Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway
Corresponding Author
Matthew McGrail PhD
University of Queensland Rural Clinical School, Rockhampton, QLD, Australia
Correspondence
Matthew McGrail, University of Queensland, Rural Clinical School, 78 Canning Street, Rockhampton, QLD 4700, Australia.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Project administration, Writing - original draft, Writing - review & editing
Search for more papers by this authorBelinda O'Sullivan PhD
University of Queensland Rural Clinical School, Toowoomba, QLD, Australia
Contribution: Investigation, Writing - review & editing
Search for more papers by this authorTiana Gurney PhD
University of Queensland Rural Clinical School, Toowoomba, QLD, Australia
Contribution: Investigation, Writing - review & editing
Search for more papers by this authorCorresponding Author
Matthew McGrail PhD
University of Queensland Rural Clinical School, Rockhampton, QLD, Australia
Correspondence
Matthew McGrail, University of Queensland, Rural Clinical School, 78 Canning Street, Rockhampton, QLD 4700, Australia.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Project administration, Writing - original draft, Writing - review & editing
Search for more papers by this authorBelinda O'Sullivan PhD
University of Queensland Rural Clinical School, Toowoomba, QLD, Australia
Contribution: Investigation, Writing - review & editing
Search for more papers by this authorTiana Gurney PhD
University of Queensland Rural Clinical School, Toowoomba, QLD, Australia
Contribution: Investigation, Writing - review & editing
Search for more papers by this authorAbstract
Objective
To review the selection policies and models used by speciality colleges to select candidates for entry to vocational training, exploring whether these processes are rural-focused.
Design
A systematic desktop audit of college selection processes and criteria was done via college websites (Australian Medical Council (AMC) requires selection information to be publicly available).
Setting and main outcomes
Material was extracted into a structured template, in 2020. Information extracted related to (i) training entry and selection steps; (ii) selection criteria and elements; (iii) rural-focused components; and (iv) rural outcomes. Findings were critically reviewed to explore their degree of rural focus.
Results
Of 14 specialist colleges included, rural-focused selection mostly related to college-led selection models rather than employer-led. Six colleges had rural-focused selection criteria (four college-led), with the Australian College of Rural and Remote Medicine strongest, utilising a ‘suitability assessment’ for rural practice. Of the remaining five, childhood background or rural work experience contributed between 5% and 20% of the curriculum vitae assessment. Of eight specialist colleges without rural-focused selection, six used employer-led selection models.
Conclusions
The majority of specialty colleges have no rural-focused selection criteria and colleges using employer-led models are weakest. Given that the colleges are required to adhere to the AMC's accreditation standards, it follows that the best way to mobilise change is by including rural selection policies within the AMC standards and requiring reporting of selection outcomes, regardless of the selection models used. This will substantially strengthen ongoing rural pathways in medicine.
REFERENCES
- 1 Department of Health. Scoping Framework for the National Medical Workforce Strategy. Australian Government; 2019. https://www1.health.gov.au/internet/main/publishing.nsf/Content/Health%20Workforce-nat-med-strategy. Accessed March 21, 2021
- 2McGrail MR, Russell D. Australia's rural medical workforce: supply from its medical schools against career stage, gender and rural-origin. Aust J Rural Health. 2017; 25(5): 298-305.
- 3O'Sullivan BG, Russell DJ, McGrail MR, Scott A. Reviewing reliance on overseas-trained doctors in rural Australia and planning for self-sufficiency: applying 10 years' MABEL evidence. Hum Resour Health. 2019; 17: 8.
- 4 KBC Australia. Independent evaluation of the Rural Health Multidisciplinary Training (RHMT) program. Final report to the Commonwealth Department of Health, May 2020. Orange, NSW: KBC Australia; 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/rural-health-rhmt-evaluation. Accessed March 21, 2021
- 5Ellaway RH, Malhi R, Bajaj S, Walker I, Myhre D. A critical scoping review of the connections between social mission and medical school admissions. BEME Guide No. 47. Med Teach. 2018; 40(3): 219-226.
- 6Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev. 2015; 6: Article No: CD005314.
