin and destination countries. Portugal is going through a period of economic hardship and much has been speculated about an increase in junior doctors’ migration during this period. Using a questionnaire administered to a sample of Portuguese junior doctors who were still in the general residency (1st-year after medical school), we aim at determining the prevalence of migration intentions among Portuguese junior doctors and to identify the most important drivers of career choice for those who are considering emigrating in the near future. In our sample, 55% of Portuguese junior doctors are considering working abroad in the coming 10 years. Several variables were associated with an intention to work abroad: female sex (odds ratio [OR] 0.559; 95% confidence interval [CI] 0.488–0.640), the National Medical Exam score (OR 0.978; 95% CI 0.961–0.996;), having studied abroad (OR 1.756; 95% CI 1.086–2.867) and considering income and research opportunities as key factors for future specialty choice (OR 1.356; 95% CI 1.132–1.626; OR 2.626; 95% CI 1.228–4.172).Our study warns of the shortages the country may face due to doctors’ migration and the main factors behind migration intentions in Portugal. Developing physician retention strategies is a priority to appropriately address these factors.