Training Part Time Research Articles

General practice registrars training part-time: a cross-sectional analysis of prevalence and associations

ABSTRACT While GPs are working fewer clinical hours and many GP trainees (registrars) do not foresee themselves working full-time in clinical practice, little is known of the epidemiology of registrars training part-time. We aimed to establish the prevalence of general practice part-time training (PTT), and part-time registrars’ characteristics and practice patterns. A cross-sectional analysis was conducted of data from the Registrar Clinical Encounters in Training project, an ongoing cohort study of Australian GP registrars’ clinical experiences over 60 consecutive consultations in each of three training terms. Univariable and multivariable logistic regression analyses were conducted with the outcome ‘training part-time’. 1790 registrars contributed data for 4,135 registrar-terms and 241,945 clinical encounters. Nine hundred and twenty-two registrar-terms (22%, 95%CI:21%–24%) and 52,339 clinical encounters (22%, 95%CI:21%–22%) involved PTT. Factors associated with PTT were registrar characteristics – female gender, older age, in a later training stage, performing other regular medical work; practice characteristics – working in a higher socioeconomic status area; and patient characteristics – seeing more patients new to the registrar and seeing more patients from a non-English-speaking background. No consultation or consultation action factors were significantly associated with PTT. Registrars, practices, and patient associations have GP training implications. The lack of registrar consultation or consultation action associations suggests there may be limited impact of PTT on patient care.

Reflections on part-time residency training, 15–25 years later: a qualitative study on wellness and career impact

Phenomenon: While part-time clinical work options are popular for physicians, part-time residency training is uncommon. Some residency training programs have offered trainees the option to complete their training on a modified schedule in the past. These part-time tracks often involved extending training in order to complete equivalent hours on a part-time basis. Having experience with trainees in such programs, we sought to explore the impact of completing residency training part-time on the professional and private lives of physicians. Approach: Between 2019 and 2020, we conducted interviews with physicians who completed portions of their residency training part-time between 1995 and 2005 in our institution’s pediatrics, combined medicine-pediatrics, and family medicine programs. Findings: Seven female physicians who completed at least some portion of residency part-time were interviewed. To better characterize their experiences, we chose phenomenology as our analytic framework. Members of the research team independently coded each interview and met to resolve conflicts. Codes were then combined and discussed to determine four overarching themes as reasons and benefits of part-time training: The pursuit of extended-time training, logistics, effects on career trajectory, and wellness. These themes highlighted the utility of part-time training and the need for programmatic support to ensure their success. Insights: Based on our findings, adaptability for training and a sense of agency from their part-time experiences persisted throughout interviewees’ careers. Each felt empowered to make career choices that fit their personal and professional needs. These findings suggest further investigation into the benefits of offering time-variable training in residency programs.

Provision of other medical work by Australian early-career general practitioners: a cross-sectional study.

Introduction There is a trend towards GPs diversifying their role by working in health areas beyond general practice. However, little is known about whether this trend is apparent among early-career GPs once they make the transition from training to independent practice. Aim To describe the prevalence of and characteristics associated with early-career GPs providing other medical work. Methods A cross-sectional questionnaire-based study of GPs ('alumni') who had fellowed within the past 2 years from three of Australia's nine regional training programs. The outcome factor was provision of medical work in addition to clinical general practice. Associations of independent variables (encompassing alumni demographics, current practice characteristics and vocational training experience) with the outcome were estimated using univariate and multivariable logistic regression. Results Of 339 responding alumni, 111 (33%) undertook other regular medical work. Sixty-five (59%) of these were in medical education. In multivariable analysis, factors associated with providing other medical work were having a spouse/partner not in the workforce (odds ratio (OR) 5.13), having done any training part-time (OR 2.67), providing two or more of home visits, nursing home visits and after-hours care (OR 2.20), working fewer sessions per week (OR 0.74), and currently working in an area of lower socio-economic status (OR 0.84). Having dependent children (OR 0.27), and being female (OR 0.43) were associated with not providing other medical work. Discussion In this study, many early-career GPs are providing other medical work, particularly medical education. Acknowledging this is important to general practice workforce planning and education policy.

Flexibility in Postgraduate Medical Training in the Netherlands.

Postgraduate medical training in the Netherlands has become increasingly individualized. In this article, the authors describe current practices for three residency programs at the University Medical Center Utrecht: anesthesiology, pediatrics, and ophthalmology. These programs are diverse yet share characteristics allowing for individualized residency training. New residents enter each program throughout the year, avoiding a large simultaneous influx of inexperienced doctors. The usual duration of each is five years. However, the actual duration of rotations or of the program as a whole can be reduced because of residents' previous medical experience or demonstration of early mastery of relevant competencies. If necessary, the duration of training can also increase.Although working hours are already restricted by the European Working Time Directive, most residents choose to train on a part-time basis. The length of their program then is extended proportionally. The extension period added for those residents training part-time can be used to develop specific competencies, complete an elective rotation or research, or explore a focus area. If the resident meets all training objectives before the extension period is completed, the program director can choose to shorten the program length. Recently, entrustable professional activities have been introduced to strengthen workplace-based assessment. The effects on program duration have yet to be demonstrated.Flexible postgraduate training is feasible. Although improving work-life balance for residents is a necessity, attention must be paid to ensuring that they gain the necessary experience and competencies and maintain continuity of care to ensure that high-quality patient care is provided.

