Future Workforce Planning Research Articles

An occupational health survey of the UK's mortuary workforce.

Mortuaries are predominantly staffed by anatomical pathology technologists (APTs) and pathologists, and the work they undertake carries implicit health risk due to its nature. Until now there has not been a nationwide assessment of the occupational health of these essential workers in the UK. To assess the current occupational health status and needs of the mortuary workforce in the UK. We created a bespoke, brief online survey which was approved by the professional bodies representing APTs and pathologists in the UK. The survey was disseminated electronically using these organizations' targeted mailing lists. Two hundred and thirty participants completed the survey, comprising 108 (47%) APTs and 122 (53%) pathologists. Most (89%) respondents reported that they have suffered from occupational health issues, the largest subcategory being musculoskeletal problems (77%). Almost half (48%) of APTs and around one-quarter (26%) of pathologists who responded have taken time off work in the last year because of occupational health problems, with almost one-fifth (19%) of the APTs having taken at least 4 weeks off. A significant number of workhours are lost per year to sick leave resulting from occupational health problems. Respondents' comments highlight issues in workspaces, rest facilities and staffing, and variability in working conditions across the country. We suggest that future workforce planning should prioritize good occupational health, with nationwide improvements in mortuary design.

A review of nurse independent prescribers: experiences, barriers and facilitators in palliative care

Background: Further exploration is needed to determine whether UK-based nurse independent prescribers (NIPs) are using their advanced skills within palliative care teams, as well as whether organisations should continue to invest in developing multidisciplinary healthcare professionals in such a resource-intense skill. Aim: This study aimed to evaluate the experiences of NIPs to inform future workforce planning and service development. Methods: Practitioners' experiences were explored through a mixed-methodology online survey, which was provided to NIPs delivering end-of-life care within hospital, hospice and community settings. Findings: The survey consisted of 13 questions and was distributed to nine NIPs, six of whom responded. The barriers to prescribing were identified as a lack of confidence, time and electronic prescribing, as well as the need for increased supervision. The advantages of prescribing were described as increased pharmacological knowledge and increased and rapid symptom control for patients. Conclusions: A clear, continuous professional development pathway within the organisation is needed to support and enhance the development of NIPs. Moving forwards, electronic prescribing should be integrated to ensure safer practice.

A Scoping Review on Determining Australian Nurse Engagement in Eye Care Settings.

As the Australian population grows and ages, the demand for eye care services, and nurses to provide the services, is expected to increase. This will impact nurses, who are Australia's largest health-care provider group. Understanding and mapping the current role and use of nurses in eye care is an essential first step for future health workforce planning and development. To map their engagement, we undertook a scoping review to gain an understanding of the current Australian nurse eye care workforce landscape, to help guide and support future workforce development activities. Secondly, we evaluated if publications in this field incorporated or mentioned the Australian Ophthalmic Nursing Association's National Standards (Practice standards) in their publication. This review also offers other nations and eye care providers the opportunity to evaluate their own health workforce plan and nurse utility. We conducted a review of academic and grey literature, via various search engines, and an inclusion and exclusion criteria. We uncovered 11 publications. Of those, five were academic papers examining extended and advanced nursing practice, one was a letter to the editor, two were industry feature reviews, two were industry reports and the final was the Practice Standards. Key themes throughout indicated the benefit of nurse training and nurse involvement in eye care. Overall, there was insufficient information or data to describe nurse deployment, practice and utility. Finally, the Practice Standards were not referenced in any publication. There is insufficient published information to calculate the level and involvement of nurses, or describe their existing role, advancement or future deployment in eye care in Australia. Without clear information, Australia is unable to develop effective health workforce strategies to attract, train, retain, and appropriately deploy nurses to meet future eye care needs.

BSG cross-sectional survey on impact of COVID-19 recovery on workforce, workload and well-being

ObjectiveThe aim of this survey was to understand the impact of the COVID-19 pandemic and recovery phase on workload, well-being and workforce attrition in UK gastroenterology and hepatology.Design/methodA cross-sectional survey...

