Australian Trainees Research Articles

Profile of Sport and Exercise Physician trainee’s clinical practice within Australasia in 2019: a cross-sectional study

ObjectiveTo identify the patient population profile and the spectrum of training activities and influencing factors of Australasian College of Sport and Exercise Physician (ACSEP) trainees.DesignRetrospective cross-sectional design.SettingTraining settings for ACSEP...

Factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees: a systematic review

BackgroundBurnout and poor psychological wellbeing are common in postgraduate medical trainees. However, data relating to Australian trainees are lacking. This systematic review aimed to identify and synthesise relevant research on the factors that influence burnout and psychological wellbeing in Australian postgraduate medical trainees.MethodsA systematic PRISMA search was conducted across eight databases from January 2000 to September 2021. Empirical peer-reviewed studies were included if they focused on one or more factors influencing burnout and psychological wellbeing in Australian postgraduate medical trainees. Screening was independently conducted by two reviewers at each stage of the process. Results were synthesised and analysed using a convergent qualitative synthesis process structured according to the Job Demands-Resources model of occupational stress.ResultsForty-eight papers were included in the final review. Factors impacting burnout and/or wellbeing (job demands) fell under four themes: (i) working hours and workload; (ii) the work and learning environment; (iii) inappropriate behaviour; and (iv) examinations and academic stress. A small number of job resources were identified.ConclusionBurnout and poor psychological wellbeing in Australian postgraduate medical trainees are most associated with long working hours and poor work and learning environments. There is limited research into resources that can protect against burnout and promote wellbeing. More longitudinal and qualitative research is needed to support systemic, long-term interventions that will improve the wellbeing of trainees, reduce the prevalence of burnout and ensure optimal patient care.

Factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees: a systematic review protocol

BackgroundThe stressful nature of medical training and other work-related factors put postgraduate medical trainees at high risk of burnout and poor psychological wellbeing. This has negative implications for patient care and the effectiveness of the healthcare system. The structure of the healthcare system and postgraduate medical education in Australia is different to that of other countries. Whilst a significant body of research exists on burnout and wellbeing in trainees in the USA, evidence specific to Australian trainees is lacking. The aim of this review is to synthesise the current knowledge on the factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees.Methods/designA systematic review will be conducted across eight digital databases: Academic Search Complete, MEDLINE, Embase, Web of Science, PsychInfo, Scopus, CINAHL Plus and Informit Health Collection. Peer reviewed empirical studies and relevant grey literature published after 2000 that address an aspect of burnout or psychological wellbeing in Australian postgraduate medical trainees will be included. Two reviewers will independently review each article against the inclusion and exclusion criteria, with disagreements resolved via discussion and consensus. Data will be extracted using a standard form and quality will be assessed using the assessment tools available from the Joanna Briggs Institute. A thematic narrative synthesis of the studies will be presented, along with an assessment of current gaps in the literature and areas for future research.DiscussionThis review will be the first to integrate the evidence on burnout and psychological wellbeing specific to Australian postgraduate medical trainees. The findings will contribute to a better understanding of the factors that impact burnout and psychological wellbeing in this population and will lay the foundation for future research into appropriate strategic interventions.Systematic review registrationThis protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020203195).

Instructions for Australian and New Zealand trainees in developing skills in formulation: a systematic review of local evidence.

To examine the peer-reviewed literature on psychiatric formulation. The term (formula*) was used to systematically search Australasian Psychiatry, Australian and New Zealand Journal of Psychiatry, British Journal of Psychiatry, BJPsych Bulletin, American Journal of Psychiatry and Academic Psychiatry. The resulting papers were reviewed. Of the 42 papers located, 22 (52%) were published between 2002 and 2019; 90% papers were published in Australasian Psychiatry (15), Academic Psychiatry (12) or BJPsych Bulletin (10), journals that focus on training and clinical practice. The papers varied in their aims and recommendations and not all justified the need for formulation. Formulation was recommended as a necessity for training, a communication tool and a guide to treatment. No article provided evidence for the superiority of any type of formulation, and the role of consumers in formulation was conspicuously lacking. There are many ways to structure formulation. However, the existing literature does not support any particular approach. More consideration needs to be given to the needs of consumers in conceptualising and practicing formulation.

