How can we develop and support positive medical graduate attributes and attitudes towards training and working throughout Scotland?
N.B. The information below is authored by the mini-project applicants, not by staff of the subject centre. This text represents the views and opinions of the mini-project team only, not those of the subject centre or its affiliates.
Principal investigator
Jennifer Cleland,Full list of project partners
Professor Gillian Needham, Dr Peter Johnston, Ms Fiona French, Dr Morven Wilson
Description
The well-documented problems with recruitment and retention of doctors in remote and rural areas of Australia (www.aihw.gov.au/publications/hwl/mlf04/mlf04.pdf) and Canada (http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/working_on/Kirby/rural.pdf) also applies in the remote areas of Scotland (Scottish Government, 2007; http://www.bma.org.uk/ap.nsf/Content/healthcarerural). There are approximately 900 medical students and 5600 doctors-in-training in Scotland currently, but we are not retaining sufficient numbers of trained doctors to deliver care effectively across Scotland.
A lack of desire to work in remote and rural areas of Scotland is apparent from undergraduate level: recent data collected from all 5th year medical students in Scotland as part of the Scottish Medical Careers Cohort study identified that most 5th years with FY1 training posts in the North of Scotland Deanery do not plan to train at ST level here. Analysis of data provided by applicants for specialty training in Scotland in 2008 revealed that the NES North Deanery (which consists of Grampian, Highland, Shetland, Orkney and Western Isles) is the least popular in the country. Similarly, the 2008 UK trainee survey conducted by the Postgraduate Medical and Education Training Board (PMETB) showed that all grades of trainee in the North Deanery were substantially less likely to indicate a desire to work in their current Deanery on completion of training compared to trainees in the West and South-East Deaneries. This recent data reflects an issue identified pre-MMC.
These data have obvious implications for retention of young doctors in Scotland, and meeting Scottish Government targets in terms of delivering trained doctors to provide remote and rural health care. However, robust studies of influences on recruitment into Scottish remote and rural (R&R) medicine are lacking: we have little or no knowledge about why students and trainee doctors in Scotland wish to train or work in certain locations or not in others. Is it simply because of where they are from originally, or are there other reasons related to their undergraduate experience, perceived limits on career progression or quality of educational experience? What influences medical students’ and young doctors’ decision-making regarding where they wish to train and work? Unfortunately, the work of the UK Medical Careers Research Group (http://www.uhce.ox.ac.uk/ukmcrg/) does not explore these issues in the Scottish context.
Thus, this application is for a qualitative study to supplement a prospective, longitudinal (medical student to first trained post) questionnaire survey led by the same applicants (funded by NHS Education for Scotland and supported by the Scottish Medical Deans’ Assessment Group (SMDAG)). An in-depth qualitative study is required to explore issues to gain a better understanding of factors influencing medical students’ and trainee doctors’ career aspirations and choices about where to train and learn, to identify if and how we can achieve the goal of retaining and/or attracting medical graduates to work throughout Scotland, including remote and rural Scotland, in the 21st Century. In terms of the Graduate attributes, if, and how, can we develop and support, through teaching and training, positive graduate attributes and attitudes towards training and working throughout Scotland.
Activities
Qualitative methodology (focus groups) will be used to collect data. They are a valuable method for investigating what people think and why (Kitzinger. BMJ. 1995; 311: 299-302).
Five focus groups of 4-8 people will be carried out with Foundation and ST doctors in the North Deanery. Participants will be selected to represent those training across the North: Aberdeen, Inverness, Highlands and Islands. Two additional focus groups will be carried out with Foundation and ST doctors in Glasgow, as PMETB data indicates that the vast majority of these doctors wish to stay in Scotland, specifically in the West, to explore potentially contrasting views and influences.
A semi-structured data collection schedule will be developed for structuring the discussion within focus groups.
The focus groups will be audio-taped with consent, and transcribed verbatim for analysis using framework analysis. Data from two focus groups will be analysed independently by a researcher and a project partner. Any discrepancies in coding will be discussed and consensus reached to generate a coding structure, then used to code the entire data set.
The seven focus groups will be carried out by March 2010, the analysis and write-up of the study completed by June 2010.
Aimed at
This study is aimed at collecting qualitative data from a sample of doctors in training in the North and West of Scotland Deaneries in 2009-2010.
The potential outcome of this work (teaching and training developments, and workforce planning) is national as it could benefit all Scottish medical students (n=approximately 900 per year) and doctors-in-training (n=approximately 5600, www.isdscotland.org/isd/5253.html, figures for September 2008) over a number of years.
This qualitative study, as part of the overall programme of research, has the potential to ultimately benefit patient care across remote and rural Scotland.
