Postgraduate Specialty Training Research Articles

Improving Italian general practice training: the role of academia.

The modern Italian national health service is a Beveridgean system centred around GPs and funded by central taxation.1,2 In order to become eligible to work as a GP, Italian doctors need to undertake a 3-year postgraduate training in general practice.3–6 The latter training — governed nationally by the Italian Ministry of Health and locally by the various Italian regions — is organised by the primary care establishment.3–6 By contrast, all other postgraduate medical specialties in Italy are organised by universities and are governed by the Ministry of Education, University and Research (MIUR). On successful conclusion of the above GP training, Italian doctors are awarded a certificate of completion of training which is then mutually recognised in all member states of the European Union (EU).3–5 Italian doctors in postgraduate university specialty training (that is, non-GP trainees) had not benefited from any financial support from the government during their training until 1991. From 1992 until 2000 a tax-free monthly studentship of about 960 000 Italian Lira was introduced to support non-GP trainees; the latter bursary then became approximately €960 from 2000 to 2006 (after the introduction the Euro currency to Italy). Proper working contracts with an annual gross salary of €22 700 (a variable monthly amount of €1600–1700 after taxes) for this category of specialist trainees started in 2007. As a result, the Italian Supreme Court recently ordered the Italian government to pay compensation to Italian doctors training for medical specialities governed by the university authority from 1 January 1983 onward, in compliance with the Directives of the Council of the EU regarding stipends of doctors during postgraduate specialist training. The latter directives were accompanied by related decisions of regional tribunals. Unfortunately, these decisions concerned only doctors in training in secondary care specialties (that is, non-GP trainees), while Italian GP trainees currently still lack working contracts for their postgraduate clinical training in …

The Impact of a Model Partnership in a Medical Postgraduate Program in North–South and South—South Collaboration on Trainee Retention, Program Sustainability and Regional Collaboration

North-South educational partnerships can potentially alleviate the scarcity of health work force in the South. A model program with the objectives of sustainability, high trainee retention, quality education, and capacity building is the goal of many similar programs. To achieve these goals a program of postgraduate clinical specialty training was implemented, between the University of Bergen, Norway and three Universities in Africa and one medical school in India between 2008 to 2014. This partnership program aimed at educating physicians from the South to specialize in various medical field. The goal was that the trained physicians would be educators in their respective countries. The program participants were 58 medical doctors.At the end of the program we conducted an evaluation survey involving program participants and coordinators. Twenty-eight physicians (48%) responded to the survey. The average program evaluation score by the physicians was 4.5 (out of a maximum of 5) with a range of 3.2 to 5. Out of the 12 program coordinators 9 (75%) responded to the survey. Their average score was 4.5 with a range of 4 to 4.9. By the time the survey was conducted, 49 of the 58 (84.5%) program participants had completed the program successfully and 47 of the 49 (95.9 %) were working in their own countries.In conclusion, the partnership program was effective in capacity building in the development of the human health workforce in Africa. We have observed a high retention rate, good quality education, a sustainable program and the model can easily be reproducible.

Standardisation of delivery and assessment of research training for specialty trainees based on curriculum requirements: recommendations based on a scoping review

Objectives(1) To conduct a scoping review of postgraduate specialty training (ST) curricula for doctors within Health Education England in order to identify common themes and variations in requirements for training...

European postgraduate training in geriatric medicine: data of a systematic international survey.

