Selection of Future Medical Practice: Using the Australian Medical Schools Outcomes Database to inform national workforce planning Author: David A Kandiah Date: 19 October 2012
I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. Author: David A Kandiah Date: 19 October 2012
, MEDICAL SCHOOLS OUTCOMES DATABASE (MSOD) & LONGITUDINAL TRACKING PROJECT
MSOD Project: The Big Picture To design and initiate a national process to collect reliable demographic and educational data on medical students across all medical schools To establish a national database that will provide the basis for short and long-term monitoring and reporting on outcomes of medical education programs and medical workforce planning
MSOD Data Collection - What, How & When Commencing Students Questionnaire (CMSQ) 95% responses - demographic, rurality, career intentions (location & specialty), previous tertiary education, income, scholarships Annual Medical Schools Data (MSD) 100% compliance - enrolment status, rural club membership, placements (discipline/ specialty, location, duration, type, infrastructure resourcing), electives (location, duration, type) Exit Questionnaire (EQ) 85% responses - internship location, career intentions (location & specialty), further tertiary education, contact details, updated demographics Postgraduate Year 1/Intern Questionnaire (PGY1Q) 75% FU Responses - status of current work, internship rotations, career intentions (location & specialty), contact details, updated demographics PGY 3 75% FU Responses, PGY 5 and PGY 8 Qs (planned) - status of current work, career intentions (location & specialty), specialty training (discipline & location), contact details, updated demographics
First year of medical program During medical program (Annually) Final year of medical program At end of internship CMSQ Medical Schools Data Exit Q PGY1Q Scanned Excel Templates Scanned Raw Unprocessed Data Files Raw Unprocessed Templates Raw Unprocessed Data Files Data Cleaning ID/ DOB/Gender Checks Data Cleaning Data Cleaning Scanning Errors Blanks & Other Anomalies Raw Cleaned Data Files Data Reports Raw Cleaned Templates Individual Medical School Data Report National Data Report Raw Cleaned Data Files Master Dataset: Cleaned Data Files Merged into a single flat file
MSOD: Outcomes All Australian and NZ medical schools participating. Records of approximately 19,409 medical students so far. High response rates. Rich source of recent data for accurate workforce planning and medical education evaluation. Robust, agreed national data set, underpinned by nationally consistent definitions for key terms. Longitudinal tracking of educational and career paths. Rigorous and validated data handling. Ethically approved process for collection, linkage & research. Linkage adding value to other national datasets such as HWA clinical placements, national registration, etc. A national independent research resource. A data collection model that can be transferred to other contexts.
Study sample The sample (n=892) consists of all participants who completed the Exit Questionnaire in 2008-09 and completed PGY1 Questionnaire 2009-10 (inclusive ie. only participants that meet both these criteria). This constitutes 76.6% (1164) and 65.4% (1364) of the total participants who completed the EQ and PGY1 (respectively) in the years given above. 39.5% of the sample was male and 60.5% was female. This cohort is derived of participants from the following types of medical schools: Medical School Frequency 4 year Graduate Medical Schools 775 (86.9%) 5 year Undergraduate Medical Schools 117 (13.1%) 8
