The latest annual, national survey of Australia’s doctors in training has revealed small but worrying signs of pressure on medical training.
Results from the 2022 Medical Training Survey (MTS) were released 30 January 2023 and are broadly consistent with previous years, with some small but statistically significant variations in year-on-year results.
These include an increase in trainee workload, a dip in the quality of teaching, a drop in the number of trainees who would recommend their current training position or organisation, and an increase in the number of trainees considering a future outside of medicine.
The MTS is a longitudinal survey run by the MBA, that tracks feedback about the quality of medical training run in Australia and each year, more than half of Australia’s doctors in training share their insights on system.
There was a 56% response rate in 2022 with 22,135 surveys analysed, and most respondents — 80% — were working in hospitals.
The MBA’s Chair, Dr Ann Tonkin, said that this year’s findings form a robust evidence base to advise ongoing improvements in training as trends are visible early, enabling close monitoring or swift action by agencies best placed to respond and effect positive change.
For example, the participation rate for Aboriginal and Torres Strait Islander trainees increased from 158 in 2021, to 191 in 2022, and their input played an important part in the process.
“The MTS has given us all an important opportunity to listen to and act on the feedback from these trainees, as we move towards providing culturally safe and appropriate medical training and more broadly, culturally safe medical care,” she explained.
Dr Tonkin pointed out that while there was still a lot going well in medical training, the results showed some critical issues that require attention and some early trends to monitor closely.
“We can all be pleased that Australia continues to deliver high quality medical training, producing doctors who provide high quality medical care to patients in this country,” Dr Tonkin said.
“But MTS results suggest that in 2022, things were not quite as good in medical training as they have been in previous years… the health sector has been given early warning about issues to address and we all owe it to trainees to act.”
She explained that qualitative research and analysis would be needed to definitively understand the reasons for this, but believed that it was possible that broader, pandemic-related health system pressures had adversely impacted training.
For example, there was a 7% increase (to 53%) in the number of trainees who rated their workload as heavy or very heavy since COVID hit in 2020, exam preparation and training opportunities were severely curtailed in 2021, and workload started to increase once again in 2022.
Just over two thirds of doctors in training (67%) reported working more than 40 hours on average per week, including one in 10 who worked more than 60 hours per week, and concerningly, 20% of trainees were considering leaving medicine.
This is up from 18% in 2021, and the rate is even higher for Aboriginal and Torres Strait Islander trainees, with 29% considering leaving.
On the upside, this year’s results also revealed an increase in the number of trainees getting paid for their overtime.
Another area of concern highlighted in the MTS was the continued existence of a culture of bullying and harassment, with the 2022 survey including a new question investigating the reasons for not reporting such behaviour.
“The culture of medical training needs attention: it is totally unacceptable that 55% of Aboriginal and Torres Strait Islander trainees have experienced and/or witnessed bullying, harassment, discrimination and racism and inexcusable that 34% of all trainees did,” Dr Tonkin said.
“We no longer have to speculate that trainees are concerned about the consequences of reporting, we know this is true.”
One in three doctors in training (34%) either experienced and/or witnessed bullying, harassment, discrimination and/or racism in their workplace in 2022 and of those who had experienced such treatment, 70% did not report it. Of these trainees, 55% were concerned about the repercussions, and 51% said nothing would be done if they did make a report.
However, the source of bullying, harassment, discrimination, and racism changed in 2022, with an increase in patients and/or family and carers identified as the source of the incident (up from 38% in 2021 to 45% in 2022).
AMA president Professor Steve Robson said the fourth national MTS had highlighted the impact of a health system under crisis, one that has ongoing systemic problems of racism and bullying.
“The fact that 20% of those who responded to the survey are considering a career outside of medicine should be a wakeup call for Governments across the country, particularly as these are doctors in training who have spent years investing in their education and training,” Professor Robson said.
He pointed out that the survey results gave an important insight into the overall quality of medical training in Australia, not just workplace environment and culture but also curriculum, orientation, clinical supervision, access to and quality of teaching, as well as career intentions, adding that while the data revealed debilitating systemic issues, there were still positives to draw from.
“For example, the survey highlights that despite ongoing workplace pressures and the impact of COVID, the quality of medical training in Australia remain high – 78% of doctors in training would still recommend their current training position to other doctors, and 77% would recommend their current workplace as a place to train,” Professor Robson said.
“This speaks to the importance of profession led training in Australia and the commitment of clinicians to training the next generation of medical professionals.”