Configurations for obtaining in-consultation assistance from supervisors in general practice training, and patient-related barriers to trainee help-seeking: a survey study

BackgroundGeneral practice (GP) trainees may seek supervisor assistance to complete their patient consultations. This in-consultation assistance plays a key role in the supervisory oversight of trainees and in trainee learning. It may be obtained face-to-face, or using phone or messaging systems, and either in front of patients or outside their hearing. Trainee concerns about decreased patient impressions of their competence, and discomfort presenting patients within their hearing, act as barriers to seeking help during consultations. Little is known about the frequency and associations of trainee concerns about these patient-related barriers, or the various trainee-supervisor-patient configurations used to obtain in-consultation assistance.MethodsAustralian GP trainees rated their frequency of use of five specific configurations for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfort presenting patients outside, compared to within, patients’ hearing. Statistical analyses included descriptive statistics and multivariable logistic regression.ResultsResponses were received from 778 Australian GP trainees (response rate 89%). Help-seeking configurations did not differ between trainees at different training stages, except for greater use of electronic messaging in later stages. In-consultation assistance was most commonly provided by phone between trainee and supervisor consulting rooms, or outside the trainee’s patient’s hearing. Supervisor assistance in the trainee’s room face-to-face with the patient was reported as either never or rarely obtained by 12% of respondents. More trainees (25%) perceived that patient impressions of their competence increased after help-seeking than perceived that these impressions decreased (19%). Most trainees (55%) preferred to present patients outside their hearing. Trainee age was the only variable associated with both patient-related barriers.ConclusionSupervisors appear to have considerable influence over trainee help-seeking, including which configurations are used and trainee perceptions of patient-related barriers. In-consultation supervision may actually increase trainee perceptions of patient impressions of their competence. Many supervisors and trainees may benefit from additional educational and workplace interventions to facilitate comfortable and effective trainee help-seeking in front of patients. More work is required to understand the clinical and educational implications of different help-seeking configurations when trainees require ‘just in time’ supervisor assistance.

The incidence and distribution of musculoskeletal disorders in final‐year Australian sonography students on clinical placement

AbstractIntroductionWork‐related musculoskeletal disorders (WRMSD) are defined as injury or pain resulting from work and are common in qualified sonographers, affecting the shoulder, neck, wrist, and hands. Risk factors include poor ergonomics, work flow, inadequate breaks, and psychological stress. WRMSD carries a significant financial and emotional cost to industry. The incidence of WRMSD in Australian trainee sonographers is unknown. The aim of this research is to identify the incidence and distribution of WRMSD in trainee sonographers.MethodThis is a prospective observational study. An anonymous online survey was distributed to final‐year medical sonography students, and participation was voluntary and based on self‐selection.ResultsThere were 35/86 respondents, a 40.7% response rate. The incidence of WRMSD was 97%. Age, body mass index, height, gender, time spent scanning/day, and number of scans performed/day were not found to be associated with the development of WRMSD. The scanning shoulder, wrist, neck, and back were most commonly affected.ConclusionWRMSD incidence and distribution in Australian trainees are similar to that of qualified sonographers. It is therefore important to begin preventative measures early on in sonographer training to help minimise WRMSD developing.

