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Fearmongering with doctors in training

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Over the past decade, there’s been a remarkable development of companies and offerings for doctors in training (DITs) to help them pass their exams, get selected onto a program or generally get ahead in an increasingly competitive environment. The range of companies putting forward these type of services has developed from opportunistic small businesses to, now, prestigious universities looking for their piece of the DIT panic money pie. These courses have a significant logistical impact on service provision within hospitals as well as financial and stress impacts on trainees.

What is the appeal of pursuing these type of extracurricular activities? DITs are afraid, of not passing exams, not getting onto a training program, not getting a job at the end of many years training. Fear about the state of the Australian medical workforce is drilled into us from the first year of medical school.

As students, we hear about it from stressed interns and residents. As interns and residents, we hear about it from panicked registrars and fellows. Ceding control over how, where and in what capacity we’ll be able to practise medicine – and live and raise our families – to the whims of medical system that isn’t investing meaningfully in medical workforce planning would raise the heckles of most in the community. Getting a little self-direction back is pitched as, as easy as signing up to our course, which will definitely get you through your exam, or improve your chances of selection.

Exams are challenging and in an uber-competitive job market, failure appears untenable. It seems insurmountable, career-defining, and not enough of those on the other side talk about their own challenges and how they faced them on the journey of their medical careers. If everyone else is doing it, and it purports to be necessary to pass – you don’t want to be the only one left behind.

Aside from the monetary cost, which is reaching new heights especially for exam years beyond even the expense of college annual and exam fees, the message that DITs allow in their mind is that this is legitimately necessary. My education provided by my hospital, my supervisors and my College aren’t enough. I have to spend significant chunks of my own hard-earned income to be able to do this. This feeds impostor syndrome – that little voice that says I’m not good enough to do this, I’m not meant to be here. Separately, it drives the CV arms race where a Masters Degree is rapidly becoming a necessity, not a standout.

So, what can be done? We can take notice. Colleges and hospitals and supervisors can take notice. We can look at our curricula and educational strategies. Are they really effective if this is happening? Are we testing the right knowledge and the right skills if it has to be delivered at such cost and outside of the workplace? The RACP advocates for both fellows and trainees to follow the 70:20:10 model of learning – where 70 per cent is experiential, 20 per cent social and 10 per cent formal learning. This is the type of sensible approach that DITs need to reinforce in their own thinking and see demonstrated in the workplace. Supervisors and mentors are an important part of modelling realistic behaviour.

There’s a place for some of these courses, as complementary educational strategies, but which are truly beneficial and which are exploiting trainee fear, under a guise of empowerment? I would ask DITs to consider how any course aligns with their educational aims and assess as objectively as possible the cost-benefit in terms of time, money and stress.