Choice of career In the Questionnaires, students/doctors are asked to nominate up to 3 choices of speciality careers they wish to undertake training in. The following are the choices of the participants in their Final Year EQ and towards the end of their Internship Choice Exit Questionnaire PGY1 Questionnaire Only 1 270 (30.3%) 365 (40.9%) 2 choices 32 ( 3.6%) 66 ( 7.4%) 3 choices 487 (54.6%) 409 (45.9%) No choices 103 (11.5%) 52 ( 5.8%) TOTAL 892 (100%) 892 (100%) 9
Choice of career specific disciplines SPECIALTY EQ-1 EQ-2 EQ-3 PGY-1 PGY-2 PGY-3 ADULT MEDICINE/INTERNAL MEDICINE 18.4 14.8 11.1 16.4 15.2 12.7 ANAESTHESIA 7.7 8.7 7.8 8.3 7.8 7.3 DERMATOLOGY 1.5 1.0 2.5 2.0 2.1 2.7 EMERGENCY MEDICINE 8.2 14.6 13.1 10.0 13.1 11.5 GENERAL PRACTICE 13.2 13.5 14.2 18.1 13.9 15.9 INTENSIVE CARE MEDICINE 2.0 4.8 6.8 2.4 12.6 9.8 MEDICAL ADMINISTRATION.3 1.3 1.2.0.4 2.0 NON-SPECIALIST HOSPITAL PRACTICE.3.4.8.4.4 1.5 OBSTETRICS AND GYNAECOLOGY 7.0 6.2 7.4 6.9 4.6 3.7 OCCUPATIONAL MEDICINE.6.0 1.0.0.2.2 OPHTHALMOLOGY 3.2 3.7 4.1 2.3 1.7 1.2 PAEDIATRICS AND CHILD HEALTH 8.6 10.6 7.8 5.0 7.8 5.4 PATHOLOGY 1.3 1.3 1.0 1.5 1.7 1.5 PSYCHIATRY 1.9 3.3 3.3 2.6 1.7 2.0 PUBLIC HEALTH MEDICINE.5 2.1 3.1.2 2.1 2.9 RADIOLOGY 1.1 1.9 2.1 2.4 3.4 4.9 REHABILITATION MEDICINE.9 2.1 2.1.2.4 2.7 RURAL AND REMOTE MEDICINE (ACRRM) 4.2 2.3 3.7 1.5 3.2 4.6 SURGERY 16.3 6.7 4.7 16.9 6.1 5.4 OTHER 2.8.6 2.3 2.7 1.7 2.2 TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 10
Observations Speciality EQ (Average) PGY1 (Average) Overall difference ADULT MEDICINE/INTERNAL MEDICINE 14.8 same 14.7 ANAESTHESIA 8.1 7.8 same DERMATOLOGY 1.7 2.3 marginal increase EMERGENCY MEDICINE 11.5 same GENERAL PRACTICE INTENSIVE CARE MEDICINE 12 13.6 16.0 increase 8.3 increase 4.5 MEDICAL ADMINISTRATION 0.9.8 same OBSTETRICS AND 5.1 decrease GYNAECOLOGY 6.9 OPHTHALMOLOGY 3.7 1.7 decrease PAEDIATRICS AND CHILD 6.1 decrease HEALTH 9 PATHOLOGY 1.2 1.6 marginal increase PSYCHIATRY 2.8 2.1 marginal decrease RADIOLOGY 1.7 3.6 increase REHABILITATION MEDICINE 1.7 1.1 decrease SURGERY 9.2 9.5 same 11
First choice of careers gender preferences SPECIALTY EQ1 MALE EQ1 FEMALE PGY1 MALE PGY1 FEMALE ADULT MEDICINE/INTERNAL MEDICINE 19.6 17.6 17.9 15.5 ANAESTHESIA 7.2 8.1 9.1 7.8 DERMATOLOGY 1.0 1.9 1.2 2.5 EMERGENCY MEDICINE 8.2 8.3 8.2 11.2 GENERAL PRACTICE 9.2 15.7 14.2 20.6 INTENSIVE CARE MEDICINE 2.6 1.7 2.4 2.4 MEDICAL ADMINISTRATION.7.0.0.0 NON-SPECIALIST HOSPITAL PRACTICE.0.4.0.6 OBSTETRICS AND GYNAECOLOGY 2.3 9.9 2.7 9.6 OCCUPATIONAL MEDICINE 1.0.4.0.0 OPHTHALMOLOGY 3.6 2.9 2.7 2.0 PAEDIATRICS AND CHILD HEALTH 5.2 10.8 3.0 6.3 PATHOLOGY 1.3 1.2 1.2 1.8 PSYCHIATRY 2.3 1.7 3.6 2.0 PUBLIC HEALTH MEDICINE 1.0.2.0.4 RADIOLOGY 2.3.4 3.0 2.0 REHABILITATION MEDICINE 1.3.6.0.4 RURAL AND REMOTE MEDICINE (ACRRM) 5.6 3.3 2.7.8 SURGERY 22.5 12.4 24.2 12.2 OTHER 3.3 2.5 3.6 2.2 Total 100.0 100.0 100.0 100.0 12
Definite first choice of careers gender preferences SPECIALITY EQ MALE (182) EQ FEMALE (250) PGY1 MALE (250) PGY1 FEMALE (290) ADULT MEDICINE/INTERNAL MEDICINE 14.3 11.6 16.4 18.6 ANAESTHESIA 6.0 6.8 8.8 9.3 DERMATOLOGY.5 1.2 1.2 2.8 EMERGENCY MEDICINE 9.3 7.2 6.4 10.3 GENERAL PRACTICE 7.1 17.6 16.0 26.6 INTENSIVE CARE MEDICINE 1.1.4 2.4 2.8 MEDICAL ADMINISTRATION 1.1 11.6.0.0 OBSTETRICS AND GYNAECOLOGY 2.7.8 2.8.3 OCCUPATIONAL MEDICINE.5 2.8.0.0 OPHTHALMOLOGY 4.4 10.0 2.8 11.7 PAEDIATRICS AND CHILD HEALTH 3.8 2.4 2.0 2.4 PATHOLOGY 1.6 2.0 1.6 7.6 PSYCHIATRY 2.2.4 3.6 3.1 RADIOLOGY 2.2.4 2.0 2.1 REHABILITATION MEDICINE 2.2 1.2.0.0 RURAL AND REMOTE MEDICINE (ACRRM) 4.9 4.4 2.8 1.4 SURGERY 30.8 16.8 26.4.7 OTHER 4.9 2.4 4.8.3 Total 100.0 100.0 100.0 100.0 13
University M Comparisons between career choices in disciplines and at the end of internship Speciality 1989 (63) 2009 (59) PGY1 2010 (68) ADULT MEDICINE/INTERNAL MEDICINE 15.3 23.5 53.7 ANAESTHESIA 0 8.5 11.8 DERMATOLOGY 0.6.0 2.9 EMERGENCY MEDICINE 10.8 6.8 5.9 GENERAL PRACTICE 15.6 11.9 13.2 INTENSIVE CARE MEDICINE 0 1.7 2.9 MEDICAL ADMINISTRATION 0 3.4.0 OBSTETRICS AND GYNAECOLOGY 1.6 11.9 8.8 OPHTHALMOLOGY 0 1.7.0 PAEDIATRICS AND CHILD HEALTH 0.6 6.8 5.9 PATHOLOGY 0.0 4.4 PSYCHIATRY 2.9 1.7 1.5 RADIOLOGY 2.7 1.7 5.9 REHABILITATION MEDICINE 0.0 1.5 SURGERY 7.6 16.9 10.3 OTHER 3.9 11.7 1.5 Total 100 100.0 100.0 14
