BREAKING bad news to patients or relatives – often considered one of the most daunting parts of being a junior doctor – is among the tasks for which recent medical graduates feel best prepared, a study of work-readiness shows.

The survey of 135 doctors who graduated from the University of Tasmania’s Launceston Clinical School since 2005 found that 95% felt at least “prepared” to break bad news, with almost half saying they felt “extremely well prepared”.

Overall, most graduates reported feeling prepared for each of the 44 capabilities covered by the survey, which was published in the MJA.

There were six areas in which at least 10% of respondents felt underprepared or unprepared: basic nutritional care (29%), using audit to improve patient care (26%), clinical governance (23%), using informatics (11%), responding to error and patient safety (11%), and cultural competency (10%).

The study authors, who included the school’s director, Associate Professor Kim Rooney, said that it was encouraging to see high levels of preparedness for “engaging in self-directed lifelong learning” and “organisational decision-making”. These were in keeping with the goal of producing doctors who were “work ready plus”, they said.

Graduates were also well prepared to work together with patients and their families to improve health, the study found, with high ratings for “understanding the concept and impact of patient-centred practice”, “educating patients” and “shared decision making”.

Australian Medical Students’ Association President, Rob Thomas, said that it was a credit to university medical schools that recent graduates felt well equipped for hard conversations with patients.

“Junior doctors are often left with the responsibility for some of the really difficult patient interactions, including breaking bad news, but all of the universities now work hard to combat the fear students have about these conversations, by providing specific training on motivational interviewing and breaking bad news,” he told MJA InSight.

Mr Thomas said that the finding that young doctors felt underprepared to give nutritional advice matched with his own educational experience.

“I guess a lot of the nutritional care ends up being provided by dieticians in the hospitals these days, so perhaps there’s a bit of deskilling of doctors in that area,” he said.

He added that some of the systems-related capabilities identified as areas of potential weakness in medical training may reflect the difficulty of equipping students for “variation in practice from hospital to hospital”.

Associate Professor Jill Sewell, president of the Australian Medical Council, said that it was not surprising to see graduates reporting that their undergraduate degree left them underprepared for issues related to safety and quality and clinical governance, which were “difficult to teach to a level of true understanding and application in a student setting”.

“These broader issues must have practical application in internship, prevocational and vocational training to underpin the lifelong requirements for medical practice,” she said.

Associate Professor Sewell said that it was important that the national curriculum enabled students to understand a “population perspective on health” and to “understand their personal responsibility throughout their practising career for improvement of quality and safety in whatever setting they work”.

“The balance of perspective between population health versus individual care is a very important aspect of student learning, and even more during early years of practice, when the acute nature of early hospital experience tends to make the individual encounter by far the dominant professional development activity,” she said.

In an editorial accompanying the MJA study, Professor Richard Murray and Professor Andrew Wilson argued for a “broader perspective from which to judge work-readiness” – whether the training system was producing the doctors Australia needed.

“There is … no overall shortage of doctors in 2017,” they wrote. “But a regional hospital attempting to recruit an Australian-trained surgeon or psychiatrist, or a remote community looking for a broadly skilled rural generalist practitioner might beg to differ.

“We must ensure more equitable geographic distribution of specialist medical training, bolster clinical generalism, emphasise teamwork, and select individuals for further training on the basis of their propensity to serve community needs,” they wrote.

The Medical Board of Australia is leading the development and implementation of a national, annual survey of trainees which it says will give them a voice and be a safe place for them to provide feedback on their training experience.

 

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