A national analysis of the pharmacy workforce in Indonesia

BackgroundPharmacists play a fundamental role in healthcare systems and achieving Universal Health Coverage (UHC) through quality primary healthcare service provision. While the World Health Organization (WHO) forecasts a global shortage of health workforce by 2030, mainly affecting low- and middle-income nations (LMICs), limited published literature is found regarding pharmacy workforce capacity in LMICs, including Indonesia. This paper aims to analyse pharmacists’ capacity in Indonesia to identify emerging workforce planning gaps for future workforce planning and policies in Indonesia.MethodSeveral data sources were accessed, including a database from the National Pharmacy Committee and the professional leadership body in Indonesia. Descriptive (frequencies, percentages, and mean), correlational and time-series analysis using curve estimation were conducted. Secondary data on the number of programmes, pharmacy students, pharmacy workforce (pharmacists and pharmacy technicians) per province were obtained from the Ministry websites and reports.ResultThere were a total of 77 191 registered pharmacists in Indonesia in 2019. The pharmacists’ pyramid showed a youth bulge as a general indication of market expansion in the education sector correlating to the pharmacy programme’s number and size. There was a variation in pharmacy workforce density and access to pharmacy programmes across islands, which also were strongly correlated. Forecasting estimates that by 2030, women will represent around 86% of pharmacists in Indonesia. More female pharmacists were found working in the hospital and primary healthcare (providing direct services to patients) than male pharmacists. Younger pharmacists worked in the industrial sector, while older pharmacists worked in governmental and educational institutions.ConclusionThis study signposted workforce planning gaps for policy development in Indonesia, including a need to develop structured training to support early career pharmacists in their practice. There is also a need for better access to professional development programmes designed to support female pharmacists return to the regulated workforce following career breaks. National policy to promote equitable distribution and retention of pharmacists is recommended.

Barriers and enablers to telehealth use by physiotherapists during the COVID-19 pandemic

ObjectivesTo investigate the perceived barriers and enablers experienced by physiotherapists whilst delivering community and outpatient services during the COVID-19 pandemic. MethodsQualitative study undertaken at a University-affiliated hospital in Melbourne, Australia. Physiotherapists working in the outpatient setting participated in a semi-structured interview. Interviews were analysed using Framework Analysis, with themes mapped to the Theoretical Domains Framework (TDF). ResultsFrom 19 interviews, we identified major themes and mapped these to the TDF domains: 1. The pandemic rapidly closed the knowledge-practice gap; 2. Adaptation of existing skills and integration of new skills were required; 3. Supportive senior leadership helped the transition; 4. Capabilities and confidence improved with time; 5. Environmental factors were crucial to success or failure of telehealth; 6. Access to and delivery of care improved for some; 7. Identification of appropriate patients and future hybrid models of care; 8. Changes in work practices, role certainty and identity; 9. Development of educational resources consolidated knowledge; 10. Socialisation of telehealth and optimism for the future. Within each domain, key barriers and enablers were also identified. ConclusionsThe findings of this study suggest that the delivery of community and outpatient physiotherapy via telehealth during the COVID-19 pandemic was an initial challenge. Growing knowledge, confidence and ability to problem solve barriers enabled physiotherapists to move along the continuum of ‘fear’ to ‘triumph’ as the pandemic progressed. These results can be used by clinicians, managers, and academics to guide future workforce planning, hospital environmental design, and service delivery. Clinical message•Physiotherapists described telehealth as a challenge. Growing experience, confidence and problem-solving ability allowed therapists to provide effective and efficient care to patients over time.•The results can be used by clinicians, managers, and academics to guide resource development, optimise clinical efficiencies and reduce inequities for vulnerable patients in future.