Early career GPs, mental health training and clinical complexity: a cross-sectional analysis

ABSTRACTPatients with mental health conditions commonly present in General Practice. Mental health curricula are broad. We do not know that trainees are exposed to the learning they require. This study aimed to establish the prevalence, characteristics and associations of GP trainees’ management of mental health problems.This paper presents a cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing multisite cohort study of Australian GP trainees (registrars) documenting their clinical experiences over 60 consecutive consultations. Univariate and multivariable logistic regression analyses were conducted with outcome of the problem/diagnosis being a mental health condition. 1659 trainees provided data on 218,325 consultations and 340,453 problems/diagnoses. Mental health conditions were associated with patients being male, of Aboriginal or Torres Strait Islander or English-speaking background. Trainee characteristics were being more senior and having trained in Australia. Practice characteristics included being in low socioeconomic areas. Trainees sought less help for mental health concerns than they did for other problems.While early-career GPs see a broad range of mental health conditions, they may benefit from training to manage patients from cross-cultural contexts. They may also need support to generate appropriate learning goals and seek assistance if they are to continue to deepen competence.

A Critical review of surgical logbook applications for the android and iOS platforms in the Australian setting

BackgroundSmartphones have become pervasive in all aspects of modern life and the health care industry is not immune. Currently smartphone applications (apps) are used by 85-87 per cent of physicians. Surgical logbooks are a mandatory part of training and time consuming to maintain.AimsWe conducted a critical review of available logbooks apps in the Australian market for Android and iPhone and reported our findings.MethodsA critical search through the Google Play Store's (Android) and Apple's App Store's (iOS) Australian marketplace was conducted with keywords of and other suitable variations in January 2017. Apps were critically reviewed and against the Royal Australasian College of Surgeons' Minimum Dataset (MDS) and Extended Dataset (EDS). Apps were included if they could be utilised to record clinical procedures.ResultsSeven apps were available and fit the criteria of our search: Surgeons Logbook, eLogbook, LogBox Academic, SurgCase, T-Res 2, Surgeon Log Book Free, and SurgiLog. None of the apps completely satisfied the requirements of maintaining a surgical logbook as stipulated by RACS. However, Surgeon's Logbook provided ability to customise the logbook fields, which allows users to modify their logbook app to meet the requirements. Furthermore, the lack of connection to hospital electronic medical records, or RACS, limits the usability of these apps for Australian trainees.ConclusionThe current apps available in the market do not meet the requirements of Australian trainees. However, with the advancing technology and rapid progress of smartphones and their apps, this is likely to change in the future.

Measuring the effectiveness of in-hospital and on-base Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) programs on reducing alcohol related harms in naval trainees: P.A.R.T.Y. Defence study protocol

BackgroundReducing alcohol related harms in Australian Defence Force (ADF) trainees has been identified as a priority, but there are few evidence-based prevention programs available for the military setting. The study aims to test whether the P.A.R.T.Y. program delivered in-hospital or on-base, can reduce harmful alcohol consumption among ADF trainees.Methods/designThe study is a 3-arm randomized controlled trial, involving 953 Royal Australian Navy trainees from a single base. Trainees, aged 18 to 30 years, will be randomly assigned to the study arms: i. in-hospital P.A.R.T.Y.; ii. On-base P.A.R.T.Y.; and iii. Control group. All groups will receive the routine ADF annual alcohol awareness training. The primary outcome is the proportion of participants reporting an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or above at 12 months’ post-intervention. The secondary outcome is the number of alcohol related incidents reported to the Royal Australian Navy (RAN) in the 12 months’ post-intervention.DiscussionThis is the first trial of the use of the P.A.R.T.Y. program in the military. If the proposed intervention proves efficacious, it may be a useful program in the early education of RAN trainees.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001332617, date of registration: 18/12/2014 ‘retrospectively registered’.

Working hours of obstetrics and gynaecology trainees in Australia and New Zealand.

