Perceptions of oncology as a career choice among the early career doctors in Pakistan

BACKGROUND

Lack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply-demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology.

METHODS

A cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis.

RESULTS

Almost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05).

CONCLUSION

Despite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.

Relationship Between Research Culture and Research Activity of Medical Doctors: A Survey and Audit

PURPOSE

To describe the research capacity and culture, and research activity (publications and new projects) of medical doctors across a health service and determine if the research activity of specialty groups correlated with their self-reported "team" level research capacity and culture.

METHODS

Cross-sectional, observational survey and audit of medical doctors at a tertiary health service in Queensland. The Research Capacity and Culture (RCC) validated survey was used to measure self-reported research capacity/culture at organisation, team and individual levels, and presence of barriers and facilitators to research. An audit of publications and ethically approved research projects was used to determine research activity.

RESULTS

Approximately, 10% of medical doctors completed the survey (n= 124). Overall, median scores on the RCC were 5 out of 10 for organisational level, 5.5 for specialty level, and 6 for individual level capacity and culture; however, specialty-level scores varied significantly between specialty groups (range 3.1-7.8). Over 80% of participants reported lack of time and other work roles taking priority as barriers to research. One project was commenced per year for every 12.5 doctors employed in the health service, and one article was published for every 7.5. There was a positive association between a team's number of publications and projects and their self-reported research capacity and culture on the RCC. This association was stronger for publications.

CONCLUSION

Health service research capacity building interventions may need a tailored approach for different specialty teams to accommodate for varying baselines of capacity and activity. When evaluating these initiatives, a combination of research activity and subjective self-report measures may be complementary.

Building the capacity for psycho-Oncology research: a survey of the research barriers and training needs within the International Psycho-Oncology Society

Background

The International Psycho-Oncology Society (IPOS) is a multidisciplinary professional network that aims to improve psychosocial care for individuals impacted by cancer. IPOS encourages research activity, recognizing that a high-quality evidence base is essential to provide best-practice, data-driven clinical care. This study aimed to determine the barriers to research involvement and the training needs and priorities of IPOS members, with the goal of facilitating the development of training resources tailored to the needs of IPOS members.

Methods

A link to an online, cross-sectional survey was disseminated to all registered members of IPOS via email. The online survey platform SimpleSurvey was used, and questions included demographic characteristics and items related to research interests, involvement, and training needs. High priority research training needs were identified as research tasks respondents rated as highly important, yet possessed a low perceived skill level in.

Results

Thirty-two percent of IPOS members (n = 142) completed the survey. Participants represented 49 countries and were at a variety of career stages. Overall, participants reported spending an average of 17.3 hours per week on research (range 0-80 hours per week), with 69% of respondents wanting to increase their research involvement. The main barriers to research participation included lack of research funding (80%) and lack of protected time (63%). IPOS members identified 5 high-priority training needs: preparing successful grant applications; preparing research budgets; community-based participatory research; working with decision makers; and finding collaborators or expert consultants. Participants suggested funding access, statistical advisors, and networking and mentorship opportunities as ways to enhance research involvement. Members preferred online training modules (39%) and mentorship programs (19%) as methods by which IPOS could provide research support. IPOS was viewed as being able to contribute to many aspects of research capacity building such as networking, training, and dissemination of research findings.

Conclusions

IPOS has an important role in encouraging research capacity building among members. This survey provides an agenda for workshops and training opportunities. Mainly, for respondents it was less about training in research methods and more about training in how to prepare successful grant applications, including budgets, and receiving mentorship on this as well as having opportunities to collaborate with other researchers.

Exploring the impact and experience of fractional work in medicine: a qualitative study of medical oncologists in Australia

OBJECTIVES

Fractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians' views on the consequences of fractional work in oncology.

DESIGN

Qualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.

SETTING

New South Wales, Australia.

PARTICIPANTS

Medical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages.

RESULTS

Four key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care.

CONCLUSION

Fractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.

Importance of publishing research varies by doctors’ career stage, specialty and location of work

Purpose

To investigate whether publishing research is an important aspect of medical careers, and how it varies by specialty and rural or metropolitan location.

Methods

Annual national panel survey (postal or online) of Australian doctors between 2008 and 2016, with aggregated participants including 11 263 junior doctors not enrolled in a specialty (‘pre-registrars’), 9745 junior doctors enrolled as specialist trainees, non-general practitioner (GP) (‘registrars’) and 35 983 qualified as specialist consultants, non-GP (‘consultants’). Main outcome was in agreement that ‘research publications are important to progress my training’ (junior doctors) or ‘research publications are important to my career’ (consultants).