High-quality education and training standards in geriatric medicine are important to develop the profession of geriatric medicine. The objective of the study was to give a structured update on postgraduate specialty training in geriatric medicine throughout Europe to assess the need for further developments in postgraduate education. The study was performed as a cross-sectional structured quantitative online survey with qualitative comments. The survey content covered organization, content and educational aspects of specialty training in geriatric medicine in European countries. After piloting, the questionnaire was sent to experts in geriatric medicine with a special interest in postgraduate training who are members of one of the following organizations; European Union of Medical Specialists (UEMS), European Academy for the Medicine of Aging (EAMA), and European Union Geriatric Medicine Society (EUGMS). Respondents to the survey represented 31 European countries. Geriatric medicine is recognized as an independent postgraduate specialty in 61.3% (19/31) and as a subspecialty in 29.0% (9/31) of the countries. In 5 of the 31 countries geriatric medicine is not recognized at all. Nearly all countries offering postgraduate training in geriatric medicine have written, competence-based curricula covering different learning domains. 20/31 countries (64.5%) have some kind of specialist assessment. The survey tries to give an actual condensed picture of postgraduate specialty training in geriatric medicine across Europe. Results show a consistent improvement in the recognition of geriatric medicine as independent specialty over the last decade. Continuous development of specialty training in geriatric medicine is required to medical address the public health needs of an aging population. Competence-based educational models including adequate forms of assessment should be targeted throughout Europe. To emphasize the importance of postgraduate geriatric training, it should be a mission to harmonize training standards across Europe.

Career and Postgraduate Education Preference of Dental Students in Umm Al- Qura University, Makka City in Saudi Arabia: A Pilot Study

<b>Objective:</b><b> </b>The aim of the study is to investigate the orientation and preference of dental students to postgraduate clinical and research programs. <b>Materials and Methods</b>: A questionnaire was distributed among male and female dental students (third, fourth, and fifth year level). The questions were directed to assess the general preference of dental students for postgraduate specialty training and education. The papers were collected and the data were extracted, tabulated, and analyzed. <b>Results</b>: Students diverted away from research basic science specialties that scored only 0.9%, while the majority (50.5%) indicated that they did not decide yet. According to clinical specialties Oral Maxillofacial surgery scored 25%, orthodontics 11.6%, and pediatrics 3.6%. <b>Conclusion</b>: Most of dental students couldn’t determine their preferred future graduate education. Basic science research has the least preference compared to clinical specialties, and hence, an orientation programs are needed for the dental students to guide them toward variable dental specialties.

Qualification of ship doctors: a German approach.

While a steady growth of cruise tourism since the 1970s created an increasing demand for ship doctors medical postgraduate specialty training did not sufficiently reflect the scope of skills and knowledge required from a physician being left to himself at sea. The German Maritime Health Association therefore tasked a working group with analysing the situation and coming up with suggestions for an adequate postgraduate training for ship doctors. The working group consisted of 19 experts with various backgrounds in maritime medicine. A literature review was done on cruise ship epidemiology as well as an assessment of tasks and environmental factors influencing medical care on board of cruise ships. Necessary knowledge and skills were derived and compared with those imparted by standard German medical education. Mandatory knowledge and skills were identified as well as elements of standard medical education contributing to these goals. Those aspects that would or could not be adequately covered by German standard education were catalogued and summarised in a course curriculum. In 2013 after approval by its board of directors the German Maritime Health Association published a qualification and training recommendation addressing colleagues planning to muster as ship doctors.

How can clinical anatomy teaching be rationalized?

