Survey of the Royal Australasian College of Physicians examination candidates: preparation and impact on lifestyle

Factors impacting health and well-being and the utilisation of supports among Australian doctors in medical specialty training

Purpose

To explore factors impacting the health and well-being of doctors undertaking various specialty training programs, and attitudes towards and utilisation of supports during their training. This is a subset of data from a larger study exploring experiences of doctors in Australian specialty training—a qualitative study of enablers, stressors and supports.

Methods

In this qualitative study, registrars in specialist training programmes in Australia were invited and interviewed between August 2015 and August 2016. Semistructured open-ended questions were used to explore topics of relevance to their workplace, training, support service utilisation and personal lives. Interviews were transcribed verbatim, deidentified and content and thematic analysis undertaken. Recruitment was ceased when data saturation was reached and no new themes emerged. Emerging key themes are reported in this study

Results

17 participants were recruited (including 1 Indigenous and 1 international medical graduate). A total of six specialty training programmes, across multiple states at various locations across Australia, were represented.

Common themes impacting health and well-being regarding workplace and training stressors were identified, including poor supervision, shiftwork and on-call, inability to take sick leave, bullying and harassment, college-related factors, examination preparation and work–life imbalance. Several of these were identified as having actual and perceived negative impacts on patient outcomes and safety.

The majority of participants underused existing supports and were unaware of the breadth of support services available to them. Barriers to accessing these services included concerns about their confidentiality and career repercussions.

Conclusions

This first Australian pilot study highlighted many stressors and enablers in the workplace, training and personal lives of registrars. The underutilisation and barriers to access of support services were discovered. Several multisystem strategies are required and discussed in this report to address these complex issues identified as affecting the health and well-being of junior doctors.

Understanding Singaporean medical students' stress and coping

Medical school is intrinsically stressful, and high levels of stress have untoward effects. Although surveys have revealed some sources of stress among medical students, little is known about the qualitative aspects of these stressors and their associated coping behaviours, particularly among medical students in Singapore. Our exploratory pilot study found that relationship issues and examinations were the major sources of stress for medical students. The respondents described multiple context-sensitive coping styles, as well as reported 'avoidance' or 'wishful thinking' coping strategies as ineffective. Their stress-and-coping process suggests the influence of Asian culture and medical school culture. Our findings thus indicate the need for further research, potentially using new methodologies such as the critical incident analysis technique, and thoughtful consideration of culture when implementing programmes in Singapore medical schools to improve the students' stress-and-coping responses.

The Impact of the Australian and New Zealand College of Anaesthetists’ Specialist Examinations on Trainee Learning and Wellbeing: A Qualitative Study

Assessment is an essential component of any medical specialist training program and should motivate trainees to acquire and retain the knowledge and skills essential for specialist practice, and to develop effective approaches to learning, essential for continuous professional development. Ideally, this should be achieved without creating an unreasonable burden of assessment. In this qualitative study we sought to investigate the underlying processes involved in trainees’ preparation for Australian and New Zealand College of Anaesthetists’ examinations, focusing on how the examinations helped trainees to learn the Australian and New Zealand College of Anaesthetists’ curriculum, and to identify any potential areas for improvement. We also explored the effect the examinations had on trainees’ lives, to identify if the examinations were a potential threat to their wellbeing. Using a phenomenological approach and purposive sampling, we conducted semi-structured interviews with post-fellowship trainees (n=20) selected from three different regions, with sampling continuing to achieve data saturation. We undertook a thematic analysis of the transcribed interview data utilising a general inductive approach. Our preliminary data suggest that, while the examinations are an important extrinsic motivator to learn and important for professional development, interviewees described many test-driven learning strategies, including rote learning and memorising past examination questions. A strong theme was the considerable impact on participants’ relationships and social activities for prolonged periods. Our findings support further research in this area and, in particular, into alternative testing strategies that might increase the proportion of time spent in useful study while decreasing less useful study time.

Seasonal timing of the Royal College examination in general paediatrics: A survey of residents' preferences

BACKGROUND

Currently, the general paediatrics examination administered by the Royal College of Physicians and Surgeons of Canada is offered annually in the spring. Controversy exists regarding its seasonal timing. Assessing the views of residents anticipating the examination is relevant to examination administrators.

OBJECTIVE

To determine paediatric residents' opinions regarding the timing of the general paediatrics examination.

METHODOLOGY

A survey was electronically distributed to all resident members of the Canadian Paediatric Society with an e-mail reminder after one week. Responses were collected independently, forwarded to the authors and summarized using descriptive statistics. Multinomial regression identified predictors of examination preference and estimated prediction value.

RESULTS

One hundred sixty-four of 585 surveys (28%) were returned. Common preferences included 'spring of 4th year' (42%) and 'fall of 4th year' (22%). Respondents intending four years of general paediatrics demonstrated a 55% preference for 'spring of 4th year' and 11% for 'fall of 4th year', compared with preferences of 29% and 34%, respectively, for respondents intending three years of general paediatrics followed by subspecialty training (P<0.001). This was confirmed by multinomial regression (OR 2.49; P<0.0001). Increasing training year was associated with increasing support for examination in the fall relative to the spring of 4th year (OR 1.37; P=0.019).

CONCLUSIONS

Residents' preferences for the timing of the examination are varied, with 'spring of 4th year' being most preferred. Residents demonstrated stronger support for 'fall of 4th year' with increasing years of training, and if planning to pursue subspecialty training after three years of general paediatrics.