COVID-19 seroprevalence after the first UK wave of the pandemic and its association with the physical and mental wellbeing of secondary care healthcare workers

ObjectivesTo determine the seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibody status amongst healthcare workers (HCWs) working through the first wave of the Coronavirus (COVID-19) pandemic in 2020. To examine the association of seroprevalence and self-reported COVID-19 symptoms with occupation, sex, and ethnicity; and how these factors were associated with physical and mental wellbeing. DesignSingle-centre cohort study. SettingLarge public hospital in the United Kingdom. InterventionAll HCWs who had been tested for anti-SARS-CoV-2 immunoglobulin (Ig) G nucleocapsid antibody in summer 2020 were asked to complete an electronic survey focusing on their physical and mental health in Winter 2020–21. This survey was comprised of the Short Form 12v2, Physical Component Summary (PCS), Mental Component Summary (MCS), and Generalised Anxiety Disorder 7-item (GAD-7) questionnaires. Results7604/9781 (77.7%) HCWs were antibody tested, of which 1082 completed the full survey. Antibody testing was conducted between 17/06/20–30/07/20, during which time our seroprevalence rate was 28% (299/1082). Of those self-reporting COVID-19 symptoms, 51% (201/395) were antibody positive. Antibody-positive participants had lower PCS scores (p = 0.016), indicating poorer physical health. Lower PCS scores were also found in those deemed high risk for COVID-19 by their GP (p = 0.001), and those aged >44 years (p = 0.009). Antibody-negative participants had lower MCS scores (p = 0.044), indicating poorer mental health. Those who self-reported COVID-19 symptoms had lower PCS scores (p=<0.001) than those with no symptoms. Lower MCS scores were found in women (p = 0.001), Caucasians (p = 0.018), non-clinicians (p = 0.001), and those aged <44 years (p = 0.009). Significantly higher GAD-7 anxiety scores were evident in staff aged <44 years (p = 0.023), and those with self-reported COVID symptoms (p = 0.031). Doctors had lower GAD-7 anxiety scores (p = 0.009). ConclusionSelf-reported symptoms did not correlate with seroprevalence; data surrounding this can be useful for future workforce planning. Interventions are needed to reduce the mental and physical burden of the pandemic on HCWs. Further work is needed to identify which particular HCWs may require further support, to ensure well-being and effective patient care. Trial registrationSponsor Protocol number - 2020COV112, Clinicaltrials.gov number -NCT04527432.

The true length of training in vascular surgery

INTRODUCTION Workforce planning in vascular surgery remains challenging since there are no data on career path intentions of trainees. The Rouleaux Club, which is the UK vascular trainee association, undertook a snapshot survey of the vascular surgery trainee workforce to help guide the allocation of the future vascular surgery workforce. METHODS An anonymous survey was sent to national training number (NTN) and non-NTN vascular surgery trainees. The survey was open for four weeks from 26 September to 23 October 2020. Data were analysed by two Rouleaux Club executive committee members using Microsoft Excel®. RESULTS The survey was completed by 147 trainees (130 NTN and 17 non-NTN trainees). When taking into consideration time out of training and less than full-time training, the average predicted Certificate of Completion of Training date for NTN trainees is delayed by one year. Eleven per cent of NTN trainees had completed or were in less than full-time training at the time of the survey. Time out of training was taken by 75% and parental leave by 28%. Just under half (47%) of NTN trainees were planning on taking parental leave in the future. Over half (51%) of NTN trainees expected to retire aged between 61 and 65 years. CONCLUSIONS Our findings suggest that vascular surgery training is not a simple six-year higher surgical training experience and may vary considerably between individuals. Future vascular workforce planning needs to take these factors into consideration. Action must be taken now to recruit and retain the future workforce so that the demand for vascular surgeons can be met.