Results

Overall, the highest proportion agreeing were registrars (65%) and pre-registrars (60%), compared with consultants (36%). After accounting for key covariates, rural location was significantly associated with lower importance of publishing research for pre-registrars (OR 0.69, 95% CI 0.61 to 0.78) and consultants (OR 0.69, 95% CI 0.63 to 0.76), but not for registrars. Compared with anaesthetics, research importance was significantly higher for pre-registrars pursuing surgery (OR 4.46, 95% CI 3.57 to 5.57) and obstetrics/gynaecology careers, for registrars enrolled in surgery (OR 2.97, 95% CI 2.34 to 3.75) and internal medicine training, and consultants of internal medicine (OR 1.84, 95% CI 1.63 to 2.08), pathology, radiology and paediatrics.

Conclusions

This study provides new quantitative evidence showing that the importance of publishing research is related to medical career stages, and is most important to junior doctors seeking and undertaking different specialty training options. Embedding research requirements more evenly into specialty college selection criteria may stimulate uptake of research. Expansion of rural training pathways should consider capacity building to support increased access to research opportunities in these locations.

Integrating the teaching role into one's identity: a qualitative study of beginning undergraduate medical teachers

Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A qualitative study was performed, involving 18 beginning medical teachers at a Dutch medical school. The teachers were interviewed twice and kept a logbook over a period of 7 months. The study shows that the integration of the teacher role into the teachers' identity was hampered by the idea that teaching is perceived by others as a low status occupation. Some teachers experienced significant tension because of this, while others showed resilience in resisting the negative associations that were thought to exist regarding teaching. The teachers used five different identity narratives in order to integrate the teacher role into their identity, in which the positions of teacher and doctor or researcher were found to be combined, adopted or rejected in diverse ways. The five identity narratives were: (1) coalition between the I-position of teacher and other I-positions; (2) no integration of the I-position of teacher: holding on to other I-positions; (3) construction of the I-position of teacher and other I-positions as opposites; (4) coalition between the I-position of teacher and a third position of coordinator; and (5) meta-position: trivialising the importance of status. These identity narratives offer starting points for supporting undergraduate teachers during their early professional years.

Retirement patterns of Australian doctors aged 65 years and older

OBJECTIVE

To investigate retirements over a 4-year period among Australian general practitioners (UPs) and specialists aged 65 years and over, and factors influencing retirement.

METHODS

Data from Medicine in Australia: Balancing Employment and Life (MABEL) for the years 2009-12 were analysed for 435 GPs and 643 specialists aged 65 years and over at the time of entry to the MABEL survey. Discrete time survival analysis was used.

RESULTS

The retirement rates were 4.1% (2009), 5.1% (2010), 4.2% (2011) and 10.4% (2012). Retirement was associated with: (1) the intention to leave medical work in 2009 and 2010; (2) working fewer hours in private consulting rooms in 2010 and 2012; (3) having lower job satisfaction in 2009 and 2011; (4) being older in 2009; (5) working fewer hours in a public hospital in 2012; and (6) working fewer hours in a private hospital in 2010. Doctors who intended to reduce their working hours were less likely to retire in 2009.

CONCLUSIONS

Strategies to support doctors at the late career stage to provide their valued contributions to the medical workforce for as long as possible may include increasing job satisfaction and addressing barriers to reducing work hours.

The medical workforce in 2025: what's in the numbers?

Key trends in Australian medical workforce supply include increasing overall supply levels and an increasing number of medical graduates, but also reduced workforce effort and a large cohort of doctors approaching traditional retirement age. Although prevocational and vocational training programs are beginning to expand, there are significant bottlenecks in the postgraduate training pathway for the sizeable cohorts of new graduates. The primary health care workforce needs continued development, including team-based approaches to care and increased use of technology. Increasing our understanding of system-level and individual-level determinants of doctors' choices and implementing innovative strategies to accommodate the increasingly diverse work patterns of doctors are critical to ensuring that in future there are sufficient doctors, with the right skills, in the right places.

Embedding research in clinical practice: differences in attitudes to research participation among clinicians in a tertiary teaching hospital

Despite a drive to increase research in healthcare settings, clinician participation in research remains infrequent. This paper describes an online survey comparing attitudes with research participation among clinicians (doctors, nurses and allied health professionals) at an Australian tertiary children's hospital. Differences between professional groups support the existence of different professional cultures surrounding research, suggesting that multiple strategies are required to improve participation in research.

The assessment of a structured online formative assessment program: a randomised controlled trial

BACKGROUND

Online formative assessment continues to be an important area of research and methods which actively engage the learner and provide useful learning outcomes are of particular interest. This study reports on the outcomes of a two year study of medical students using formative assessment tools.

