PsychStart: a novel mentoring scheme for supporting and valuing medical students interested in psychiatry

The die-hards, negotiators and migrants: Portraits of doctors' career pathways through specialisation

INTRODUCTION

Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties?

METHODS

A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP.

RESULTS

Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school.

CONCLUSIONS

Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages.

Equivalence, Justice, Injustice - Health and Social Care Decision Making in Relation to Prison Populations

Prisons represent sites of singular healthcare need-characterized by high levels of distress and disorder. In many jurisdictions, practitioners are ethically charged with delivering healthcare that is "equivalent" to that available in the wider community. This claim has been much debated-yet the emergence of a global coronavirus pandemic has highlighted the arguments in a particularly stark manner. In the following conceptual analysis, we explore the emergent discourse of the coronavirus and consider its particular significance for prison healthcare decision making and the concept of equivalence. For example, both the coronavirus pandemic and practice of prison incarceration induce a sense of varied temporality: The discourse of prison is replete in this area-such as the concept of "hard time." Alongside this, the discourse in relation to coronavirus has highlighted two competing modes of temporal understanding: The political-where the pandemic is conceptualized as has having a discrete "beginning and end", and the scientific-where the "new normal" reflects the incorporation of the "novel" coronavirus into the wider ecology. The impact of these disparate understandings on the prison population is complex: "Locking down" prisoners-to safeguard the vulnerable against infection-is relatively simple, yet it has traumatic repercussions with respect to liberty and psychosocial health. Easing lockdown, by contrast, is a difficult endeavor and risks collision between the temporalities of prison-where "hard time" is accentuated by separation from the "real world"-the political and the scientific. Whither then the concept of equivalence in relation to a field that is definitively non-equivalent? How can practitioners and policy makers maintain a just ethical stance in relation to the allocation of resources when it comes to a politically marginalized yet manifestly vulnerable population? We argue that further debate and consideration are required in this field-and propose a framework for such discussion.