Multiple and multidimensional transitions from trainee to trained doctor: a qualitative longitudinal study in the UK.

OBJECTIVES: To explore trainee doctors' experiences of the transition to trained doctor, we answer three questions: (1) What multiple and multidimensional transitions (MMTs) are experienced as participants move from trainee to trained doctor? (2) What facilitates and hinders doctors' successful transition experiences? (3) What is the impact of MMTs on trained doctors? DESIGN: A qualitative longitudinal study underpinned by MMT theory. SETTING: Four training areas (health boards) in the UK. PARTICIPANTS: 20 doctors, 19 higher-stage trainees within 6 months of completing their postgraduate training and 1 staff grade, associate specialist or specialty doctor, were recruited to the 9-month longitudinal audio-diary (LAD) study. All completed an entrance interview, 18 completed LADs and 18 completed exit interviews. METHODS: Data were analysed cross-sectionally and longitudinally using thematic Framework Analysis. RESULTS: Participants experienced a multiplicity of expected and unexpected, positive and negative work-related transitions (eg, new roles) and home-related transitions (eg, moving home) during their trainee-trained doctor transition. Factors facilitating or inhibiting successful transitions were identified at various levels: individual (eg, living arrangements), interpersonal (eg, presence of supportive relationships), systemic (eg, mentoring opportunities) and macro (eg, the curriculum provided by Medical Royal Colleges). Various impacts of transitions were also identified at each of these four levels: individual (eg, stress), interpersonal (eg, trainees' children spending more time in childcare), systemic (eg, spending less time with patients) and macro (eg, delayed start in trainees' new roles). CONCLUSIONS: Priority should be given to developing supportive relationships (both formal and informal) to help trainees transition into their trained doctor roles, as well as providing more opportunities for learning. Further longitudinal qualitative research is now needed with a longer study duration to explore transition journeys for several years into the trained doctor role.

Core competencies in teaching and training for doctors in Scotland: a review of the literature and stakeholder survey.

BACKGROUND: The UK General Medical Council requires all registered doctors to be competent in all areas of their work, including teaching and training. AIMS: The current research sought consensus on core competencies for all consultants and GPs involved in teaching and training in Scotland. METHOD: A draft list of 80 competencies was developed from the literature and made available as a survey to all consultants and GPs with teaching roles and all final year speciality trainees working in Scotland. Respondents rated the importance of each competency and provided free text comments. RESULTS: There were 1026 responses. Eighteen competencies were rated as "high priority", and are recommended as a baseline for all doctors involved in teaching and training; 55 were rated as "medium priority", and are recommended in relation to specific teaching and training roles; and 7 were rated as "low priority". Free text responses suggested the topic was controversial and emotive, and emphasised the importance of further work to engage trainers. CONCLUSIONS: The findings appeared to have face validity, and it was felt these could be used as the basis for developing a "Scottish Trainer Framework" for doctors and others involved in teaching and training in Scotland.

Associations between medical school and career preferences in Year 1 medical students in Scotland.

OBJECTIVES: Little is known about the relationship between the career preferences of medical students and the medical schools at which they are enrolled. Our aim was to explore this relationship early in students' medical training. METHODS: Year 1 (2009-2010) medical students at the five Scottish medical schools were invited to take part in a career preference questionnaire survey. Questions were asked about demographic factors, career preferences and influencing factors. RESULTS: The response rate was 87.9% (883/1005). No significant differences were found among medical schools with regard to first-choice specialty. Surgery (22.5%), medicine (19.0%), general practice (17.6%) and paediatrics (16.1%) were the top career choices. Work-life balance, perceived aptitude and skills, intellectual satisfaction, and amount of patient contact were rated as the most important job-related factors by most respondents. Few differences were found among schools in terms of the impact of job-related factors on future career preferences. Students for whom the work-life balance was extremely important (odds ratio [OR]=0.6) were less likely to prefer surgery. Students for whom the work-life balance (OR=2.2) and continuity of care (OR=2.1) were extremely important were more likely to prefer general practice. CONCLUSIONS: Students' early career preferences were similar across the five medical schools. These preferences result from the interplay among demographic factors and the perceived characteristics of the various specialties. Maintaining a satisfactory work-life balance is very important to tomorrow's doctors, and the data hint that this may be breaking down some of the traditional gender differences in specialty choice. Longitudinal work is required to explore whether students' career preferences change as they progress through medical school and training.

Developing a sensitive search strategy in MEDLINE to retrieve studies on assessment of the diagnostic performance of imaging techniques.