189 Association of British Neurology trainees: biennial national census

BackgroundThe Association of British Neurology Trainees (ABNT) conducts a biennial census of neurology trainees.This acquires data on training, education, research, out of program experiences and trainees’ future plans, which are invaluable in shaping the future workforce. This is particularly important given the introduction and implementation of Shape of Training in 2022.AimTo review trainee perspectives on neurology specialist training in 2020.MethodsOnline questionnaire, designed by the ABNT committee, sent by email to all specialist neurology trainees and associate ABN members.ResultsResults will be reviewed and compared with previous data by members of the ABNT committee. We hope to present these results to an audience of aspiring neurologists, trainees and consultant neurologists.ConclusionThe results of this census, in combination with those conducted in 2015 and 2017, will influence Shape of Training discussions and new curriculum design. We hope the information it provides will facili- tate communication and collaboration between the ABN, Specialty Advisory Committee, Joint Royal College of Physicians Training Board and other external bodies. This will inform future workforce planning and guide the transition through curriculum reforms.hena.ahmad2@nhs.net

275 Undergraduate Career Aspirations in Northern Ireland - a National Qualitative Study

Abstract Introduction Undergraduate career aspirations are accurately translated to chosen career paths. Understanding what influences these decisions has implications for future workforce planning. The aim of this study was to identify future career intentions in Northern Irish Medical Students. Method An anonymous voluntary survey consisting of binominal, Likert and free text responses was distributed to all medical students registered at Queen’s University Belfast (QUB). Data was collected over 6 weeks in April-May 2021. The primary outcome was future career aspiration and secondary outcome was the reported attrition rate from medicine. Local Ethical approval was obtained. Results 202 responses were received (Response rate 15%). Two thirds (n = 135) were female. One third of respondents remained undecided about their future career choice, with senior students demonstrating greatest certainty in future career choice. Respondents were least likely to choose a career in Surgery (33%). Factors influencing these decisions were a lack of academic interest in the speciality, perceived workload, and the length of the training scheme. 10% of respondents were unsure or unlikely to pursue a career in Medicine after they graduated. Thematic analysis demonstrated, fear of making mistakes, poor work life balance and poor working environments as reasons for leaving medicine. Conclusions Uncertainty over future career intention remains common with surgery the least popular speciality. The rate of potential attrition is concerning which warrants further investigation.

What recently graduated podiatrists think of rural work, and how services are responding: a qualitative study.

Access to healthcare services should be equitable no matter where you live. However, the podiatry needs of rural populations are poorly addressed, partly because of workforce maldistribution. Encouraging emerging podiatrists to work in rural areas is a key solution. The aims were to explore (1) recently graduated podiatrists' perceptions regarding working rurally and (2) broader industry views of the factors likely to be successful for rural recruitment and retention. Recruitment for interviews pertaining to podiatrist recruitment and retention was conducted during 2017. Recruitment was through social media, podiatry professional association newsletters, public health podiatry emails. Graduate perceptions were explored via two focus groups of Australian podiatrists enrolled in the Podiatrists in Australia: Investigating Graduate Employment longitudinal survey. Industry views were explored through semistructured interviews with podiatry profession stakeholders. Inductive thematic analysis was used to analyse data about the perceptions of recently graduated podiatrists and stakeholders and the themes were triangulated between the two groups. Overall, 11 recent graduate podiatrists and 15 stakeholders participated. The overarching themes among the two groups were the importance of 'growing me' and 'growing the profession'. Three superordinate themes were generated through analysis of both datasets, including (i) building a career, (ii) why I stay, and (iii) it cannot be done alone. This study identified that recently graduated podiatrists are likely to be attracted to rural work and retained in rural areas if they foresee opportunities for career progression in stable jobs, have a background of training and living in rural areas, like the lifestyle, and are able to access appropriate professional and personal supports. Building employment that spans public and private sector opportunities might be attractive to new graduate podiatrists seeking a breadth of career options. It is also important to recognise rural generalist podiatrists for any extended scope of services they provide along with raising public awareness of the role of rural podiatrist as a core part of multidisciplinary rural healthcare teams. Future training and workforce planning in podiatry must promote podiatrists taking up rural training and work so that maldistribution is reduced.

Plastic surgery in a trauma center: a multidisciplinary approach for polytrauma patients.