The importance of doctors' working hours has gained significant attention with evidence suggesting long hours and fatigue may compromise the safety and wellbeing of both patients and doctors. This study aims to quantify the working hours of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) specialist trainees in order to better inform discussions of working hours and safety within our region. An anonymous, online survey of RANZCOG trainees was conducted. Demographic data were collected. The primary outcomes were: hours per week at work and hours per week on-call. Secondary outcomes included the frequency of long days (>12h) and 24-h shifts, time spent studying, staff shortages and opinions regarding current rostering. Response rate was 49.5% (n=259). Full-time trainees worked an average of 53.1±10.0h/week, with 11.6% working on-call. Long-day shifts were reported by 85.8% of respondents, with an average length of 14.2h. Fifteen percent reported working 24-h shifts, with a median duration of uninterrupted sleep during this shift being 1-2h. Trainees in New Zealand worked 7.0h/week more than Australian trainees (P≤0.001), but reported less on-call (P=0.021). Trainees in Western Australia were more likely to work on-call (P≤0.001) and 24-h shifts (P≤0.001). While 53.1h/week at work is similar to the average Australian hospital doctor, high rates of long days and 24-h shifts with minimal sleep were reported by RANZCOG trainees in this survey.

Outcomes of open partial nephrectomies performed by Australian trainees.

Partial nephrectomy (PN) has become the standard of care for small renal tumours, with open partial nephrectomy (OPN) being superseded by minimally invasive PN. Advances in minimal access surgery have resulted in fewer relative contraindications, with subsequently fewer OPN being performed. Consequentially, trainees have less opportunity to gain skills and experience in open renal surgery. The aims of this study were to assess the standard of OPN performed by Australian urological trainees and to define whether OPN is a safe and suitable training opportunity. A retrospective review was undertaken on patients who underwent OPN performed by urology trainees from 2010 to 2014 at two training hospitals in Western Australia. Data collected included patient demographics, surgical and oncological outcomes and morbidity. Sixty patients underwent OPN, with a mean age of 56 years. Most tumours were single, with mean size 31 mm. Mean operative time was 157 min, with a mean cold ischaemic time of 27 min. Mean pre- and post-operative creatinine levels were equivalent (77 μmol/L). The overall complication rate was 18%, with no documented urinary leaks, and 1.7% blood transfusion rate. Median length of stay was 4 days. There were no oncological positive margins or recurrence after a median follow-up of 2 years. Our data support the notion that Australian urological trainees can perform the majority of OPN cases, with equivalent oncological outcomes. We would advocate that when an OPN is being performed, the supervising consultant should use the case as an adjuvant for open renal surgery training.

In-consultation information and advice-seeking by Australian GP trainees from GP trainers – a cross-sectional analysis

The apprenticeship model of general practice (GP) training is based on appropriate supervision. A central component of supervision - in-consultation information-seeking of GP trainees from their trainer - has not been documented. We aimed to establish the prevalence, characteristics and associations (trainee, practice, patient and consultation) of this information-seeking. Australian trainees recorded demographic, clinical and educational details of 60 consecutive consultations in each GP term of their training, including the rate and nature of information-seeking. Six-hundred and forty-five trainees contributed data for 1426 trainee-rounds, 84 723 consultations and 131 583 problems. Information was sought from the trainer for 9130 (6.9% (95% CI 6.8-7.1)) of all problems encountered (and in 7833 (9.2% (95% CI 9.0-9.4)) of consultations): 11.7% (95% CI 11.0- 12.4) were for diagnosis, 53.1% (95% CI 52.1-54.2) for management and 35.2% (95% CI 34.2-36.2) for both diagnosis and management. Assistance was sought most commonly for skin problems (20.0%) and musculoskeletal problems (12.6%). Significant adjusted associations of information-seeking included patient age; male patient gender; earlier training term; trainee being younger and female; trainee's training organisation; longer consultation; and trainee generation of learning goals. Our findings have implications for trainer workload and professional development, patient care and trainee education and training.

46.: Job variation in advanced training in adult neurology in Australia and New Zealand: A follow-up study

