1
|
Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM. The provision of general surgery in rural Australia: a narrative review. Med J Aust 2024; 220:258-263. [PMID: 38357826 DOI: 10.5694/mja2.52232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural-facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.
Collapse
Affiliation(s)
- Jessica Paynter
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Kirby R Qin
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Janelle Brennan
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | | | | |
Collapse
|
2
|
Rajaratnam V, Ng HJH, Rahman NA, Dong C. Online training module for micro suturing incorporating motor imagery and mental practice: a design and development research study. ANZ J Surg 2022; 92:2072-2081. [PMID: 35579060 DOI: 10.1111/ans.17772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/24/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There have been reduced opportunities for surgical skill acquisition due to the COVID-19 pandemic and the regulated training hours. Despite these challenges, self-regulated learning allows trainees to learn continuously, and one form of this is through mental practice and motor imagery. The study aimed to design and develop an online basic micro suturing training module for skill acquisition for self-regulated learning using a low-fidelity rubber glove model. METHODS This study utilized a design and developmental research framework and Mayer's multimedia theory guidelines. The primary author created an online instructional module on micro suturing based on the ADDIE instructional design model. This module was then evaluated in a pilot study comparing the new training model to traditional methods of learning using an experimental design. RESULTS This study describes the use of Design and Development Research to create a new model for surgical skill training and a tool for producing instructional materials and learning products for online learning. The product was evaluated using an experimental design and showed a significant effect on the quality of motor skill outcome and the richness of motor imagery using the resource developed in the research. CONCLUSION This study describes the methodological approach of a design and developmental framework to create an online training module for micro suturing which has significant utility in hand surgery.
Collapse
Affiliation(s)
- Vaikunthan Rajaratnam
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun Central, Singapore
| | - Hannah Jia Hui Ng
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun Central, Singapore
| | | | - Chaoyan Dong
- Department of Medical Education, Sengkang General Hospital, Sengkang E Way, Singapore
| |
Collapse
|
3
|
Coulshed A, Fernandes B, Hettige S. Overtime claiming among Australian doctors-in-training. AUST HEALTH REV 2022; 46:163-169. [PMID: 35314024 DOI: 10.1071/ah21323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo quantify patterns of overtime among doctors-in-training in New South Wales and to explore the reasons doctors-in-training cite for not claiming overtime worked.MethodsA confidential online self-reporting survey was conducted of post-graduate doctors-in-training, working in hospitals in NSW, from post-graduate year 1 through to completion of specialist training. Questions sought to determine the average amount of overtime worked, overtime claiming patterns, and reasons why overtime was not claimed. Comparisons were made by level of training and specialty training pathway.ResultsA total of 1351 valid responses were received. Unrostered overtime was extremely common, as was underpayment for work completed. Though 73.5% of respondents reported working at least 5 h of unrostered overtime per fortnight, only 15.6% of respondents reported claiming all their unrostered overtime, and among those who did claim overtime, only 45.5% reported being paid the amount in full. Common reasons for not claiming overtime included workplace cultural expectations (37.0%), and overtime not falling under approved reasons (32.6%). There were statistically significant differences (P < 0.001) in all response categories between critical care, physician and surgical training pathways.ConclusionsThe survey data demonstrated a significant disconnect between expectations and reality of working hours among doctors-in-training. This is indicative of concerns regarding loss of income, impaired ability to plan workforce allocation due to hidden workload, and possibly impaired wellbeing.
Collapse
Affiliation(s)
- Andrew Coulshed
- Royal Prince Alfred Hospital, University of Sydney, 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - Brian Fernandes
- Royal Prince Alfred Hospital, University of Sydney, 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - Sanjay Hettige
- Nepean Hospital, University of Sydney, Derby Street, Kingswood, NSW 2747, Australia
| |
Collapse
|
4
|
Petrie K, Crawford J, LaMontagne AD, Milner A, Dean J, Veness BG, Christensen H, Harvey SB. Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey. BMJ Open 2020; 10:e033525. [PMID: 31964674 PMCID: PMC7045753 DOI: 10.1136/bmjopen-2019-033525] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors' mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors' (JDs') mental health in Australia. DESIGN AND PARTICIPANTS A randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded. OUTCOME MEASURES Main outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia. RESULTS JDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40-44 hours per week. CONCLUSIONS Our results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees.
