Medical Training Survey reveals culture needs addressing

According to more than 21,000 doctors in training who completed the 2020 Medical Training Survey (MTS), the quality of their training is generally high, but concerns persist regarding the culture of medicine.

The MTS is an annual, confidential, profession-wide survey of all doctors in training in Australia, funded by the Medical Board of Australia and developed collaboratively with stakeholders, including doctors in training. The 2020 survey had a strong response rate with 57% of doctors in training doing the survey, providing robust national data about the experience of doctors in training.

In broad terms, the 2020 MTS results are consistent with 2019 data. Medical Board of Australia Chair Dr Anne Tonkin said the MTS data were rich and provided fascinating insights.

“There’s a lot going well in medical training in Australia and we’re doing a lot of things right to keep producing doctors who can provide patients with high-quality care,” Dr Tonkin said.

“But there is serious work for agencies across the health sector to do to improve the culture of medicine,” she said.

In 2020, 87% of doctors in training who responded to the survey rated the quality of their clinical supervision very highly; 75% said their orientation was good or excellent; and 81% would recommend their current training position to other doctors.

Prevocational and unaccredited trainees value and rate highly the training they receive, but these training opportunities are limited. Dr Tonkin said there is an opportunity to provide prevocational and unaccredited trainees with greater access to training.

About 66% of all trainees reported that they work more than 40 hours per week but many value the extra training opportunities this provides. Nearly half of Australia’s international medical graduates (IMGs) with limited or provisional registration did the MTS (49%). Encouragingly, 83% of IMG respondents said they were very satisfied with their training experience.

Doctors in training who identified as Aboriginal and/or Torres Strait Islander rated their training slightly lower than the national response, found their training plans extremely useful if they had them, and reported higher levels of discrimination, bullying and harassment. Dr Tonkin said the results of revised questions about the culture of medicine in 2020 paint a clearer and disappointing picture, confirming that there is a lot still to be done in medicine and the wider health sector.

Bullying, harassment and discrimination

In 2020, 34% of doctors in training reported they had experienced and/or witnessed bullying, harassment or discrimination, consistent with 33% in 2019.

Nearly half of Australia’s interns (47%) experienced and/or witnessed bullying, harassment or discrimination, followed by 39% of prevocational and unaccredited trainees, 36% of specialist non-GP trainees, 23% of IMGs and 21% of specialist GP trainees.

The sources of the bullying, harassment and discrimination experienced by trainees was by consultants and specialists (51%), nurses or midwives (36%), and patients and/or patients’ family/carers (34%) — 66% of trainees said that they did not report the incident they experienced, and 78% did not report the incident they witnessed.

“For the future of our profession, we must all listen to what the thousands of trainees have told us and work together to build a culture of respect,” Dr Tonkin said.

“We must keep our trainees safe and make it safe for them to speak up. An urgent and shared commitment to this across medicine and the wider health sector will lead to safer patient care,” she said.

The impact of COVID-19

There were questions in the 2020 MTS about the impact of COVID-19. About 80% said the pandemic had impacted their training, with one-third of trainees overall reporting it having a negative effect. Nearly half said the impact on their training was mixed, and more than one-third said it had led to innovative ways to learn.

The board has prioritised trainee confidentiality — results are only published in a de-identified and aggregated format, and when there are 10 or more responses for any given question.

Click here to view the MTS interactive dashboard.

Image credit: ©stock.adobe.com/au/Robert Kneschke