With the increasing number of polytrauma patients treated at high-level trauma centers, plastic surgery has entered the specialty of traumatology. Plastic surgeons specialize in the simultaneous surgical care of patients with facial or hand trauma and soft tissue injuries requiring microsurgery. The purpose of this study was to introduce the role of plastic surgery in a high-level trauma center. Between January 2020 and December 2020, 5,712 patients with traumatic injuries were admitted to the emergency department of a tertiary hospital. Of these 5,712 patients, 1,578 patients were hospitalized for surgical treatment and/or critical care. Among the 1,578 hospitalized trauma patients, 551 patients (35%) required at least one plastic surgery procedure. The patient variables included age, sex, etiology, the injured area, and injury characteristics. We also retrospectively investigated surgical data such as the duration of the operation, hospital stay, length of time from injury to surgery, and collaboration with other departments. The most common injury referred to plastic surgery was facial trauma (41%), followed by hand trauma (36%), and soft tissue injuries requiring microsurgery in various parts of the body other than the hand (7%). The majority of facial and hand traumas were concomitant injuries. Sixteen percent of patients underwent collaborative surgical management for polytrauma involving both plastic surgery and another department. The role of plastic surgery in multidisciplinary teams at high-level trauma centers has become increasingly important. The results of this study may help in the development of multidisciplinary trauma team strategies and future workforce planning.

The impact of COVID-19 on cleft services in Great Britain & Northern Ireland

Cleft lip and/or palate is the most common craniofacial anomaly and occurs in 1 in 650 to 700 live births in the United Kingdom (UK). The majority of cleft surgery is elective, and as a result, almost all cleft surgery was suspended across the UK in March 2020 during the first national lockdown. The UK has centralised regional Cleft Services which all use the same agreed target-age standards for primary surgery including lip and palate repairs. The coronavirus disease-2019 (COVID-19) response has caused a delay in carrying out procedures. The severity of this delay depends on the impact of COVID-19 on local trusts and R-value within that region. As the country goes through the second and third wave, the impact could be long lasting, and we aimed to quantify it so that the data could be used to guide service prioritisation in the NHS and help future workforce planning. An online survey was designed based on the cleft quality dashboard indicators and circulated nationally to all nine cleft regions in the UK. The survey was divided into three main headings: • Duration of suspended cleft services • Quantification of the impact on delayed in surgery/services • Changes needed to restart surgery/services RESULTS: We obtained a 60% response rate with five completed surveys from five out of nine regions. All regions reported that they suspended their cleft services in March 2020 around the time of the first wave and the first national lockdown. There has been an impact on delayed surgical and clinical interventions for cleft patients. Regions were affected differently with some on an exponential waiting list growth projection, whereas other teams are on track to recover from the backlog within 7-22 weeks. There has been an impact on the allied health professionals' services within the cleft multidisciplinary team. The cleft nurses' 24-h reviews, Speech And Language Therapy (SALT), and psychology maintained service delivery in some format. Patient-facing services such as audiology and dentistry were significantly disrupted and continue to experience delays due to reduced capacity. Various regions have seen a varied impact from COVID-19 on their services, from all cleft regions there seems to be an impact on achieving surgery within the national target age. The adverse effect of the COVID-19 impact is unlikely to be known for a few years to come; however, the data are a useful guide when supporting the allocation of resources within the healthcare setting. A prospective long-term study is required to assess the impact of COVID-19 on cleft surgery, follow-up, assess access to allied health professional MDT clinics, and long-term complications.