PURPOSE: To prospectively develop a search strategy in MEDLINE for identifying studies on the diagnostic performance of any imaging modality, with maximized and minimized retrieval of relevant and irrelevant studies, respectively. MATERIALS AND METHODS: Predefined inclusion criteria were used to conduct a hand search of two sets of radiologic journal articles for studies on assessment of the diagnostic performance of imaging techniques. These two sets of articles formed independent derivation and validation record sets for developing and evaluating the search strategy. The sensitivity and positive predictive values (PPVs) of search terms from the derivation reference-standard set of records were used to select terms and develop two components of the search strategy. The first component was used to identify any study (from the imaging literature) in which diagnostic test performance was assessed. The second component was used to identify studies of any imaging modality. The two components were combined in the final search strategy. The sensitivity, specificity, and PPV of the search strategy in the derivation and validation record sets were calculated. RESULTS: The final search strategy had a sensitivity of 92.8%, a specificity of 58.5%, and a PPV of 25.1% for retrieval of the derivation set of records. Validation with an independent set of records gave a sensitivity of 91.9% (95% confidence interval [CI]: 87.1%, 95.1%), a specificity of 52.2% (95% CI: 49.2%, 55.2%), and a PPV of 25.1% (95% CI: 22.0%, 28.5%). Removal of irrelevant publication types further improved specificity and PPV in the validation set: to 77.6% (95% CI: 75.0%, 80.0%) and 40.9% (95% CI: 36.2%, 45.7%), respectively. The volume of imaging literature retrieved from MEDLINE by using the described search strategy has tripled since 1975. CONCLUSION: A sensitive search strategy to identify studies of the diagnostic performance of any imaging test was developed and validated. The retrieval estimates of this strategy in MEDLINE are adequate to develop a register of studies.

Why do work patterns differ between men and women GPs?

PURPOSE: The purpose of this study was to explore gender differences in contractual commitments, job satisfaction and spouses' occupation among GP principals in NHS Scotland. DESIGN/METHODOLOGY/APPROACH: This paper is based on data provided by a self-completion, postal questionnaire survey. The response rate was 50 per cent. FINDINGS: Males worked more hours than females and were more likely to work out-of-hours. Females reported greater job satisfaction but only when they worked fewer hours. Females earned less than males but there were no gender differences in total household income. Both genders planned to retire at 59 years. More males would delay retirement if they could work part-time. More females than males were in dual-doctor households. Male respondents in dual-doctor households were more likely to have modified their working hours or career aspirations than males in other households. PRACTICAL IMPLICATIONS: The number of hours worked by GPs is in part determined by the occupation/earning power of their spouse. The number of women GPs is increasing and they are likely to continue to choose to work fewer hours than their male counterparts have done in the past. ORIGINALITY/VALUE: This study has attempted to incorporate spouse's occupation/income as a factor in the career choices of GPs in Scotland.

General practitioner non-principals benefit from flexible working.

PURPOSE: The purpose of this study is to explore non-principals' working patterns and attitudes to work. DESIGN/METHODOLOGY/APPROACH: The article is based on data provided by a questionnaire survey. Findings - Gender division was apparent among the non-principals. Males were more likely to work full-time, because their spouses modified their working hours. RESEARCH LIMITATIONS/IMPLICATIONS: It was impossible to identify all non-principals in Scotland or to compare responders and non-responders, due to the lack of official data. Hence, the results might not be representative. PRACTICAL IMPLICATIONS: More flexible posts would enable GPs to more easily combine paid work with family commitments. It is anticipated that the new GP contract should deliver this. ORIGINALITY/VALUE: This was the first time a study of all non-principals in Scotland had been attempted. The findings provide a more comprehensive picture of GPs in Scotland and provide valuable information for policymakers.

What do hospital consultants value about their jobs? A discrete choice experiment.

OBJECTIVE: To examine the strength of hospital consultants' preferences for various aspects of their work. DESIGN: Questionnaire survey including a discrete choice experiment. SETTING: NHS Scotland. PARTICIPANTS: 2923 hospital consultants in Scotland. MAIN OUTCOME MEASURES: Monetary valuations or prices for each job characteristic, based on consultants' willingness to pay and willingness to accept extra income for a change in each job characteristic, calculated from regression coefficients. RESULTS: The response rate was 61% (1793 respondents). Being on call was the most important attribute, as consultants would need to be compensated up to pound 18,000 (30% of their average net income) (P < 0.001) for a high on-call workload. Compensation of up to pound 9700 (16% of their net income) (P < 0.001) would be required for consultants to forgo opportunities to undertake non-NHS work. Consultants would be willing to accept pound 7000 (12% of net income) (P < 0.001) in compensation for fair rather than good working relationships with staff, and pound 6500 (11% of net income) (P < 0.001) to compensate them for a shortage of staff. The least important characteristic was hours of work, with pound 562 per year (0.9% of their net income) (P < 0.001) required to induce consultants to work one extra hour per week. These preferences also varied among specific subgroups of consultants. CONCLUSIONS: Important information on consultants' strength of preferences for characteristics of their job should be used to help to address recruitment and retention problems. Consultants would require increased payment to cover more intensive on-call commitments. Other aspects of working conditions would require smaller increases.