ARM to debate whether new junior contract disadvantages women

Doctors from across the profession are set to discuss whether the proposed new contract for junior doctors in England will disadvantage women, particularly those who train part time or have children. Delegates at the BMA’s annual representative meeting (ARM) in Belfast will discuss the issues on Thursday 23 June. The motion is one of several that focus on issues related to the new contract. It says, “This meeting is appalled that changes in the junior doctor contract will disadvantage women, particularly those who are training part time, or who are carers or lone parents.” Doctors previously raised concerns that the new contract discriminated against women when the government published an equality analysis …

Strategies for College and University Instructional Physical Activity Programs (IPAP) Directors

There is a growing trend to rely on part-time instructors including both adjunct faculty and graduate teaching assistants (GTAs) in higher education (Eney, & Davidson, 2012). Most kinesiology departments depend on part-time instructors to teach instructional physical activity programs (IPAPs) to the general student population historically referred to as basic instruction. These part-time instructors are content experts but come from many different backgrounds. The purpose of this article is to highlight important topics for program coordinators, directors and faculty supervisors to consider including when training part time instructors of instructional physical activity programs using a best practice approach. Three main area of concern will be addressed; adjusting to graduate school, classroom issues and teaching administrative duties. The use of effective strategies, such as orientation, mentoring, and teacher development for part-time instructors, will help ensure quality teaching and learning in physical activity programs.

Nutritional Support for Athletic Performance.

In recent years, all personnel involved in maximizing athletic performance have adopted a science-based approach to the nutritional support of athletes and active individuals. The field of sports nutrition has exploded in terms of applied research interest and publications, and also in the practical application of the research findings to the ‘real’ or ‘athletic’ world. Many of us tend to concentrate on nutrition for hydrating and fuelling the athlete during training sessions and competitions, but we realize that the ‘before, during and after exercise’ nutritional approach is also important for recovery and preparation for the next exercise session. In addition, nutrition can also play a role in circumstances that the athlete may find themselves in, such as having to lose weight while training, recovering from an injury and trying to train part-time or full-time, and deciding whether to take nutritional supplements, such as beta-alanine or sodium bicarbonate, which would be consumed in larger quantities than found in the diet. This supplement examines many of these issues. Applied researchers and sports personnel are continually learning more about the importance of nutrition for elite athletes. This issue considers the unequivocal importance of dietary and supplemental carbohydrate as the key fuel for success of elite-level endurance athletes, who work at extremely high exercise intensities. Elite team sports athletes also rely heavily on carbohydrate as a fuel, both for high-intensity aerobic-based activity and for sprint movements. Carbohydrate is the only fuel that can provide a substrate for both of these types of activities. Another advantage of carbohydrate is that it can be ingested during exercise and taken up and used by the skeletal muscles and central nervous system. During prolonged exercise at lower intensities, the provision of fat in the form of free fatty acids from adipose tissue can make a significant contribution to the contracting muscle’s fuel supply, but fat is not a high-intensity fuel. Not surprisingly, attempts to employ high-fat, low-carbohydrate diets to maximize elite athletic performance have not been successful. Fluid ingestion during exercise is also important, as body mass losses of ~2–3 % for endurance events and ~2 % for stop-and-go, decision-making sports can negatively affect elite performance. Typically, mass endurance events provide carbohydrate in liquid, gel and solid forms for participants, as well as various forms of liquids to maintain hydration. The decision on whether to engage in what we might call ‘supplemental’ sports nutrition is always something to be considered for athletes. This often involves ingesting naturally occurring substances in large quantities, such as beta-alanine to increase skeletal muscle carnosine levels and intracellular buffering capacity, or sodium bicarbonate to enhance extracellular buffering capacity. In sports that require repeated sprints and generate high levels of acidity in the muscle and blood, these nutritional supplements can improve performance in many individuals. It is also clear that nutritional support is critical in situations where athletes are attempting to lose body mass while continuing to train and prepare for competitions. Evidence suggests that lean mass can be preserved during weight loss with a sound nutritional programme. Equally important is dealing with injuries that partially or totally restrict athletes from training for varying periods of time. Nutrition can again play a major role in stimulating muscle protein synthesis and/or reducing protein breakdown during the periods of partial or total exercise restriction to counteract lean body mass losses. The Gatorade Sports Science Institute (GSSI) brought together researchers for a meeting in March 2014 to discuss these varied topics of interest to the sports nutrition world. Following the meeting, authors were asked to summarize the recent work in their topic area, resulting in the manuscripts in this Sports Medicine supplement. Lawrence L. Spriet, PhD Guest Editor

Flexible higher training in psychiatry

Aims and methodThis survey was commissioned and funded by the Department of Health to examine perceptions of training by flexible trainees in higher psychiatric training. A total of 214 trainees were surveyed using a postal questionnaire.ResultsOne hundred and thirty-five questionnaires were returned (response rate 63%). In general, flexible trainees valued the opportunity to train part-time and perceived the quality of their training to be high. However, there were drawbacks such as: perceived lack of status, restricted training opportunities and a lack of part-time consultant posts at the end of training.ImplicationsFlexible training plays a major role in maintaining doctors in the workforce. However, there is a need for part-time opportunities to extend beyond the training grades and into consultant posts.