- 7McGrail MR, Humphreys JS, Joyce CM. Nature of association between rural background and practice location: a comparison of general practitioners and specialists. BMC Health Services Res. 2011; 11: 63.
- 8Laven G, Wilkinson D. Rural doctors and rural backgrounds: how strong is the evidence? A systematic review. Aust J Rural Health. 2003; 11(6): 277-284.
- 9Kondalsamy-Chennakesavan S, Eley DS, Ranmuthugala G, et al. Determinants of rural practice: positive interaction between rural background and rural undergraduate training. Med J Aust. 2015; 202(1): 41-46.
- 10O'Sullivan BG, McGrail MR. Effective dimensions of rural undergraduate training and the value of training policies for encouraging rural work. Med Educ. 2020; 54(4): 364-374.
- 11Ostini R, McGrail M, Kondalsamy-Chennakesavan S, et al. Rural Physicians: Training and Professional Support Study. Toowoomba, QLD: University of Queensland, Rural Clinical School; 2019.
- 12McGrail MR, O'Sullivan BG, Russell DJ, Rahman M. Exploring preference for, and uptake of, rural medical internships, a key issue for supporting rural training pathways. BMC Health Serv Res. 2020; 20: 930.
- 13Patterson F, Roberts C, Hanson MD, et al. 2018 Ottawa consensus statement: selection and recruitment to the healthcare professions. Med Teach. 2018; 40(11): 1091-1101.
- 14Murray RB, Larkins S, Russell H, Ewen S, Prideaux D. Medical schools as agents of change: socially accountable medical education. Med J Aust. 2012; 196(10): 653.
- 15Lindsay T. Career cliff: an end to the Australian training model? MJA Insight. 2019. https://insightplus.mja.com.au/2019/6/career-cliff-an-end-to-the-australian-training-model/. Accessed March 8, 2021
- 16Roberts C, Khanna P, Rigby L, et al. Utility of selection methods for specialist medical training: a BEME (best evidence medical education) systematic review: BEME guide no. 45. Med Teach. 2018; 40(1): 3-19.
- 17Dore KL, Roberts C, Wright S. Widening perspectives: reframing the way we research selection. Adv Health Sci Educ. 2017; 22(2): 565-572.
- 18Gennissen LM, Stegers-Jager KM, de Graaf J, Fluit CR, de Hoog M. Unraveling the medical residency selection game. Adv Health Sci Educ. 2021; 26(1): 237-252.
- 19Glick S. Selection for entry to medicine and specialist training. Med Teach. 2015; 2(5): 443-447.
- 20Larkins S, Michielsen K, Iputo J, et al. Impact of selection strategies on representation of underserved populations and intention to practise: international findings. Med Educ. 2015; 49(1): 60-72.
- 21Hay M, Mercer AM, Lichtwark I, et al. Selecting for a sustainable workforce to meet the future healthcare needs of rural communities in Australia. Adv Health Sci Educ. 2017; 22(2): 533-551.
- 22Fox GJ, Arnold SJ. The rising tide of medical graduates: how will postgraduate training be affected? Med J Aust. 2008; 189(9): 515-518.
- 23 Australian Competition & Consumer Commission, Australian Health Workforce Officials Committee. Report to Australian Health Ministers: Review of Australian Specialist Medical Colleges. Canberra, ACT: Commonwealth of Australia; 2005. https://www.accc.gov.au/system/files/Review%20of%20Australian%20specialist%20medical%20colleges%20July%202005_0.pdf. Accessed March 21, 2021
- 24Lawson KA, Gregory AT, VanDer Weyden MB. The medical colleges in Australia: besieged but bearing up. Med J Aust. 2005; 183(11/12): 646-651.
- 25Brennan P. Trainee Selection in Australian Medical Colleges. Canberra, ACT: Medical Training Review Panel, Commonwealth Department of Health and Family Services; 1998.
- 26Fors M. Geographical narcissism in psychotherapy: countermapping urban assumptions about power, space, and time. Psychoanal Psychol. 2018; 35(4): 446-453.