Outcomes
Objectives:
• To identify and explore, via focus groups with a sample of participants from the main study population (doctors in training in the North and West of Scotland Deaneries in 2009-2010):
o What factors influenced their careers choice in terms of locality of training post, and what factors underpin their plans for future locality choices in terms of training and employment?
Anticipated outcomes/materials:
• A paper for publication in a peer-reviewed medical education journal
• A presentation for a peer-reviewed medical education conference
• The collection of data to inform the next stage of the main programme of study (e.g., revision of the main study questionnaire)
• The collection of data to feed back to the SMDAG and NES to inform workforce planning, teaching and training developments.
Benefits to the disciplinary community:
If we can gain a clearer understanding of the influences on medical students’ and trainee doctors’ decision-making and attitudes towards locality and careers choices, the study, as part of the overall programme of research, has the potential to inform and ultimately benefit undergraduate and postgraduate medical training, as well as patient care, across Scotland.
Personal experience
The research team is made up of: Drs Jennifer Cleland, Morven Wilson and Peter Johnston, Professor Gillian Needham and Ms Fiona French. The applicants are also members of the Scottish Medical Careers Cohort Study Group:
Dr Jennifer Cleland is a Clinical Senior Lecturer in Medical Education and Primary Care, University of Aberdeen. She is Lead for Medical Education Research, University of Aberdeen, and heads the Clinical Communication vertical strands of the MBChB and BDS. She collaborates locally and nationally on medical education research and developing evidence-based teaching. She has published many medical education original research studies using survey and qualitative methodology in journals including Medical Education and Medical Teacher.
Dr Morven Wilson is a Senior Registrar in Anaesthetics and a former Clinical Teaching Fellow, Raigmore Hospital, Inverness. Her main research interest is remote and rural medicine. She lead author, with Dr Jennifer Cleland, of an article of a mixed methods (focus groups and questionnaire survey) study entitled Evidence for the acceptability and academic success of an innovative remote and rural extended placement. Rural and Remote Health 2008; 8: 960.
Dr Peter Johnston is a Consultant Pathologist at Aberdeen Royal Infirmary, Associate Postgraduate Dean, NHS Education for Scotland, North of Scotland Deanery, and Regional Specialty Advisor, Royal College of Pathologists. He chairs the Scottish Specialty Board for Training in Diagnostic Specialties. He has a special interest in sustaining rural training and services.
Professor Gillian Needham is Regional Postgraduate Dean for the North of Scotland, which is a region with a high proportion of rural and remote
placements. She has led a multi-professional work stream for NHS Scotland to develop support for remote and rural healthcare education (RRHEAL).
Ms Fiona French is a Research and Development Officer employed by NHS Education for Scotland and based in the North Region. She has worked in research for 15 years. Her main research interests are postgraduate training and workforce planning. In recent years, she has played a leading role in several large projects including surveys of consultants and GPs in NHS Scotland (2002 and 2006) and a study of the impact of Foundation training on trainees and the wider health care team. She is skilled in questionnaire design and qualitative and quantitative data analysis. She has published a variety of papers in peer-reviewed journals and presented at national and international conferences.
Ethical approval
Ethical advice and approval for the Scottish
Medical Careers Cohort Study questionnaire survey
has been obtained from the North of Scotland
Research Ethics Committee (NoSREC). If this
application for funding is successful, we will
submit a substantial amendment to the original
study protocol to NoSREC in order to ensure the
relevant permissions are obtained before we
approach potential participants.
Outcomes
Objectives:
• To identify and explore, via focus groups with a sample of participants from the main study population (doctors in training in the North and West of Scotland Deaneries in 2009-2010):
o What factors influenced their careers choice in terms of locality of training post, and what factors underpin their plans for future locality choices in terms of training and employment?
Anticipated outcomes/materials:
• A paper for publication in a peer-reviewed medical education journal
• A presentation for a peer-reviewed medical education conference
• The collection of data to inform the next stage of the main programme of study (e.g., revision of the main study questionnaire)
• The collection of data to feed back to the SMDAG and NES to inform workforce planning, teaching and training developments.
Benefits to the disciplinary community:
If we can gain a clearer understanding of the influences on medical students’ and trainee doctors’ decision-making and attitudes towards locality and careers choices, the study, as part of the overall programme of research, has the potential to inform and ultimately benefit undergraduate and postgraduate medical training, as well as patient care, across Scotland.
Contact details
Amount awarded: £5, 821
Subject centre project contact: Victor Ottaway
This proposal was funded under the Funded mini-projects from SFC institutions reflecting the new Quality Enhancement Theme: Graduates for the 21st century call
Reports and resources
Reports and articles will appear here once avaliable