468 Free Flap Breast Reconstruction in the UK: Are We Meeting the Demand?

Abstract The demand for free flap breast reconstruction appears to be increasing. This study aims to evaluate the capacity for microsurgical breast reconstruction across the UK and compare this to the apparent demand to inform future workforce planning. A questionnaire was sent to all the plastic surgery units in the UK to establish whether they performed reconstructive breast surgery, the number of free flaps they performed a year and what issues they were encountering in meeting the demand. The response rate was 92.8% of 56 units. Current workforce planning figures show that there are 161 Consultant Plastic Surgeons who perform free tissue breast reconstruction. Across the UK, the total number of extra breast reconstructive surgeons felt to be needed was 78. The mean number of free flaps per year per surgeon was 20 [11-37]. Responders suggested that they felt 20 [12-30] free flaps were a suitable number to maintain their skills. 66% of the responders reported issues impairing delivery of their free flap service with access to theatre (41%) and inability to meet the demand (18%) as 2 of the key reasons. Our results show that there is a demand for microsurgical breast reconstruction that is not being fully met at present. The authors hope that this survey may add to the evidence base that plastic surgeons remain an integral part of the care of many breast cancer patients and will encourage trainees to consider it as a subspecialty of choice.

UK paediatric surgical academic output (2005–2020): A cause for concern?

BackgroundThe publication record can be regarded as a key metric of the academic output of a craft surgical speciality with an almost exponential increase in the number of such publications worldwide over the past 20 years (Ashfaq et al. J Surg Res 2018;229:10–11). We aimed to examine and explore if this was the experience within UK paediatric surgery centres. MethodsThe academic search engine Scopus™ (Elsevier) was used to track every paediatric surgeon's (NHS or University) publication history between Jan. 2005 – Dec. 2020. This was validated by an algorithmic search of PubMed™. The h-index (citations/publication), considered a validated metric of career academic output, was also calculated for each individual surgeon. A Field-Weighted Citation Index (Scopus™) (FWCI) was used to assess impact of individual publications. Textbooks, book chapters, abstracts, duplications (“double dipping“) and output attributed to UK BAPS-CASS national studies were excluded. Some output(s), not considered as relevant to “paediatric surgery”, was edited. Data are quoted as median(range). ResultsDuring this 16-year period, there were 3838 publications identified from 26 centres with a “top ten” listing of those paediatric surgical units contributing over half the output (n = 2189, 57%). To look for evidence of trend(s) we analysed the output from these surgical centres in two 5-year periods (2005–9 and 2015–19) and showed an overall fall in output(s) - [730 (53.4%) to 645 (46.4%)] with 6/10 (60%) ‘ top ten ‘ centres here recording a reduction in publications. The median h-index of the 232 contributing paediatric surgical consultants was 12 (range 1–56). The best performing publication from the “top ten” centres had 96.5(51–442) citations with the FWCI being 4.5 (2.2 – 30.2). ConclusionsThis study highlights current paediatric surgery publication output metrics in UK centres. There is evidence of a relative reduction in outputs overall which is a cause for concern for the future, although individual publications from the 10 most active units in the UK remain highly cited. These findings may serve purpose in several ways: (i) UK paediatric surgical centre rankings may be helpful for guiding residency / trainee application; (ii) surgical research funding for the top performing units may be better facilitated and finally (iii) UK centres showing a ‘ fertile ground ‘ for nurturing and training paediatric surgeons with academic aspirations could be useful for future workforce planning.

Making a difference: workforce skills and capacity for integrated care

PurposeThe aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.Design/methodology/approachSemi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.FindingsAnalysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.Research limitations/implicationsThis study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.Practical implicationsMany of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.Social implicationsThis study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.Originality/valueThis paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Training in cardiothoracic surgery: how far is the other side of the table?

This article discusses the history and process of national selection of trainees, future workforce planning and projections in cardiothoracic surgery. In addition (and perhaps most importantly), it describes the challenges of the new, shorter, seven-year specialty training curriculum.

The effects of COVID-19 on sickness of medical staff across departments: A single centre experience

COVID-19 presents a risk to healthcare workers, incurring harm to staff physical and mental wellbeing and difficulties in provision of care and service planning. Doctors' anonymised demographic and staff sickness data were collected between 16 March and 26 April 2020, corresponding with the single centre's greatest COVID-19 caseload. 128 (39%) of doctors experienced at least one sickness episode. Episodes totalled 1,240 days, equating to a sickness absence rate of 9.1%. Rates varied between departments and grades. High levels of sickness were seen in medicine and both adult and paediatric emergency departments with the lowest levels seen in intensive care. COVID-19 caused a burden of sickness on the medical workforce which must be accounted for in future workforce planning. The disparity in sickness rates across departments is likely to be multi-factorial. Further study is needed to investigate these factors to protect healthcare staff and their patients.