A recent article by John Farey and his colleagues on behalf of the Australian Medical Students' Association1 has rekindled the debate as to how, when and what anatomy to teach medical students. In recent years, the teaching of anatomy within the medical curriculum has undergone major changes, including a reduction in teaching hours – mainly the cadaveric dissection component – in order to accommodate emerging disciplines such as genetics and molecular biology, and an increased emphasis in public health, epidemiology and communication skills. Introduction of problem-based learning (PBL) has led to the fragmentation of anatomy teaching, which is a sequential subject that requires basic knowledge as its foundation. The consequences of these changes to recent medical graduates and postgraduate students have been highlighted in several recent publications.1, 2 The observations regarding the examination results of surgery fellowship trainees (where a high failure rate in the basic sciences occurred within the University of Sydney graduate cohort upon the drastic reduction in anatomy teaching at that school,2 a trend now reversed by a very substantial increase in anatomy teaching3) is a sentinel wake-up call for all medical schools. In the current climate, there is a need for more effective pedagogy to develop a clinical anatomy course with emphasis on understanding rather than endless memorization, which is the common belief among students.4 A core course of clinical topographical anatomy (including regional and systemic approaches), coupled with an appropriate process of assessment, should precede the students' progress to a PBL model that supports a preferred process of inquiry-based learning. Students profit most when multiple, problem-oriented modalities are integrated.5 The core anatomy course should also be vertically integrated and reinforced with PBL during the entire undergraduate curriculum. The call for a core National Anatomy Curriculum1, 6 requires critical consideration. This is already occurring, though not in Australia, but in the American Association of Clinical Anatomists7 and the Anatomical Society of Great Britain and Ireland.8 As ‘the anatomy and anatomical problems of safe clinical practice, even at a junior level, are similar everywhere’1 – there is no need to reinvent the wheel. However, there is a need to define with clarity the depth of core knowledge, skills, values and attitude required by the graduating medical students that must be possessed for safe clinical practice. This is a daunting but I believe, is attainable goal, if we, the anatomical educators, work collaboratively in a format similar to the Stanford Medicine 25.9 The continuing argument between dissection and prosection is unlikely to bring back old methods of dissection-based anatomy teaching, especially within the context of ‘time-poor, four-year graduate programs’.1 The elective Anatomy by Whole Body Dissection Course at the University of Sydney10 is commendable but unlikely to be replicated in all medical schools for the entire cohort of students. Topp11 suggested prosected cadaver materials for undergraduate teaching and presented convincing arguments in favour of this. The dissection-based anatomy teaching may suit those pursuing postgraduate training in the surgical specialties. The latter idea seems to be the reasonable approach. The teaching of anatomy by surgeons, surgical trainees and near-peer tutors has multiple benefits including the teaching of anatomy in the context.12 Near-peer teaching also provides a strategy for vertical integration and encourages deeper learning in anatomy.13 The College of Surgeons can promote the teaching of anatomy to undergraduates by trainee surgeons by formalizing this process as part of its training requirements, as suggested earlier.14 The tertiary hospitals can also contribute in this regard by following the example described by Taylor and Keay.15 After all, improved anatomical knowledge leads to safe patient care and reduces medical litigation. The concern expressed regarding the assessment of anatomy1, 6 deserves serious consideration. Assessment is known to increase students' motivation to learn anatomy,16 and anatomy assessment through integration of factual knowledge with the principles of problem-solving in different formats should be considered.17 Also, a national Annotated Multiple Choice Question bank facilitated by the Australian and New Zealand Association of Clinical Anatomists would be an important step in the right direction.6 Finally, more research is needed to provide sufficient evidence underpinning most of the claims alleged to be exerting negative influence on anatomical knowledge of medical students.18

Developing national selection processes for entry into postgraduate specialty training: the case of trauma and orthopedics in the United Kingdom.

A large body of international research has been done investigating best practice selection across many occupational groups, but there is relatively little research on developing selection methodology for entry to postgraduate training. Hitherto, various selection processes have been used, some of which relied heavily on patronage. Developments in Medical Education, including curriculum design, formal work-based place assessment, alongside the introduction of MMC (Modernizing Medical Careers) paved the way for significant change. Trauma and orthopedics in England is the last surgical specialty to adopt National Selection and did so first in 2013. This paper sets out that journey, the implementation of National selection in 2013, what has been learned, and our goals for the future.

Factors driving James Cook University Bachelor of Medicine, Bachelor of Surgery graduates' choice of internship location and beyond.