METHOD

The study was conducted over two consecutive years using two different strategies for engaging students. The Year 1 strategy involved voluntary use of the formative assessment tool by 129 students. In Year 2, a second cohort of 130 students was encouraged to complete the formative assessment by incorporating summative assessment elements into it. Outcomes from pre and post testing students around the formative assessment intervention were used as measures of learning. To compare improvement scores between the two years a two-way Analysis of Variance (ANOVA) model was fitted to the data.

RESULTS

The ANOVA model showed that there was a significant difference in improvement scores between students in the two years (mean improvement percentage 19% vs. 38.5%, p < 0.0001). Students were more likely to complete formative assessment items if they had a summative component. In Year 2, the time spent using the formative assessment tool had no impact on student improvement, nor did the number of assessment items completed.

CONCLUSION

The online medium is a valuable learning resource, capable of providing timely formative feedback and stimulating student-centered learning. However the production of quality content is a time-consuming task and careful consideration must be given to the strategies employed to ensure its efficacy. Course designers should consider the potential positive impact summative components to formative assessment may have on student engagement and outcomes.

Junior doctors' preferences for specialty choice

A number of studies suggest that there is an over-supply of specialists and an under-supply of general practitioners in many developed countries. Previous econometric studies of specialty choice from the US suggest that although income plays a role, other non-pecuniary factors may be important. This paper presents a novel application of a choice experiment to identify the effects of expected future earnings and other attributes on specialty choice. We find the implied marginal wage estimated from our discrete choice model is close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs' earnings by $50,000, or increasing opportunities for procedural or academic work can increase the number of junior doctors choosing general practice by between 8 and 13 percentage points. The simulation implies an earnings elasticity of specialty choice of 0.95.

Impact on the dermatology educational experience of medical students with the introduction of online teaching support modules to help address the reduction in clinical teaching

BACKGROUND/OBJECTIVES

With increasing medical student numbers and decreasing clinical teaching opportunities, there has been a need to develop alternative learning resources. The aim of this study was to examine the effectiveness of a new dermatology online teaching resource, from a student perspective.

METHODS

The Australasian College of Dermatologists developed an undergraduate dermatology curriculum and subsequently created online teaching modules in partnership with the University of Sydney. These modules were introduced to final year medical students at the University of Western Australia in 2010. The dermatology learning experiences of these 142 students were compared with the 2009 medical student cohort who did not have access to this resource. A self-administered questionnaire, with a 5-point rating scale, was used.

RESULTS

The 2010 cohort described an improved educational experience using the online modules. Despite a reduction in the number of clinics attended, knowledge and skills gained were scored higher among the 2010 cohort. The student's confidence in their ability to manage common dermatological conditions was also statistically higher in the cohort with the online teaching resource. The learning experience for dermatology compared to other subspecialty teaching in medical school was ranked as a significantly more positive experience in the 2010 cohort.

CONCLUSIONS

Our results suggest that the introduction of the online modules described in this paper to support learning have improved the perceived educational experience of medical students and should be incorporated as a way to improve student teaching in the face of reduced clinic teaching.

'I enjoy teaching but...': Paediatricians' attitudes to teaching medical students and junior doctors

AIM

To explore consultant paediatricians' attitudes, motivations, and barriers to training medical students and junior doctors.

METHODS

Qualitative research involving 24 paediatricians (with a diversity of specialties, experience, age, gender, teaching activity and employment status) from a tertiary paediatric hospital and clinical school in Sydney, Australia. Participants were engaged in semi-structured focus group discussions which explored their attitudes to teaching medical students and junior doctors, their role and experience of teaching, their training in medical education, perceived barriers to teaching, and possible solutions to these barriers. Data from the transcriptions of the focus group discussions were coded using the constant comparative method and analysed for themes using NVivo 7 software. Differences in responses between participants were explored.

RESULTS

All participants reported enjoying teaching. However, a number of factors which occurred at the consultant, learner and institution level affected the enjoyment or challenge of teaching. Consultant factors included time commitments, knowledge of and confidence in the learner's course, and comfort with teaching. Learner factors included level of knowledge, attendance, interest and enthusiasm, and cultural changes. Institution factors included acknowledgement of teaching contribution, communication, teaching support and resources, and attitude to teaching. These factors and the consultant's relationship with the learner and institution impacted on their ownership, involvement, and commitment to teaching.

CONCLUSIONS

Consultant paediatricians identified challenges to their involvement and commitment to teaching. Actions to address these challenges and improve the relationship between the consultant and the learner and the consultant and the institution may enhance the consultant's commitment to teaching.