Six years ago, a survey of Australian trainees in neurology highlighted a number of differences in the training offered by the various positions. There has been a subsequent increase in trainee numbers. This survey aimed to re-examine the workload and exposure provided by individual positions and to compare training in Australia and New Zealand. A questionnaire was circulated in 2012 to all advanced trainees in core adult neurology positions in Australia and New Zealand, looking at ward work, outpatient clinics, neurophysiology exposure, and on-call commitments. The response rate was 85.7%. There was a 48.7% increase in the number of core training positions in Australia, but an average increase in inpatient workload of 56%. General neurology clinic numbers were unchanged while specialist clinic exposure had risen from 1.0 to 1.8 clinics/week. In some cases, exposure to neurophysiology had fallen. The requirement for out-of-hours on-call had fallen. There were no major differences between positions in Australia and New Zealand. There have been significant improvements in advanced training in adult neurology in the 5 years between 2007 and 2012; numbers of trainees have increased, on-call commitments have fallen and exposure to specialist clinics has risen. However, inpatient workload has increased significantly, accompanied by a slight reduction in exposure to training in neurophysiology in some cases. Overall, the changes are encouraging but more work is still needed to ensure that individual positions meet the training needs of trainees.

Job variation in advanced training in adult neurology in Australia and New Zealand: a follow‐up study

Six years ago, a survey of Australian trainees in neurology highlighted several differences in the training offered by the various positions. There has been a subsequent increase in trainee numbers. This survey aimed to re-examine the workload and exposure provided by individual positions and to compare training in Australia and New Zealand. A questionnaire was circulated in 2012 to all advanced trainees in core adult neurology positions in Australia and New Zealand, looking at ward work, outpatient clinics, neurophysiology exposure and on-call commitments. The response rate was 85.7%. There was a 48.7% increase in the number of core training positions in Australia, but an average increase in inpatient workload of 56%. General neurology clinic numbers were unchanged while specialist clinic exposure had risen from 1.0 to 1.8 clinics/week. In some cases, exposure to neurophysiology had fallen. The requirement for out-of-hours on-call had fallen. There were no major differences between positions in Australia and New Zealand. There have been significant improvements in advanced training in adult neurology in the 5 years between 2007 and 2012: numbers of trainees have increased, on-call commitments have fallen and exposure to specialist clinics has risen. However, inpatient workload has increased significantly, accompanied by a slight reduction in exposure to training in neurophysiology in some cases. Overall, the changes are encouraging, but more work is still needed to ensure that individual positions meet the training needs of trainees.

Working with young people: Evaluation of an education resource for medical trainees

Many health professionals report interest in consulting more effectively with young people but have unmet training needs. We set out to evaluate a teaching resource in adolescent health and medicine that was designed for Australian trainees in specialist medicine. Thirty-two paediatric and adult trainees of the Royal Australasian College of Physicians completed a pre-evaluation questionnaire to assess attitudes and confidence in working with young people. They were then provided with a training resource and, 6 weeks later, completed a post-evaluation questionnaire. Repeated-measures anovas were used to assess changes in attitudes, self-reported knowledge and confidence by trainee type. χ(2) -tests were used to compare variation in the use of and opinions about the resource. Trainees' awareness of the health issues that affect young people, confidence in working with young people and confidence in their knowledge greatly improved after using the resource. Beforehand, adult medicine trainees scored lower than paediatric trainees. A relatively higher rate of improvement resulted in similar scores between trainee types after using the resource, which was rated equally highly by the different groups of trainees. As a result of significant gains in the confidence of specialist medicine trainees after access to the resource, it will now be made available for Australian trainees in specialist medicine.

Case‐based nuclear medicineDonohoeK, Van den AbbeeleA. Thieme, New York, 600 pp, 400 figures, ISBN: 978‐1‐58890‐652‐6, Price: A$145.