Collapse
Affiliation(s)
- Katherine Petrie
- Black Dog Institute, Randwick, New South Wales, Australia
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anthony D LaMontagne
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
- The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Allison Milner
- The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica Dean
- St Vincents Hospital Melbourne, Fitzroy, Victoria, Australia
- Beyond Blue, Hawthorn, Victoria, Australia
| | - Benjamin G Veness
- Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Helen Christensen
- Black Dog Institute, Randwick, New South Wales, Australia
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | |
Collapse
|
5
|
The effect of working on-call on stress physiology and sleep: A systematic review. Sleep Med Rev 2017; 33:79-87. [DOI: 10.1016/j.smrv.2016.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/19/2016] [Accepted: 06/02/2016] [Indexed: 11/20/2022]
|
6
|
Tucker PE, Cohen PA, Bulsara MK, Acton J. Fatigue and training of obstetrics and gynaecology trainees in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2017; 57:502-507. [PMID: 28345217 DOI: 10.1111/ajo.12604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have linked doctor fatigue with adverse patient events and an increase in risk to doctors' personal safety and wellbeing. The present study assesses the rostering structure of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and its association with trainees' reported fatigue levels, training opportunities and wellbeing, which were secondary outcomes of a larger study of trainee working hours which has been separately reported. METHODS An anonymous, online survey of RANZCOG trainees was conducted. Demographic data collected included: age, gender, level of training and current rotation. Data were also collected on hours worked per week, long shifts (>12 h), self-reported fatigue levels, and opinions regarding current rostering and training. RESULTS A majority (72.9%) of respondents regularly felt fatigued, with higher fatigue levels being associated with more hours worked per week (P = <0.001) and working long shifts (>12 h) (P = 0.007). Fatigue was associated with an increased risk of dozing while driving (P = 0.028), with 56.1% of respondents reporting that this occurs. Trainees appeared to be less confident in achieving their technical skill requirements, with increasing hours not increasing confidence in achieving these skills (P = 0.594). Trainees who worked under 50 h per week were less likely to report fatigue (P = <0.001) and more likely to report greater work enjoyment (P = 0.043), and working hours being conducive to learning (P = 0.015). CONCLUSION Fatigue was frequently reported by RANZCOG trainees with increased working hours and long shifts being significant factors in fatigue levels. Strategies should be developed and trialled to enable trainees to obtain adequate case exposure and teaching without compromising patient and doctor safety.
Collapse
Affiliation(s)
- Paige E Tucker
- King Edward Memorial Hospital, Subiaco, WA, Australia.,St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,School of Medicine, University of Notre Dame, Fremantle, WA, Australia
| | - Paul A Cohen
- King Edward Memorial Hospital, Subiaco, WA, Australia.,St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
| | - Jade Acton
- King Edward Memorial Hospital, Subiaco, WA, Australia
| |
Collapse
|
7
|
Acton J, Tucker PE, Bulsara MK, Cohen PA. Working hours of obstetrics and gynaecology trainees in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2017; 57:508-513. [DOI: 10.1111/ajo.12605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jade Acton
- King Edward Memorial Hospital; Subiaco Western Australia Australia
| | - Paige E. Tucker
- King Edward Memorial Hospital; Subiaco Western Australia Australia
- Bendat Family Comprehensive Cancer Centre; St John of God Hospital; Subiaco Western Australia Australia
- School of Medicine; University of Notre Dame; Fremantle Western Australia Australia
| | - Max K. Bulsara
- Institute for Health Research; University of Notre Dame; Fremantle Western Australia Australia
| | - Paul A. Cohen
- King Edward Memorial Hospital; Subiaco Western Australia Australia
- Bendat Family Comprehensive Cancer Centre; St John of God Hospital; Subiaco Western Australia Australia
- Institute for Health Research; University of Notre Dame; Fremantle Western Australia Australia
- School of Women's and Infants' Health; University of Western Australia; Crawley Western Australia Australia
| |
Collapse
|
8
|
Glassman D, Yiasemidou M, Venkateswaran B, Sivakumar R, Majumder S, Biyani CS. A multi-specialty surgical course for residents transitioning from early to intermediate training. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:130-131. [PMID: 27132256 PMCID: PMC4860289 DOI: 10.5116/ijme.5708.e9ea] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/09/2016] [Indexed: 06/05/2023]
MESH Headings
- Curriculum
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/trends
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/trends
- Humans
