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Overall satisfaction high, but long hours and bullying remain concern for trainees

The latest snapshot of medical training in Australia has revealed ophthalmology ranks highly in terms of trainees recommending their position to other doctors, but bullying, harassment, discrimination and long work hours remain a concern for the profession.

The 2020 Medical Training Survey (MTS) is the Medical Board of Australia’s second ever nationwide survey of all doctors in training and is a confidential way to get national, comparative, profession-wide data to strengthen training.

Almost 22,000 trainees participated in the 2020 survey at a 57% response rate, more than double the inaugural 2019 figure. Seventy-four trainee ophthalmologists responded, providing a more accurate picture than 2019 when just 26 took part.

While overall training satisfaction was high, the survey found almost one in four RANZCO trainees (24%) experienced bullying, harassment and/or discrimination in the workplace, compared with a national average of 21%. In total, 77% agreed they knew how to raise these concerns, including racism, in their workplace, while 70% believed they could access support from their workplace after experiencing a traumatic event.

Dr Justin Mora.

RANZCO censor-in-chief Dr Justin Mora, previously chair of the college’s Advanced Clinical Examination Committee, told Insight bullying, harassment and/or discrimination was “a significant area of concern”, and an issue the college took seriously.

He said trainees were covered by employers’ bullying, harassment and discrimination policy and RANZCO requires training posts to have an appropriate policy before they are accredited.

“The accreditation process also has stringent and confidential processes for trainees to report any issues that they experience or witness,” he said.

“At each accreditation review we are asking training posts to report the outcome of any bullying complaints. We hope this ensures the staff at each training post are aware of their policies and are supported to enact them. Training posts are not provided reaccreditation until all issues are satisfactorily addressed.”

RANZCO would also like to see the number of average weekly hours worked decrease among its trainees.

On average, RANZCO trainees worked 49.7 hours a week, 4.1 hours more than the national average of 45.6 hours. Also, 83% of ophthalmology trainees are working 40 hours a week or more, compared with 66% across other professions.

When working unrostered overtime, 68% of RANZCO trainees got paid at least most of the time, markedly higher than the 50% national average. But 23% valued the extra training opportunities this provided.

Mora said RANZCO trainees were employed by hospitals or health services, which are generally covered by state health employment awards, meaning the college did not have direct control over trainees’ employment arrangements.

However, he said RANZCO had begun asking questions about trainees’ employment conditions during accreditation inspections.

“And appropriate remedial action will be taken if a trainee is found to be working unreasonably excessive hours to what is outlined in their position description and award,” he said.

“As a result, we expect that the number of working hours for ophthalmology trainees will trend downwards towards the national average in future surveys.”

Quality of training commended 

In other findings, ophthalmology trainees rated their training highly in 2020, despite major disruption due to COVID-19.

In total, 92% agreed they would recommend their training position to other doctors, which rated higher than the national average of 81%. Also, 85% of RANZCO trainees said they would recommend their workplace as a place to train, compared with 81% nationally.

Mora said the pandemic made 2020 a difficult year for RANZCO trainees, with training suspended for part of the year. All exams were deferred to the end of the year and face-to-face examinations were conducted virtually.

“It is encouraging that the key performance indicators in the MTS were rated positively by trainees despite the difficult year they had to experience,” he said.

“We believe the results are testament to the work undertaken by RANZCO Fellows, Committees and staff to support trainees during the disruption of training, subsequent transition to restart of training and the additional support provided to trainees once training recommenced.”

Other favourable responses included the quality of ophthalmology orientation (75% rated it excellent/good), quality of clinical supervision (88%) and quality of teaching sessions (94%).

In terms of assessments, 84% of RANZCO trainees felt exams always reflected the college training curriculum – considerably higher than 58% nationally – while 90% felt exam information the college provided was always accurate and appropriate (65% national average).

However, just 27% surveyed said they received useful feedback about their exam performance (38% nationally).

Mora said RANZCO has started conducting an internal survey from 2020 and was pleased MTS 2020 corroborated its initial findings.

“RANZCO is using MTS to evaluate how we compare against other Medical Colleges in the key performance indicators. In combination with our own survey and other internal feedback mechanisms, to help determine the key areas that we need to be focusing on so that the trainees have a great experience during their training whilst ensuring that we continue to provide high quality ophthalmic training and maintain our leadership role in ophthalmology in the Asia Pacific region,” he said.

Australian Medical Association president Dr Omar Khorshid was pleased the majority of medical trainees rated their training experience highly in 2020.

“But the results show we have more work to do to address long standing issues – unpaid overtime, excessive hours … and, most importantly, stamping out bullying and harassment, which is still a big issue in medicine and health,” he said.

“It’s time for state and territory health departments to get serious about valuing the time doctors in training spend learning and providing excellent patient care by reviewing and providing appropriate staffing and better rostering practices. It’s also time for employers to improve their workplace culture. They have a legal responsibility to provide a safe workplace for all employees.”

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