This second edition atlas presents 166 cases. Purchasing the book also entitles you to 12 months' access to further cases online. The book is divided into 14 sections covering all the expected areas of imaging including 23 positron emission tomography/computed tomography (PET/CT) cases, 11 cardiac cases including single-photon emission computed tomography (SPECT) and PET, and a section on radioisotope therapy. The cases presented provide a good overview of commonly encountered conditions. The images are generally of good quality, although an occasional image lacks contrast. This does not prevent the relevant findings from being displayed and the teaching value of the case is not diminished. The discussions are relevant and informative. While most experienced practitioners will already be aware of the issues, residents and registrars will find much to interest them. The authors end each case with a Pearls and Pitfalls section that is particularly useful to the doctor in training. The technique used for each study is described in detail. Unnecessarily, this is repeated for each case even when identical to the last case. This is a US-based text. Doses are given in millicurie rather than standard SI units (becquerels). Lung scanning cases remain well behind the forefront of current imaging techniques being restricted to planar images, often without a ventilation component. Xenon is still the main ventilation agent used, although one case with DTPA aerosol is present. No SPECT imaging or SPECT CT is evident. This section has little relevance to Australian trainees. Similarly, the section on neuroendocrine scanning has no Ga68 DOTA cases and this radiopharmaceutical is not included in the discussion. The online cases (currently 252) are a nice addition to the book. Overall, I believe the book to be valuable and recommend it to those embarking on a nuclear medicine career. It covers most of the common indications and findings with helpful discussions and suggested further reading. Just skip the lung chapter!

Challenges faced by trainee psychiatrists working towards competency in psychotherapies

This paper explores the challenges that trainees of the Royal Australian and New Zealand College of Psychiatrists face as they work towards competency in psychotherapy during basic training. The state of training programs in other countries including the trainee and supervisor perspectives on the outcomes of the shift to competency-based assessment is reviewed, and the limited literature examining the systemic problems impacting on the quality of the training experience in psychotherapies for Australian and New Zealand trainees is considered. The risk of an increasing gap between the ideals and the reality of training expectations and experiences is discussed. The importance of auditing the adherence of training services to College guidelines and formally evaluating the training outcomes in the future is emphasised.

Designing a semiotic-based approach to intercultural training

This exploratory enquiry seeks to examine the largely unexplored potential of semiotics for intercultural training and education. The proposed threepart discussion describes the process by which semiotic theoretical principles were selected and progressively refined into an applied model which was then piloted through a 2007 research initiative entitled Tools for Cultural Development. The case study involved six groups of French and Australian trainees from both the academic and professional sectors, in collaboration with university, government and community partners. The first part of the article summarizes a review of the literature on approaches to cultural competence training. The study then outlines the transcoding process by which the stated objectives of intercultural education were reformulated in semiotic terms, particularly in reference to cultural semiotics on which the theoretical core of the applied model was subsequently based. Relevant principles from other semiotic schools as well as similar theoretical and methodological stances in the social sciences reinforced the established body of theory for the training design. The third part of the study discusses the process by which semiotic principles were further defined as skill-based outcomes and goals for workshop implementation. This pragmatic defining process facilitated development of questionnaires and surveys, thereby allowing participants to evaluate the training experience by examining their perceptions about the workshop outcomes at the beginning and end of the sessions. This article presents the quantitative results of the evaluation and, in discussing the gains and limits of data obtained, provides the context for a follow-up article on the qualitative findings of the study.

Cervical pedicles: Correcting a common misconception

To bring to the attention of Australian radiologists in training, directors of training and radiologists in general, a commonly held erroneous misconception, specifically that of the plain radiographic appearance of the cervical spine pedicle and the transverse process in oblique projections. A human C5 vertebra was appropriately marked and radiographed in the oblique projection to demonstrate key anatomical structures and their relations. The rounded cortical contour overlying the vertebral body is commonly misinterpreted as a cervical transverse process but is the plain radiographic outline of the end-on ipsilateral pedicle. Because of the right-angle relationship of the transverse process long axis and the end-on pedicle long axis, the ipsilateral transverse process appears as a faint elongated corticated structure projecting beyond the vertebral body contour. It may also be obscured because of small size, relative osteopaenia and overlying soft tissue bulk. The end-on pedicle has been unequivocally demonstrated, as has the ipsilateral transverse process. The two lie at right angles to each other. The common misconception (amplified by an error in an earlier edition of a popular atlas) should be debunked by radiologists and should not be promulgated to Australian radiology trainees.

Australian Psychiatry Trainees' Reports of Expanded Specialist Training Placements

Australian Psychiatry Trainees' Reports of Expanded Specialist Training Placements