To identify the main reason James Cook University (JCU) Bachelor of Medicine, Bachelor of Surgery graduates chose their internship location and first four practice relocations. This cross-sectional study invited 261 JCU medical graduates to participate in an email or telephone survey. Graduates' main reason for choosing internship location and up to four subsequent relocations, post-graduate specialty training undertaken and practice location (either metropolitan or non-metropolitan) for graduates' internship year and current practice year (2012). Respondents (n=175; response rate=67%) reported personal factors as the primary driver for choosing their internship location, with 33% returning to 'near their family/home town', and 21% staying in the town they were based in Years 5 and 6. Professional reasons dominated for subsequent relocations, particularly 'long-term career ambitions'. Fifty-nine of the 175 (34%) JCU graduates had undertaken their internship in a metropolitan location (Australian Standard Geographical Classification Remoteness Area 1), while 80 (46%) currently (in 2012) practised in a metropolitan location. Internship location was not associated with later specialty training, but current metropolitan practice was associated with Surgical or Paediatrics training (P=0.007 and P=0.063, respectively), while current non-metropolitan practice was associated with General Practice and Rural Generalist training (P=0.010 and P=0.001, respectively). Personal decisions take precedence over professional career decisions for why JCU medical graduates chose their internship location, but subsequent relocations are driven by career ambitions, usually around specialty training requirements. These findings support establishing more post-graduate training opportunities in non-metropolitan settings for Surgical and Paediatric specialties as a retention strategy for a rural medical career.

Healthcare in Singapore: the present and future

Singapore’s rapidly evolving economy and social progress has helped accelerate the milestones of healthcare development in the country.(1) In 1970, a committee on specialisation was commissioned by the Singapore government to look into the development of specialised medical services and postgraduate specialty training. Since then, there has been a steady focus on the development of our healthcare sector and the advancement of medical specialties. This has catapulted Singapore’s health system to a level on par with other advanced nations.(2) Today, healthcare systems around the world spend trillions of dollars annually to tackle the growing challenges in healthcare.(2-6) These challenges include epidemiological transitions of death rates (from maternal, perinatal and infectious diseases to cardiovascular diseases and cancers) and an ageing population with improved life expectancies.(2,7) Current lifestyle trends, which are by and large the result of technological advancements, have led to individuals having an increased number of risk factors, leading to the increased prevalence of multiple chronic diseases.(2,6) These chronic diseases are also increasingly being diagnosed in the younger adult population in the recent years.(2,4-6,8) Such trends will result in greater financial costs for the nation and the individual, and our current healthcare system may not remain sustainable if we continue to invest in and develop what had served us well in the past five decades.(1) It is intuitive that the answer does not lie in ‘more of the same’. An increase in healthcare spending does not always translate to better outcomes due to the complexity of the healthcare situation. The fundamental question that should be asked is what will likely deliver better value or outcome per unit cost in the coming years. The new funding model for healthcare should be one that moves away from the episodic, fee-for-service model to one that is outcome- or value-based for a population. The targeted outcome or value should be patient-centred, with each member of the healthcare system providing for all the needs of a patient as a whole.(9) Members of the healthcare system should no longer be called healthcare ‘stakeholders’. This term is passe, and was used when we built and developed our healthcare system in parts.(1) As we move toward a more patient-centric healthcare system, healthcare institutions and services would be more correctly termed ‘providers’ because they serve as providers for the healthcare needs of a patient. The term ‘stakeholders’ should be reserved for the public, patients, payers (the government, employers or other third-party payers), policy-makers and the healthcare system (the regional health system and their partners). There are three main areas that we can focus on in order to deliver better value – healthcare integration, strengthening of primary healthcare, and collaboration for health in the community. These are further elaborated in the following text.

GP induction and refresher and retainer schemes: are they cost-effective?

There are many reasons why doctors may not wish to commit fully to a lifetime’s work in the NHS. However, the early loss of GPs is contributing to the impending GP workforce crisis. The Retainer and Induction & Refresher (I&R) schemes help to keep or reintroduce GPs in the workforce, but at a time of intense budgetary restrictions there is pressure to review the limited funding that supports them. This article analyses how cost-effective they are. The Department of Health (DoH) has set a target that one-half of all UK medical graduates entering postgraduate specialty training should go into GP training.1 However, according to the Centre for Workforce Intelligence (CfWI),2 we are 550 short of the target, therefore undertraining GPs by approximately 18% per year. It is possible to increase the number of UK GPs by: 1. increasing the number of students in UK medical schools and then GP training; 2. raising the number of medical graduates who go through GP training; 3. attracting more EU-trained GPs and providing them with an induction to prepare them for UK general practice; 4. bringing more GPs back to practice after a career break; and 5. retaining more GPs who, principally because of domestic commitments, can only undertake a small amount of paid professional work. The first two options have significant time and cost implications. It costs £488 730 for a student to complete undergraduate medical school and then GP training,3 while the cost of a GP training programme for a medical graduate is £196 500 (£11 600 per subsequent working year using …

