Ian Campbell

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Early Medical Training Streaming Is it moving
too fast?

• Ian Campbell
• Principal House Officer General Surgery
• Gold Coast Hospital

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Disclaimer

• Who is Ian Campbell and why is he talking about
  this?

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Objective

• What is streaming?
• The need for speed
• The Performance
• The Sadness
• The findings so far.

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What is streaming?

• Tailoring postgraduate training into certain
  areas.
• e.g. As a PGY2 undertaking only surgical
  subspecialty terms, or medical subspecialty terms

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The Need for Speed
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• Findings
• Strength of country's primary care system
  associated with improved population health
  outcomes
• Orientation toward specialist-based system
  enforces inequity in access

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• Aim
• Examine uptake of streaming by students
• If adversely affect student performance on
  licensing examinations
• Matching to career plan
• 1977 43
• 1978 - 50 70 did
  this deliberately
• 1979 51
• Performance on exams
• Clear decline in scores

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• Career destination matched
• 1st year choice following graduation 54
• 3rd year choice following graduation - 70
• 5th year choice following graduation 83

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• Subjective indicators
• Surveys
• 1981 48 would not recommend the practice of
  medicine as highly as they would 10 years earlier
• 2001 58 stated enthusiasm declined in previous
  5 years. 87 stated overall moral declined during
  past 5 years

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• Opposed to early streaming
• Supports continued emphasis in well founded
  generalist orientation (in first 2 years)
• Highlighted
• Low levels of career decions made early in career
• Need for range of experiences to make robust
  career choice and experience for sound foundation
  for specialist careers

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Survey

• Background
• Survey of two tertiary QLD hospitals, one that
  has option for streaming as a PGY2 and one that
  does not have streaming
• Aim
• Survey of interns for these locations to examine
  a number of key aspects related to streaming.
  Main area of interest is pressure on career
  decision making

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Demographics

• Streaming Hospital
• Age

• Non-Streaming Hospital

Male 9
Female 6
15
Male 10
Female 6
16
,23 0
24-26 9
27-29 4
gt30 2
lt23 0
24-26 6
27-29 8
gt30 2
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Demographics

• Streaming Hospital
• 14 of 15 respondents staying at hospital for 2012
• All will be streaming

• Non-Streaming Hospital
• 16 respondents staying at hospital for 2012

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Would you prefer to work at a hospital that did
/does not stream?

• Streaming Hospital

• Non-Streaming Hospital

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Have you decided on a long term career plan?

• Streaming Hospital

• Non-Streaming Hospital

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Have you changed your career plan since starting
as an intern?

• Streaming Hospital

• Non-Streaming Hospital

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Do you feel pressured to make a long-term career
decision at this point in your career?

• Streaming Hospital

• Non-Streaming Hospital

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Pressure related to streaming

• Streaming Hospital
• Do you feel that streaming as a PGY2 results in
  added pressure to make a long term career
  decision?

• Non-Streaming Hospital
• Do you feel that streaming at a PGY2 would add
  more pressure to make a long-term career decision?

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Summary Of Findings

• Junior doctors would prefer to work at a hospital
  that does not stream
• Junior doctors in Queensland change there career
  plan as interns (in keeping with international
  findings)
• Junior doctors feel pressured to make career
  decisions
• Streaming adds more pressure to make a career
  decision

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Conclusion

• There is a large influx of new graduates, the
  vast majoriy need to enter into vocational
  education and thus speed is a virtue
• There a benefits to good primary care therefore
  can be argued that well rounded doctors have
  improved outcomes
• Junior doctors change their mind about career
  plans
• Streaming results in added pressure for junior
  doctors to make career plans

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