Why UK medical students change career preferences: an interview study.

IntroductionMedical career preferences are influenced by a multitude of factors. Currently several specialties are undergoing recruitment problems; we must develop our understanding of medical career decision-making to ensure the production of an appropriate workforce. We aimed to explore the changing career preferences of students during medical school, to better understand this.MethodsThis was an interpretivist, qualitative study. Data were collected through semi-structured interviews with seven final-year students to explore why their career preferences had changed during medical school. Transcripts of these interviews were thematically analysed.ResultsThree overarching themes emerged from the analysis: The ‘influence of medical school’, ‘perceived suitability to specialty’ and ‘belonging and fitting in’. A thematic map captured the participants’ perceptions on why their preferences had changed, with major influences echoing existing research. However, novel findings included participants’ personalities and enthusiasm changing over time, the need for a ‘sense of belonging’ and participants defining the term ‘variety’ uniquely, perceiving their current specialty preference to match their definition.DiscussionThis was an original, in-depth study on changing career preferences, which is an ill-defined subject within the literature. Analysis revealed preferences changed for a variety of medical school, personal and specialty reasons, leading to the construction of an updated model of medical career decision-making. Medical career preference remains a dynamic and ever-evolving phenomenon, influenced by an intricate interplay of internal and external factors. An understanding of this is crucial for future workforce planning.Electronic supplementary materialThe online version of this article (10.1007/s40037-020-00636-7) contains supplementary material, which is available to authorized users.

Factors influencing specialty choice and the effect of recall bias on findings from Irish medical graduates: a cross-sectional, longitudinal study

BackgroundDespite being a vital part of medical workforce planning and development, how medical students and graduates choose their career specialty is still not well understood. This study aimed to identify the factors medical graduates consider important influences in their choice of specialty after their first year of practice, and to test the validity of relying on respondent recall to measure changes in specialty choice.MethodsThe baseline survey was administered online to all final year students in Ireland’s six medical schools. Those who consented to follow-up (n = 483) were surveyed 18 months later (June 2018), during the final month of first year of practice.ResultsThe baseline survey had a 67% (n = 483) response rate. At the follow-up survey, (n = 232, 48% response rate) the top specialty choices were: Medicine, n = 54 (26%); Surgery, n = 34 (16%); General Practice, n = 28 (13%); Anaesthesia, n = 16 (8%) and Paediatrics, n = 14 (7%). Of the 49 respondents (28%) reporting a change of specialty since baseline, 13 (27%) selected the same specialty in both surveys; of the 121 (69%) reporting no change, 22 (18%) selected a different specialty at follow-up.Over 90% of respondents rated as ‘important or ‘very important’: ‘Own aptitude’, ‘Work-life balance’ and ‘What I really want to do’. Over 75% rated as ‘not at all’, or ‘not very important’ ‘Current financial debt’ and ‘Inclinations before medical school’.When adjusted for sex and age, compared with Medicine, General Practice rated as more important: continuity of patient care (RRR 3.20 CI(1.59–6.41), p = 0.001); working hours/conditions (RRR 4.61 CI(1.03–20.60), p = 0.045) and a career that fit their domestic circumstances (RRR 3.19 CI(1.27–8.02), p = 0.014). Those choosing Surgery rated as less important: patient contact (RRR 0.56 CI(0.33–0.95), p = 0.033) and working hours/conditions (RRR 0.55 CI(0.31–0.96), p = 0.035).ConclusionsThe different demographic and motivational profiles by specialty choice are consistent with other studies suggesting a distinct profile for doctors intending to enter General Practice. In addition, our results suggest longitudinal study designs guard against recall bias and so provide more robust medical workforce models to inform and direct recruitment drives and interventions in future medical workforce planning.