Choice of speciality amongst first-year medical students in the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal

BackgroundTrends in career choice amongst medical graduates have considerable implications for the percentage of the workforce available for training.ObjectiveTo investigate and review factors affecting career choice by undergraduate first-year medical students.MethodThis was a cross-sectional study using a closed-ended, semi-structured survey instrument. Two hundred and four questionnaires were administered to all first-year medical students at the Nelson R. Mandela School of Medicine in the first term of the 2012 academic session.ResultsThe questionnaire was completed by 167 out of 204 students (81.8% response rate). Most of the respondents were South Africans (91%) and blacks (72%), with a higher proportion of women to men (2:1). The majority (86%) intended to undertake their postgraduate training in surgical specialties (53%), general surgery (50%) and cardiology (46%). Few were interested in an academic career in basic sciences (27.6%), either because they were not interested in research and/or teaching (48%), not clinically-orientated (20%), or found it to be an unattractive choice (12.3%). The top perceived career-related factors favouring choice of speciality were personal interest and benefits to patients as many (83%) respondents still viewed the medical profession as having a bright future in South Africa.ConclusionsOur study highlighted the fact that self and patient interests were strong determinants of speciality choices by the students and the role of parents and practice in rural areas were considered least as potential influencing factors. This would appear to be a good indicator that the healthcare sector may be boosted in the future by doctors who are wholeheartedly committed to the service of the communities with the greatest disease burden.

What is wrong with assessment in postgraduate training? Lessons from clinical practice and educational research

Workplace-based assessment is more commonly given a lukewarm than a warm welcome by its prospective users. In this article, we summarise the workplace-based assessment literature as well as our own experiences with workplace-based assessment to derive lessons that can facilitate acceptance of workplace-based assessment in postgraduate specialty training. We propose to shift the emphasis in workplace-based assessment from assessment of trainee performance to the learning of trainees. Workplace-based assessment should focus on supporting supervisors in taking entrustment decisions by complementing their “gut feeling” with information from assessments and focus less on assessment and testability. One of the most stubborn problems with workplace-based assessment is the absence of observation of trainees and the lack of feedback based on observations. Non-standardised observations are used to organise feedback. To make these assessments meaningful for learning, it is essential that they are not perceived as summative by their users, that they provide narrative feedback for the learner and that there is a form of facilitation that helps to integrate the feedback in trainees’ self-assessments.

Postgraduate Specialty Training in Private Institutions

Postgraduate Specialty Training in Private Institutions

Communication skills &amp; overseas medical graduates

Formal communication skills teaching and training has been a feature of undergraduate medical education now for over two decades and, for postgraduate training, for over a decade in the UK, North America and Australasia. However, as the authors point out, it is generally not a core component of medical education elsewhere in the world. Quite apart from the idealistic aim of providing a better service to patients, there is also a financial imperative for organizations employing or indemnifying medical practitioners to ensure high-level communication skills, given that a large proportion of patient complains are at least in part attributable to issues of failed communication early on in the process. Either one believes (as I do and the GMC purports to do) that formally-taught modules are an important part of developing doctors' and medical students' communications skills (in which case there has to be some kind of remedial training established for overseas doctors graduating from medical schools or postgraduate specialty training programmes where this was not the case), or one has to believe that communication skills training is a modern ‘educationalists fad’ and that actually learning ‘on the job’ through interacting with patients and colleagues is the only worthwhile way forward. If one believes the former (as I do and the GMC purports to do), then the present situation exposes foreign medical graduates to an unnecessarily high risk of stress, litigation and disciplinary action, at least during initial phase of their working careers in the UK. If one doesn't believe it (as these non-UK medical schools presumably feel) then it has to be assumed that UK medical graduates are missing out on invaluable elements of education in human disease that have been displaced from the UK curriculum through greater focus on ‘soft skills’.

