Trainees not happy with colleges

A NATIONAL survey that highlights disgruntlement among junior doctors about aspects of their training program, including bullying, is a timely call to colleges to get their house in order, says a trainee representative.

Dr Michael Bonning, chair of the AMA’s Council of Doctors in Training and co-author of its 2010 Specialist Trainees Survey, said that with the impending increase in graduating medical students vying to enter postgraduate training, the survey would give colleges insight into how they could improve their programs.

The inaugural survey, reported in this week’s MJA, found that while colleges rated well in many areas such as selection and access to supervision, several areas elicited negative feedback, including the capacity of trainees to raise concerns without fear of recrimination. (1)

A mere 11% of trainees agreed or strongly agreed that their college responded in a timely and appropriate manner to cases of bullying and harassment, 16% said there was appropriate remediation for unsuccessful candidates and the same proportion said there was an effective appeals process.

Training costs were also called into question, with only 23% agreeing or strongly agreeing that training was good value for money.

“… 40% of respondents reported that the cost of their training program had caused them financial hardship”, the authors said. “Ensuring reasonable costs for training and assessment is integral to minimising the adverse consequences of study debt.”

The 55-item online self-report survey was available to all 10 649 hospital-based vocational trainees although only those on the AMA database received an email about it. There were 538 respondents from 18 disciplines.

The researchers said the bullying and harassment finding was of concern.

“Trainees are at risk because distinctions between workplace and training supervisors can be blurred”, they said. “It is critical that colleges have well defined and transparent processes for dealing with these matters, which are the responsibility of educators as well as employers.”

Dr Bonning said bullying could take several forms, including belittling of junior staff.

“There are ingrained cultural problems in the way in which more senior doctors treat more junior doctors, [including] unreasonable work requirements”, he said.

Problems were often not resolved because colleges rarely had a strong presence in hospitals.

“What we find is that the college’s representatives are the same people who are sometimes the ones handing out the treatment deemed as bullying”, Dr Bonning said.

Dr John Quinn, executive director for surgical affairs at the Royal Australasian College of Surgeons, said his college attempted to tackle bullying and harassment head on. The college had developed a booklet on the issue, which was distributed to all fellows and trainees and posted on the college website.

Dr Quinn said trainees were represented at all levels of the college, even on the governing council, and the college would continue to strive to improve satisfaction rates.

A fair and effective appeals process was a condition of the college’s regular accreditation by the Australian Medical Council.

A spokesperson from the Royal Australasian College of Physicians also said the college had made progress in supporting trainees, including improving procedures to promote transparency and procedural fairness.

Measures to further improve arrangements at the RACP included the implementation of the Code of Conduct and programs covering bullying and harassment. In 2012, the RACP will develop the “trainee in difficulty” program to further support trainees.

Dr Bonning said the single largest increase in vocational training numbers ever in Australia would occur over the next 5 years, putting increased pressure on training programs.

The AMA plans to repeat the survey every 4 years.

In a joint editorial, MJA editor Dr Annette Katelaris and guest editor Dr Christine Jorm said the dual role of junior doctors as both hospital employees and trainees of colleges created problems over who was responsible for them. (2)

- Cathy Saunders

1. MJA 2011; 195: 382

2. MJA 2011; 195: 369

Posted 4 October 2011