Australasian Trainees Research Articles

The role of universities in Australasian emergency medicine training.

The role of universities in Australasian emergency medicine training.

Appropriate working hours for surgical training according to Australasian trainees

The demands of surgical training, learning and service delivery compete with the need to minimize fatigue and maintain an acceptable lifestyle. The optimal balance of working hours is uncertain. This study aimed to define the appropriate hours to meet these requirements according to trainees. All Australian and New Zealand surgical trainees were surveyed. Roster structures, weekly working hours and weekly 'sleep loss hours' (<8 per night) because of 24-h calls were defined. These work practices were then correlated with sufficiency of training time, time for study, fatigue and its impacts, and work-life balance preferences. Multivariate and univariate analyses were performed. The response rate was 55.3% with responders representative of the total trainee body. Trainees who worked median 60 h/week (interquartile range: 55-65) considered their work hours to be appropriate for 'technical' and 'non-technical' training needs compared with 55 h/week (interquartile range: 50-60) regarded as appropriate for study/research needs. Working ≥65 h/week, or accruing ≥5.5 weekly 'sleep loss hours', was associated with increased fatigue, reduced ability to study, more frequent dozing while driving and impaired concentration at work. Trainees who considered they had an appropriate work-life balance worked median 55 h/week. Approximately, 60 h/week proved an appropriate balance of working hours for surgical training, although study and lifestyle demands are better met at around 55 h/week. Sleep loss is an important determinant of fatigue and its impacts, and work hours should not be considered in isolation.

Working hours and roster structures of surgical trainees in Australia and New Zealand

The working hours of surgical trainees are a subject of international debate. Excessive working hours are fatiguing, and compromise performance, learning and work-life balance. However, reducing hours can impact on continuity of care, training experience and service provision. This study defines the current working hours of Australasian trainees, to inform the working hours debate in our regions. An online survey was conducted of all current Australasian trainees. Questions determined hours spent at work (AW) and off-site on-call (OC) per week, and roster structures were evaluated by training year, specialty and location. The response rate was 55.3%. Trainees averaged 61.4 ± 11.7 h/week AW, with 5% working ≥80 h. OC shifts were worked by 73.5%, for an average of 27.8 ± 14.3 h/week. Trainees of all levels worked similar hours (P= 0.10); however, neurosurgical trainees worked longer hours than most other specialties (P < 0.01). Tertiary centre rotations involved longer AW hours (P= 0.01) and rural rotations more OC (P < 0.001). Long days (>12 h) were worked by 86%; median frequency 1:4.4 days; median duration 15 h. OC shifts of 24-h duration were worked by 75%; median frequency 1:4.2 days; median sleep: 5-7 h/shift; median uninterrupted sleep: 3-5 h/shift. This study has quantified the working hours and roster structures of Australasian surgical trainees. By international standards, Australasian trainee working hours are around average. However, some rosters demand long hours and/or induce chronic sleep loss, placing some trainees at risk of fatigue. Ongoing efforts are needed to promote safe rostering practices.

Palliative medicine trainees and their mandatory oncology module

Palliative medicine trainees are currently required to complete 36 months of core and non-core training, including a 6-month oncology module. There are presently few published data from palliative medicine trainees regarding the structure and appropriateness of their curriculum. The aim of this study was to evaluate skills related to the Royal Australasian College of Physicians essential learning objectives and the experiences gained by the individuals during their oncology training. An investigator-designed questionnaire was emailed out to all current Australasian trainees or first year consultants. A 45% response rate was achieved. Women were significantly more negative in their responses to the improvement of communication skills and the understanding of ethics. Chapter trainees rated improved leadership and future management skills lower than other respondents. Fifty-eight per cent of the respondents believed the oncology module should remain mandatory. Although valuable, a more tailored and flexible approach to this part of training should be considered.

Training outside of the box.

Developments in surgical training in Australasia allow for individualization of training to suit individual requirements. One uncommon career track is medical aid or missionary surgery in the developing world. It is difficult to receive appropriate training for this type of surgical practice in Australasia. The present paper describes a novel approach to preparing for this kind of work by spending a 6 month rotation in a mission hospital in rural East Africa. The surgical trainee spent 5 months working at Kijabe Hospital in Kenya. This is a large mission hospital with a busy general surgical workload and adequate staffing for training. The trainee performed 214 major cases, in a broad range of general surgery, under appropriate supervision. He also took part in regular educational sessions, surgical audit, and helped to develop one of East Africa's pioneering laparoscopic surgical -programmes. The present paper demonstrates that it is possible for Australasian trainees to gain useful experience in the rural African environment, in hospitals where appropriate surgical supervision is available.

A fellowship in the USA: essential information for the Australasian medical graduate.

There have been many recent changes to the immigration and educational requirements necessary to obtain both clinical and research positions in the USA. This paper describes these requirements in detail and examines the cost of obtaining a position. An extensive review of Medline and relevant documents from educational and immigration bodies is undertaken in addition to personal and peer experience of the processes necessary to fulfil educational and immigration requirements for funded medical positions in the USA. A cost analysis is performed based upon the latest charges for exam requirements and visa fees. A 'minimum' cost for fulfilling exam and visa requirements only and a 'likely' cost (which represents a more realistic appraisal of the expenses likely to be incurred) are investigated. This review shows that many recent changes have made the attainment of a position difficult and expensive. Much foresight and planning is required to obtain the necessary requirements for medical licensure and to obtain working visa status in addition to the application for the position itself. The cost analysis reveals that the minimum cost is $4050 (AU$) and the 'likely' cost is $8600 (AU$). Australasian trainees and Fellows need to be fully aware of the difficulties and expenses likely to be encountered in order to make an informed decision with regard to overseas training in the USA.

A comparison of Australasian and United States emergency medicine training programmes

AbstractTraining in emergency medicine differs from country to country. This article compares the emergency medicine training programmes of Australasia and the United States of America. The perceived advantages of programmes are highlighted, but no attempt is made to determine which is the better programme. The Australasian programme is significantly longer and places greater emphasis on the basic clinical sciences, physical examination skills and academic output. Australasian College for Emergency Medicine regulations are relatively flexible, and allow trainees to design their own programmes. Australasian trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part‐time training may be acceptable. In the US, trainees rotate within and from one parent institution which provides a rigid teaching structure for a ‘critical mass’ of trainees, based upon a core curriculum. Rotations tend to be much shorter than in the Australasian programme but ensure exposure to a broader range of clinical experience. In the US programme, evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. In addition, trainees are under the close supervision of the teaching faculty at all times when working in an emergency department.