Postgraduate training in anaesthesiology, pain and intensive care

Postgraduate training in anaesthesiology, pain and intensive care

Depressive symptoms in junior doctors: a follow-up study on work-related determinants

The study investigates the long-term effects of accumulated working conditions on depressive symptoms in junior doctors. Drawing on the Job Demand-Control-Support model, this study aims to identify personal and job-related determinants for self-reported depression in junior doctors-a professional group that is vulnerable to depression. We conducted a prospective cohort study with measures of work characteristics and depressive symptoms over three time-points among hospital doctors during postgraduate specialty training in Germany. Participants were 415 junior doctors with full-time contract (47.5% women; mean age, 30.5 years). The outcome was depressive symptoms assessed with the Spielberger State-Depression Scale. Odds ratios (OR) were computed to analyse the cumulative effect of initial depressive symptoms scores, demographic variables, and working characteristics across T1 and T2 on subsequent depressive symptoms at T3. The percentage of junior doctors reporting depressive symptoms scores above a critical value varied between 12.0% at T1, 10.4% at T2, and 13.3% at T3; N = 34 doctors (8.19%) were classified as incident cases during the observation period. Elevated depressive symptoms at T3 were positively predicted by depressive symptoms scores across T1 and T2 (OR: 1.37; 95% confidence interval: 1.25-1.50) and negatively by professional tenure (0.54; 0.31-0.96), free weekends (0.52; 0.28-0.97), and job autonomy (0.35; 0.18-0.65). After controlling for demographic and working time influences, findings suggest that junior doctors' perceived job autonomy is negatively associated with future depressive symptoms. Enhancing job control emerges as a promising strategy to lower the risk of depression during first years of professional practice.

Five-year training: a radical rational approach to delivery

The MRCGP as it stands . Acquisition of the MRCGP has evolved over the years and the most recent changes, introduced in 2008, incorporate both examination modules and satisfactory submission of work place based assessment evidence. One of the most significant steps in the recent change has been the requirement for the trainee to enter a GMC approved and Deanery delivered 3-year programme from the outset of their specialty training. Parallel to the changes in the entry requirements for Royal College Membership has been discussion on how long the training programme should be. In 2008 the Tooke1 report on postgraduate specialty training was published and shortly thereafter accepted by the then Secretary of State for Health. One of its key points being that general practice training should be extended to 5 years. However, since then, adverse national economic factors have arisen and discussion on this change appears very low key.2,3 Simultaneous with the changing financial challenges, the NHS has been subject to further organisational and structural change.4 Some of the key points include the dismantling of the current administrative structure of the PCTs, and the assumption of leadership by GPs in the commissioning of health care. This additional proposed responsibility has coincided with the ongoing development of an ever-growing body of health knowledge, the development and implementation of complex systems of …

Postgraduate specialty training in northeastern Ontario and subsequent practice location

