'Mainstreaming' of less than full-time training

Welfare practices for anaesthesiology trainees in Europe: A descriptive cross-sectional survey study

BACKGROUND

Current regulations of anaesthesiology training programmes may affect gender equity, female representation and leadership.

OBJECTIVE

To describe the work regulations of anaesthesiology training programs and working conditions during the early period of child-rearing in European countries.

DESIGN

Cross-sectional survey.

SETTING

National Anesthesiologists Societies Committee (NASC) representatives of the European Society of Anesthesiology and Intensive Care.

PARTICIPANTS

Thirty-eight NASC representatives.

MAIN OUTCOME MEASURES

Basic specialist training working conditions, gender-related data, return to work after childbirth and workplace policies against discrimination during anaesthesiology specialist training.

INTERVENTIONS

A 48-item questionnaire to explore the work patterns and conditions for trainees especially for new parents, professional development opportunities and work discrimination regulations in each representative country was distributed to NASC representatives of 44 European countries.

RESULTS

We collected the replies of each representative (38 representatives from 44 invited countries' representatives, 86% response rate). The median [IQR] proportion of female trainees was 60% [50 to 68]. There were no reported pay differences between sexes. In eight European countries, pregnant trainees worked fewer hours and were excused from night shifts. Women could not be laid off during pregnancy in all 38 countries (100%). The countries offered a median of 18 weeks of paid (total or partial) maternity leave (range, 13 to 60 weeks). Most countries (89%) accommodate paid paternity leaves. A significant proportion of parental leave was unpaid ( n =18, 42%). Twenty-one (55%) countries allowed part-time work after delivery. The UK was the only country with clear recommendations to formally complain after harassment.

CONCLUSION

European countries have a wide variety of regulations. On paper, numerous countries have various paid maternal, paternal and parental leave; however, it remains to be determined if such leave takes place in practice. The practical consequences of these regulations on female trainees during the child-rearing period need to be explored further.

TRIAL REGISTRATION

None.

Why residents quit: Prevalence of and reasons for attrition among anaesthesia residents in a single sponsoring institution

Background:

The SingHealth Anaesthesiology Residency Programme (SHARP) is a 5-year postgraduate training programme in Singapore. Since its inauguration in 2011, SHARP has taken in the largest number of anaesthesia residents in Singapore. However, we noticed significant attrition over the years. As attrition is a costly and disruptive affair, both to the individual and the programme, we seek to investigate the prevalence of and reasons for separation, in order to determine ways to minimize attrition.

Methods:

An online anonymous survey was conducted among all residents who have separated from SHARP. The questionnaire comprised questions regarding demographic data, reasons behind separation, obstacles faced during residency, and potential ways to reduce attrition.

Results:

From 2011 to 2018, 22 out of 127 residents have separated from the programme, giving an overall attrition prevalence of 17%. Nineteen (86%) of the separated residents responded to our questionnaire. The most common reason for separation was due to difficulties in juggling childcare and training commitments. Of the residents who have separated, more than half of them would consider rejoining the programme if a less than full time (LTFT) option was available.

Conclusion:

One out of every six residents in the SHARP quits residency training. The reasons behind separation are often varied due to each resident’s unique social circumstances. An individualized training programme with a LTFT option that allows for flexibility may boost retention in the programme.

Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation

BACKGROUND

Workforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision.

AIM

To assess doctors' views on the timing of choosing a clinical specialty.

METHODS

Surveys of two cohorts of UK-trained doctors 3 years after qualification, in 2011 and 2015.

RESULTS

Presented with the statement 'I had to choose my career specialty too soon after qualification', 61% agreed (27% strongly) and 22% disagreed (3% strongly disagreed). Doctors least certain about their choice of specialty were most likely to agree (81%), compared with those who were more confident (72%) or were definite regarding their choice of long-term specialty (54%). Doctors not in higher specialist training were more likely to agree with this statement than those who were (72% vs 59%). Graduate medical school entrants (ie, those who had completed prior degrees) were less likely to agree than non-graduates (56% vs 62%). Qualitative analysis of free text comments identified three themes as reasons why doctors felt rushed into choosing their future career: insufficient exposure to a wide range of specialties; a desire for a greater breadth of experience of medicine in general; and inadequate career advice.

CONCLUSIONS

Most UK-trained doctors feel rushed into choosing their long-term career specialty. Doctors find this difficult because they lack sufficient medical experience and adequate career advice to make sound choices. Workforce trainers and planners should enable greater flexibility in training pathways and should further improve existing career guidance.

Factors associated with less-than-full-time working in medical practice: results of surveys of five cohorts of UK doctors, 10 years after graduation

BACKGROUND

The greater participation of women in medicine in recent years, and recent trends showing that doctors of both sexes work fewer hours than in the past, present challenges for medical workforce planning. In this study, we provide a detailed analysis of the characteristics of doctors who choose to work less-than-full-time (LTFT). We aimed to determine the influence of these characteristics on the probability of working LTFT.

METHODS

We used data on working patterns obtained from long-term surveys of 10,866 UK-trained doctors. We analysed working patterns at 10 years post-graduation for doctors of five graduating cohorts, 1993, 1996, 1999, 2000 and 2002 (i.e. in the years 2003, 2006, 2009, 2010 and 2012, respectively). We used multivariable binary logistic regression models to examine the influence of a number of personal and professional characteristics on the likelihood of working LTFT in male and female doctors.

RESULTS

Across all cohorts, 42 % of women and 7 % of men worked LTFT. For female doctors, having children significantly increased the likelihood of working LTFT, with greater effects observed for greater numbers of children and for female doctors in non-primary care specialties (non-GPs). While >40 % of female GPs with children worked LTFT, only 10 % of female surgeons with children did so. Conversely, the presence of children had no effect on male working patterns. Living with a partner increased the odds of LTFT working in women doctors, but decreased the odds of LTFT working in men (independently of children). Women without children were no more likely to work LTFT than were men (with or without children). For both women and men, the highest rates of LTFT working were observed among GPs (~10 and 6 times greater than non-GPs, respectively), and among those not in training or senior positions.

CONCLUSIONS

Family circumstances (children and partner status) affect the working patterns of women and men differently, but both sexes respond similarly to the constraints of their clinical specialty and seniority. Thus, although women doctors comprise the bulk of LTFT workers, gender is just one of several determinants of doctors' working patterns, and wanting to work LTFT is evidently not solely an issue for working mothers.