Evaluation of flexible senior registrar training in obstetrics and gynaecology.

To evaluate part-time senior registrar training in obstetrics and gynaecology from the perspective of the trainees. Postal questionnaire. Past and present senior registrar trainees on the PM(79)3 scheme. Thirty-two questionnaires were returned (86% response rate) from 20 current trainees (100% response) and 12 (71% response) past trainees. Family commitments were the main reason for training part-time. Of these, 84% were satisfied with their training and most (81%) thought the quality as good or better than full time training. Personalised timetables were seen to be of particular benefit. Negative attitudes towards part-time training and discrimination in favour of full time trainees were seen as some of the biggest difficulties associated with part-time training. Other problems included administrative delays in organising part-time posts, time restriction, and the length of training. Part-time senior registrar training is effective in retaining trainees with domestic commitments within the speciality. It is regarded as being of high quality but with attendant problems, particularly those related to the negative attitudes of others. Recommendations for improvements have been made.

Juniors call for renegotiation of flexible training Health secretary meets royal colleges over bed shortages Government will not climb down over nurses' pay Former Eastern Europe requests help BMA urges research in primary care Postgraduate deans should not be civil servants NHS Executive offers guidance on local pay for purchasers Pay must be linked to work intensity Correction

# Juniors call for renegotiation of flexible training {#article-title-2} Representatives of junior hospital doctors have called for an urgent renegotiation of the framework for flexible training in the wake of the proposals for a unified training grade. As a result of a recommendation in the Calman report, Hospital Doctors: Training for the Future, the NHS Executive published proposals last year for a new grade—the specialist registrar—to replace the present career and senior registrar grades (21 January, p 149). Proposing the motion, which was carried by 19 votes to 16, Dr Mark Porter, a registrar in anaesthetics in Coventry, told the Junior Doctors Committee last month that his motion was not limited to the new grade nor was there a time scale but there had been little reference to flexible training in the report of the working party on the unified training grade: “The specialist registrar grade should be flexible enough to accommodate those wishing to undertake training on a part time basis. The entry criteria and selection processes for all trainees should be the same, irrespective of the training patterns adopted during the training programme. Similarly, the standards for achieving the certificate for completion of specialist training should be the same for both full and part time trainees.” There was provision for only 5% of doctors to undertake flexible training, Dr Porter said, despite about 40% indicating that they would like it. Flexible training did not have to be double full time training but it had to be high quality, accessible, and attract appropriate remuneration. Although half the entrants to medical school are now women and many men would like to train part time, the chairman of the negotiating subcommittee, Dr Paul Miller, a psychiatric senior registrar in Liverpool, and other speakers urged the committee to vote against and wait until the broader issues of the grade had been …

Hard times--hard choices: positive decision-making for part-time women doctors.

In an increasingly competitive medical market-place, one of the authors had observed that women applying for training posts often appear lacking in self-confidence and unclear in decisions concerning their career plans. A successful workshop was held for women training part time which provided a forum for individuals to identify and explore their career dilemmas and an opportunity to make some quantitative assessment of their attitudes. Questionnaires completed by the 22 attenders and a further 16 returned by post showed that the majority of this group had realistically thought out career plans, had resolved the dilemmas posed by combining career and family commitments and were clear that their eventual career goal was to become a Consultant in the National Health Service. A much smaller group of women who tended to be both older and occupying more junior grades emerged as being confused about how the career/children conflict could be resolved and unclear as to their career aims. The oft-stated assumption that 'most women prefer a job with less responsibility than a Consultant' was not supported but it is clear that if women are not to be nudged into career cul-de-sacs they need clear advice and information so that they can complete their training and compete successfully with their male colleagues for career posts.

PART-TIME SENIOR REGISTRAR POSTS: WESSEX REVIEWED

A Government memorandum guided regional boards on how to set up schemes for re-employment of women doctors to ensure that they could train part-time in the hospital service with the aim of gaining consultant posts. Of the 14 senior registrars who have held part-time contracts in Wessex during the past 5 years, 2 are now full-time consultants and 8 have completed their higher qualifications. A high standard of qualification and training can be achieved on a part-time basis but subsequent employment prospects need to be more flexible: regional health authorities should create more part-time consultant posts.