12 Nov 2022

Lack of hands-on training for new doctors - report

7:04 am on 12 November 2022
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A study based on a survey of 13 house officers working at North Shore Hospital in the year to December 2021 has been published in the New Zealand Medical Journal. Photo: 123RF

Some newly-graduated doctors warn the lack of hands-on learning during their training has left them feeling ill-prepared for the reality of dealing with emergencies.

A study, published today in the New Zealand Medical Journal, is calling for medical schools to put more focus on stress management skills to stop young doctors burning out.

Junior doctor Vanshay Bindra was at least prepared for how unprepared he would feel starting his new career, after surveying new graduates for this research in his final year of study.

He said he finished six years study with a lot of technical knowledge but it was still a steep learning curve.

"My experience is similar to what we saw in the survey - we have a lot of medical skills and technical skills needed for the job but we missed out on some of that how to manage our time and prioritisation, how to manage fatigue and that side of things."

Half of those surveyed had never attended a trauma call or a resuscitation with clinical teams before starting work in a hospital.

Fewer than half had received specific teaching in mental self-care, managing workloads or cross-cultural interaction.

Another of the report's co-authors, professor Jonathan Koea, said medical students did not get as much practical experience these days, partly because of modern concerns about patient safety and student wellbeing.

Teaching was more university-style, involving "more tutorials and Powerpoint presentations and less bed-side teaching", he said.

"What that means is, there's quite a jump to make and you're often exposed to things that you may not have seen before. And there's quite a close correlation in overseas research that, not surprisingly, those individuals are more prone to burnout and mental health issues."

Koea, who is also a liver surgeon at North Shore Hospital, said while the study was small - based on a survey of just 13 house officers working at North Shore Hospital in the year to December 2021 - its findings echoed larger studies from North America and Europe.

And Covid-19 has made these findings even more relevant.

"We've trained a group of medical graduates as best we can during Covid but there's been lots of non-contact stuff in that time, and then they're thrown into the current maelstrom of the health system, which is in an extraordinary state," Koea said.

"We probably haven't prepared them as best we might have."

Auckland University medical school deputy dean Professor Warwick Bagg said the pandemic and workforce shortages could mean some students had had less hands-on experience.

However that was "not the norm", he said.

The last three years of a medical degree involve lengthy clinical attachments in hospitals and primary care settings, with gradually increasing responsibilities.

Bagg conceded the transition from student to doctor was a step up.

"There's a lot of research that demonstrates that's always going to be a bit of a challenge.

"Can we do more? Probably yes. But there's a lot of evidence that most students are very satisfied with their learning and are reasonably prepared."

Professional skills, including stress management, cultural competence and dealing with distressed or angry patients, had been a core part of the medical school curriculum for several years.

Otago Medical School acting dean Professor Tim Wilkinson said medical students spent most of their fourth and fifth years in clinical settings and their sixth year working fully, as much as possible like a first-year doctor.

"This allows medical students to integrate into a variety of clinical teams with graded clinical responsibilities. Of course, legally, they are still students and therefore restricted as to what they are able to do. We provide simulated opportunities for students to learn skills in conflict resolution."

As with any occupation, experiences gained as a student in clinical settings could feel very different once on the job - "preparation only gets you so far", Wilkinson said.

"Studies such as this one are always useful for informing how we improve our programme - something we are constantly endeavouring to do."

Sixth-year medical students are paid the medical trainee intern grant of $26,756.

However, the Resident Doctors' Association wants a return to the model in place 30-odd years ago, when final year medical students were officially part-time employees.

Union head Deborah Powell said that eased the step into clinical practice because they were already part of the team.

"They didn't take the same workload, they didn't take the same responsibility, they couldn't prescribe, but they were part of the team seeing and assessing patients, working alongside the house officers, which is within a matter of months what they were going to be.

"So it certainly assisted with transition and it should be re-introduced."

Up to one in five junior doctors have told the union they were planning to quit their hospital jobs next year.

Some were heading overseas for higher pay - but others were leaving the profession, Dr Powell said.

Dr Bindra said he had no regrets, he loved his job - but nothing could have completely prepared him for the reality of starting his career in a pandemic.

"There's multiple vacancies on a day-to-day basis across all services in our hospitals, which only adds to the pressures we face when are at work, because we essentially do the work of the people who are missing."

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