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Getting to grips with the training experience

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By Dr Kate Kearney, AMA Council of Doctors in Training

In 2015, the medical colleges produced a combined 2954 new fellows – that is virtually 3000 new consultants ready to practice across all specialties, on a yearly basis.

As a junior doctor at the other end of the pipeline, I hear consistent reports of how difficult it is to gain employment, and how I will need to complete years of further study in the form of a PhD and international fellowships to be able to be considered a highly employable candidate.

Is that a realistic assessment of the concept of “exit block”, or are we seeing maldistribution in the workforce?

We constantly hear about medical workforce shortages in rural and peripheral metropolitan areas, necessitating that about 25 per cent of newly graduated fellows are recruited from among overseas trained doctors.

The AMA advocates for rural and regional training networks as the major, evidence-based strategy to address this – the current Specialised Trainee Program resources 900 positions in regional areas a year, and is under review.

Rural and regional trainee networks address maldistribution by giving trainees exposure to working in regional areas and, secondly, increasing engagement by helping trainees to establish their lives and families in these areas.

Vocational medical training is a long and arduous process in all specialties, and the support networks that trainees establish in this time make a lasting impact. The AMA strongly supports the establishment of these networks to allow trainees to forge careers in these settings.

So, is vocational training meeting trainee and workforce needs? Where do these intersect, and how do we help trainees plan their careers and their lives to ensure fulfilling medical careers for doctors that meet the community needs and utilise the massive training investment by the community in creating new specialists? How do we keep trainees safe through an intense, stressful training process?

One of the tenants of reform has to be identifying where we are at presently.

In the United Kingdom, the National Trainee Survey (NTS) has been an important reform tool since its inception in 2006. The NTS has helped address patient safety concerns, improve training environments, strengthen performance management and, as a centralised tool, it has provided unbiased, anonymous feedback about what works and what undermines training.

The AMA has coordinated a specialist trainee survey as well as a GP registrar survey since 2010, both of which have identified a gradual improvement in training environments for those in vocational training programs.

This is a major undertaking, but a significant start towards the goal. Good quality data is sorely missed in this space.

A yearly national trainee survey would take an annual temperature check of where training is at for Australian junior doctors. It would capture anonymous information about how training sites are faring, how colleges treat their trainees, and could identify potentially deleterious situations before they escalate.

We undergo all number of formal registration processes annually, including renewing our general medical registration – this would be the perfect time to capture valuable data about where junior doctors are based, what are their training experiences like, where they intend to go and how these change over time.

Documenting this kind of longitudinal data would make an enormous contribution to providing the kind of reliable information that is needed for us to accurately describe our current workforce situation – and to model future patterns.