Messages Workforce planning have to consider: Work-life balance opportunities in disciplines including part-time and shift duties and family-based requirements Acute medicine versus chronic care Training opportunities Perceived attractiveness of discipline especially salary Reality of clinical experience Role-modelling New scientific challenges and discoveries e.g. biologic therapies New disciplines and more clearly defined roles e.g. clinical genetics 15
Health Workforce responses and their effects on choice of careers Rural physicians to train for dual role Australian Doctor 5 October, 2012 Sarah Colyer The Federal Government has given $90,000 to a project to develop a new kind of physician for rural areas, who can work as a generalist in addition to their specialty area. The funding to the Royal Australian College of Physician s dualtrained physicians project follows warnings from the college that the current narrow specialisation of physicians is failing to address the broad needs of the ageing population and rising rates of chronic disease particularly in the bush. 16
Can we make this more structured and less opportunistic? Career counselling Ascertain students aspirations longitudinally (family, money, interests outside medicine) Personality tests/traits often helpful to narrow options Academic performance can we use this as surrogate for future performance (often for high achieving students) Skills and talents have the students developed clear aptitudes for certain types of work? Career Expo/Fair chance to speak to specialists in a number of areas so that definitive choices can be made. Flexibility preparedness for travel to other sites where job opportunities may be better Meet workforce needs and challenges 17
Tools to help students and trainees make decisions on career choice e.g. The Medical Specialty Aptitude Test in https://www.med-ed.virginia.edu/specialties/home.cfm Rank Specialty Score 1 thoracic surgery 48 2 nephrology 48 3 infectious disease 47 4 general internal med 47 5 plastic surgery 47 6 pathology 47 7 rheumatology 47 8 nuclear med 46 9 neurology 46 10 neurosurgery 46 physical med & 11 rehabilitation 46 12 occupational med 46 13 aerospace med 46 14 family practice 46 15 hematology 46 16 med oncology 45 17 endocrinology 45 18 allergy & immunology 45 19 psychiatry 45 20 preventive med 45 21 otolaryngology 45 22 orthopaedic surgery 44 23 ophthalmology 44 24 pulmonology 44 25 radiation oncology 44 26 dermatology 44 27 cardiology 44 28 gastroenterology 44 29 urology 43 30 general surgery 43 31 radiology 42 32 obstetrics/gynecology 42 33 emergency med 42 34 colon & rectal surgery 41 35 anesthesiology 40 36 pediatrics 38 18
Future Research Follow this cohort of graduates PGY3, PGY5 and PGY8. Include other cohorts in this research as their data become available. Develop an Australian specific career matching tool to include general as well as unique parameters including workforce needs. Utilise this tool and follow the graduates in their career choices and qualification. 19
Acknowledgements The research on which this presentation is based used data provided by the Medical Schools Outcomes Database and Longitudinal Tracking (MSOD) Project, Medical Deans Australia and New Zealand Inc. We are grateful to the medical students, graduates and doctors who participated. The MSOD project was possible due to funding made available by Health Workforce Australia (2011 onwards) and The Australian Government Department of Health and Ageing (2004-2011). MSOD staff Mr Nathaniel Hogan, Ms Rebecca Astles- Phillips and Ms Bal Kaur 20
Thank you