- Internship and Residency/methods
- Internship and Residency/organization & administration
- Internship and Residency/trends
- Specialties, Surgical/education
- Specialties, Surgical/trends
- Surgeons/education
- Teaching/trends
Collapse
Affiliation(s)
- Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | | | | | - Sanjib Majumder
- Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK
| | | |
Collapse
|
9
|
Petrushnko W, Perry W, Fraser-Kirk G, Ctercteko G, Adusumilli S, O'Grady G. The impact of fellowships on surgical resident training in a multispecialty cohort in Australia and New Zealand. Surgery 2015; 158:1468-74. [DOI: 10.1016/j.surg.2015.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 06/17/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
|
10
|
Glasgow NJ, Bonning M, Mitchell R. Perspectives on the working hours of Australian junior doctors. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S13. [PMID: 25560522 PMCID: PMC4304269 DOI: 10.1186/1472-6920-14-s1-s13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The working hours of junior doctors have been a focus of discussion in Australia since the mid-1990s. Several national organizations, including the Australian Medical Association (AMA), have been prominent in advancing this agenda and have collected data (most of which is self-reported) on the working hours of junior doctors over the last 15 years. Overall, the available data indicate that working hours have fallen in a step-wise fashion, and AMA data suggest that the proportion of doctors at high risk of fatigue may be declining. It is likely that these changes reflect significant growth in the number of medical graduates, more detailed specifications regarding working hours in industrial agreements, and a greater focus on achieving a healthy work-life balance. It is notable that reductions in junior doctors' working hours have occurred despite the absence of a national regulatory framework for working hours. Informed by a growing international literature on working hours and their relation to patient and practitioner safety, accreditation bodies such as the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the Australian Medical Council (AMC) are adjusting their standards to encourage improved work and training practices.
Collapse
Affiliation(s)
- Nicholas J Glasgow
- Medical School, Australian National University, Canberra ACT 0200, Australia
| | - Michael Bonning
- Past Chair, Australian Medical Association, Council of Doctors-in-Training, Barton ACT 2604, Australia
| | - Rob Mitchell
- Past Chair, Australian Medical Association, Council of Doctors-in-Training, Barton ACT 2604, Australia
| |
Collapse
|
11
|
Affiliation(s)
- David A K Watters
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
12
|
McDonald RE, Jeeves AE, Vasey CE, Wright DM, O'Grady G. Supply and demand mismatch for flexible (part‐time) surgical training in Australasia. Med J Aust 2013; 198:423-5. [DOI: 10.5694/mja12.11685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Carolyn E Vasey
- Royal Australasian College of Surgeons Trainees Association, Melbourne, VIC
| | - Deborah M Wright
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Royal Australasian College of Surgeons Trainees Association, Melbourne, VIC
| |
Collapse
|
13
|
O'Grady G, Harper S, Loveday B, Adams B, Civil ID, Peters M. Appropriate working hours for surgical training according to Australasian trainees. ANZ J Surg 2012; 82:225-9. [DOI: 10.1111/j.1445-2197.2011.05992.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
McCaskie AW, Kenny DT, Deshmukh S. How can surgical training benefit from theories of skilled motor development, musical skill acquisition and performance psychology? Med J Aust 2011; 194:463-5. [PMID: 21534904 DOI: 10.5694/j.1326-5377.2011.tb03062.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 04/05/2011] [Indexed: 01/22/2023]
Abstract
Trainee surgeons must acquire expert status in the context of reduced hours, reduced operating room time and the need to learn complex skills involving screen-mediated techniques, computers and robotics. Ever more sophisticated surgical simulation strategies have been helpful in providing surgeons with the opportunity to practise, but not all of these strategies are widely available. Similarities in the motor skills required in skilled musical performance and surgery suggest that models of music learning, and particularly skilled motor development, may be applicable in training surgeons. More attention should be paid to factors associated with optimal arousal and optimal performance in surgical training - lessons learned from helping anxious musicians optimise performance and manage anxiety may also be transferable to trainee surgeons. The ways in which the trainee surgeon moves from novice to expert need to be better understood so that this process can be expedited using current knowledge in other disciplines requiring the performance of complex fine motor tasks with high cognitive load under pressure.
Collapse
Affiliation(s)
- Andrew W McCaskie
- Musculoskeletal Research Group, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | | | | |
Collapse
|