Physician specialists are under-represented in communities in northern Ontario, even in larger communities of approximately 100 000 population. The positive association between postgraduate training in northern or rural areas and eventual practice in these locations has been well documented in the literature, but only for family medicine/general practice. Few, if any, studies have explored the association for other specialties. The objective of this study was to determine if there was an association between northern training and northern practice location for physicians who were enrolled in the Northeastern Ontario Postgraduate Specialty (NOPS) program, which offers placements in northeastern Ontario in specialties such as anesthesiology, internal medicine and surgery. METHODS; A national medical human resources database provided the 31 December 2006 practice location of all 50 participants in the NOPS program since its inception in 2000 until 2006. Program records provided data on participants' specialty rotations in northeastern Ontario, including number, location, and duration of rotations. Non-NOPS participants (n=50) were randomly selected for comparison, matched one for one to the NOPS group on sex, year of birth, language, medical school, year of graduation from medical school, age at the time of graduation, and specialty. Hierarchical log-linear models and 2 tests were used to assess differences between NOPS and non-NOPS participants in geographic location and population size of practice community. Chi-square tests were used to analyze the relationship between the duration of northeastern rotations and practice location of NOPS participants. NOPS and the matched non-NOPS groups did not differ significantly for age or age at graduation from medical school (paired t-tests, p>0.80) and matched exactly for sex, medical school location and specialty group. Forty-six percent of NOPS participants were female and 80% came from Ontario residency programs. Seventy-two percent of the program participants were enrolled in medical specialties (the remainder were in surgical specialties) and this differed significantly by sex: 83% of females vs 63% of males (Χ (2)=4.76, df=1, p=0.03). A majority completed residency training at 31-35 years of age. Fifty percent of NOPS participants obtained medical degrees from Ontario universities, 34% from other Canadian universities and 16% from other universities. Significantly more NOPS participants than non-participants were located in northeastern Ontario (9 vs 0), significantly fewer were in other provinces (13 vs 22) and identical numbers were located in southern Ontario (28 vs 28) (=11.61, df=2, p<0.01). Significantly more NOPS participants than non-participants were practicing in communities of 10 000-99 999 people (15 vs 4), approximately equal numbers in communities of 100 000-499 999 (9 vs11) and non-significantly fewer were practicing in areas of 500 000 or more (26 vs 35) (Χ (2)=7.90, df=2, p=0.02), though this interaction was not significant in the hierarchical log-linear model. The NOPS participants located in northeastern Ontario were more likely to have longer northeastern rotations (>4 weeks) than those located in southern Ontario (Χ (2)=7.81, df=2, p=0.02). However, a longer northeastern rotation was no guarantee of a northeastern practice location because roughly equal numbers of participants with longer rotations were spread throughout the 3 geographic practice locations. Conversely, a shorter rotation was strongly associated with a southern Ontario practice location (18/25). The NOPS participants located in communities of ≥ 500 000 people were more likely to have shorter rotations than longer rotations, but this difference was only marginally statistically significant Χ (2)=5.13, df=2, p=0.08). The study found that specialists who participated in NOPS postgraduate specialty training in northeastern Ontario were more likely to practice in northeastern Ontario than non-participants. There was also a strong association between the duration of training in the northeast and northeastern practice and avoidance of practice in metropolitan areas. It is not clear yet whether longer northeastern rotations encourage northeastern practice or whether this reflects an existing disposition; it is clear, however, that specialists with longest specialty training rotations in the northeast were more likely to practice in the northeast. The results from this study provide the first empirical evidence of positive association between postgraduate specialty training in the northeast and eventual practice in northeastern Ontario and smaller cities.

Evaluating candidate reactions to selection practices using organisational justice theory

This study aimed to examine candidate reactions to selection practices in postgraduate medical training using organisational justice theory. We carried out three independent cross-sectional studies using samples from three consecutive annual recruitment rounds. Data were gathered from candidates applying for entry into UK general practice (GP) training during 2007, 2008 and 2009. Participants completed an evaluation questionnaire immediately after the short-listing stage and after the selection centre (interview) stage. Participants were doctors applying for GP training in the UK. Main outcome measures were participants' evaluations of the selection methods and perceptions of the overall fairness of each selection stage (short-listing and selection centre). A total of 23,855 evaluation questionnaires were completed (6893 in 2007, 10,497 in 2008 and 6465 in 2009). Absolute levels of perceptions of fairness of all the selection methods at both the short-listing and selection centre stages were consistently high over the 3years. Similarly, all selection methods were considered to be job-related by candidates. However, in general, candidates considered the selection centre stage to be significantly fairer than the short-listing stage. Of all the selection methods, the simulated patient consultation completed at the selection centre stage was rated as the most job-relevant. This is the first study to use a model of organisational justice theory to evaluate candidate reactions during selection into postgraduate specialty training. The high-fidelity selection methods are consistently viewed as more job-relevant and fairer by candidates. This has important implications for the design of recruitment systems for all specialties and, potentially, for medical school admissions. Using this approach, recruiters can systematically compare perceptions of the fairness and job relevance of various selection methods.