Advocacy for advanced trainees

AMA is working at both a State and Federal level to improve the quality of vocational training.

The AMA Specialist Trainee Experience Health Check, released in late November, reveals the challenges and stressors faced by advanced trainees.

The Health Check compares the specialty training experience across 11 Colleges, ranking them from A+ (excellent) to F- (unsatisfactory) in four areas:

• Communication and Engagement

• Examination and Assessment

• Supervision and Teaching

• Workplace Environment and Culture

No College achieved higher than a B in any area, while the lowest mark was D-.

Almost 10,000 respondents completed the survey, which revealed the stressors doctors face as they complete their training.

“Australia has a world-renowned system of specialist training and our medical Colleges are doing a fantastic job in preparing doctors for independent specialist practice. However, the Health Check shows that there is room for improvement,” said AMA President, Dr Omar Khorshid.

“This includes areas such as exam feedback, providing access to mental health services, addressing bullying, discrimination and harassment, access to study leave, and supporting employment at the end of training.”

The survey found 32% reported receiving useful exam feedback while almost half (45%) indicated they did not.

Meanwhile 66% reported having access to protected study time or leave.

The survey found that one in five respondents experienced bullying, discrimination or harassment, while 36% reported its occurrence. Once reported, it was followed up half of the time. About a quarter of respondents (27%) indicated they witnessed bullying, discrimination and harassment, while only one-third reported it and 41% followed up on these issues.

With regard to employment concerns, almost half (45%) of respondents agreed they were concerned about their ability to secure employment at the end of their training.

Access to mental health services was also highlighted as another area for improvement, with only 38% indicating they were supported in this area.

To help address doctors’ mental health and wellbeing, AMA partnered with other medical groups and mental health leaders to launch its Every Doctor, Every Setting: A National Framework in October 2020.

NSW ADVANCED TRAINEES AND FELLOWS

Concerns from advanced trainees and fellows about workplace conditions and career options following completion of training sparked AMA (NSW) to also survey its members.

Preliminary results from this survey suggest more than half of respondents (55%) do not have a rest policy in the event they are called to come into work at night, with several respondents commenting that they are expected to come in and work the next day as rostered, after coming in overnight. Others indicated there wasn’t a formal policy in place but informally they could take the morning off to rest or leave work early the next day depending on clinical load.

Respondents were divided in their responses on how often they are required to come in when on call. About 18% said ‘always’ while another 18% indicated ‘never’.

Almost 60% indicated they are ‘always’ paid for callbacks, while three-quarters (74%) indicated they are ‘never’ paid for remote clinical appraisals.

The majority of respondents (85%) said they are pursuing a public appointment upon completion of their fellowship, but almost 40% said they are ‘not at all confident’ they will achieve that.

More than a third indicated they will pursue work in private practice and 28% are interested in doing an international fellowship.

Nearly all respondents (79%) felt they must undertake additional education to receive a public hospital appointment.

One respondent commented, “Thank you for looking into AT and fellow welfare. AT training can be very tough with a lot of exploitation occurring due to the desire for career advancement/public appointments.”

Paid paternity was another issue cited by respondents, as was part-time flexibility.

“Paid paternity leave is standard in most other industries (banking, law, etc)… paternity leave affords working mothers the opportunity to return to work sooner.”

Another respondent commented, “[I] currently have a 12-month-old with another on the way and I’m studying for fellowship exams. I am working part time while my wife has to work full time due to her training and workplace inflexibility. My department’s roster is underfilled (always is!) but recently I’ve been informally informed that they will be reviewing the sustainability of allowing part-time employment for trainees. Nothing formal but this is concerning given that there is no way I can work more, study and afford childcare and in addition, it’s highly unlikely I will be able to get a 1.0 FTE staff specialist job even if I had the flexibility to work that much. Bottom line, I feel there is a background attitude that trainees fill the roster and that’s it – with no acknowledgement of exam pressures or even that we might have lives outside the hospital at the age of 30!”

AMA (NSW) will be examining these survey results in further detail to determine advocacy for advanced trainees and fellows.