- 27 Australian Medical Council. Standards for Assessment and Accreditation of Specialist Medical Programs and Professional Development Programs by the Australian Medical Council. Canberra, ACT: AMC; 2015. https://www.amc.org.au/wp-content/uploads/accreditation_recognition/specialist_edu_and_training/assessment/standards_for_assessment.pdf. Accessed March 21, 2021
- 28 Australian Government Department of Health. General Practice Training in Australia: The Guide. Canberra, ACT: Department of Health (Australian General Practice Training program); 2020. https://www.health.gov.au/resources/publications/general-practice-training-in-australia-the-guide. Accessed March 21, 2021
- 29Wakerman J, Humphreys JS. “Better health in the bush”: why we urgently need a national rural and remote health strategy. Med J Aust. 2019; 210(5): 202-204.
- 30O'Sullivan B, McGrail M, Russell D. Rural specialists: the nature of their work and professional satisfaction by geographic location of work. Aust J Rural Health. 2017; 25(6): 338-346.
- 31May J, Walker J, McGrail M, Rolley F. It's more than money: policy options to secure medical specialist workforce for regional centres. Aust Health Rev. 2017; 41(6): 698-706.
- 32Olsson C, Kalen S, Ponzer S. Sociological analysis of the medical field: using Bourdieu to understand the processes preceding medical doctors' specialty choice and the influence of perceived status and other forms of symbolic capital on their choices. Adv Health Sci Educ. 2019; 24(3): 443-457.
- 33O'Sullivan B, Joyce C, McGrail MR. Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution. Hum Resour Health. 2014; 12: 50.
- 34 Australian Government Department of Health. National Health Workforce Dataset Canberra; 2019. https://hwd.health.gov.au/datatool.html. Accessed August 20, 2020.
- 35Rourke J, Dewar D, Harris K, et al. Strategies to increase the enrollment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada. Canad Med Assoc J. 2005; 172(1): 62-65.
- 36Lennon MJ, O'Sullivan BG, McGrail MR, Russell DJ, Suttie JJ, Preddy J. Attracting junior doctors to rural centres: a national study of work-life conditions and satisfaction. Aust J Rural Health. 2019; 27(6): 482-488.
- 37 Australian Medical Association Council of Doctors in Training. How Accreditation Practices Impact on Building a Rural Medical Specialist Workforce (submission to Department of Health consultation). Canberra, ACT: Australian Medical Association; 2019. https://ama.com.au/submission/how-accreditation-practices-impact-building-rural-medical-specialist-workforce. Accessed March 21, 2021
- 38 Australian Government Department of Health. Review of the Specialist Training Program and the Emergency Medicine Program: Final Report. Canberra, ACT: Department of Health; 2017. https://www1.health.gov.au/internet/main/publishing.nsf/Content/E47B2272ABFC709CCA257BF0001F510C/$File/Review%20of%20the%20STP%20and%20EMP%20Program%20-%20March%202017.pdf. Accessed March 21, 2021
- 39Sen Gupta T, Manahan DL, Lennox DR, Taylor NL. The Queensland Health Rural Generalist Pathway: providing a medical workforce for the bush. Rural Remote Health. 2013; 13: 2319.
- 40 Australian Government Department of Health. Regional Training Hubs Canberra. Department of Health; 2019. https://www1.health.gov.au/internet/main/publishing.nsf/content/regional-training-hubs. Accessed November 25, 2020
- 41Runge CE, MacKenzie A, Loos C, et al. Characteristics of Queensland physicians and the influence of rural exposure on practice location. Intern Med J. 2016; 46(8): 981-985.
- 42Chong A, Kiroff G. Preparing surgeons for rural Australia: the RACS Rural Surgical Training Program. ANZ J Surg. 2015; 85(3): 108-112.
- 43Bingmer K, Ofshteyn A, Bliggenstorfer JT, Steinhagen E, Stein SL. Where is the leak in the surgeon pipeline? Am J Surg. 2020; 220(5): 1174-1178.
- 44Gardner AK. How can best practices in recruitment and selection improve diversity in surgery? Ann Surg. 2018; 267(1): e1-e2.
- 45 Australian Medical Council. Accreditation Report: The Training and Education Programs of the Royal Australasian College of Surgeons. Canberra, ACT: AMC; 2017. https://www.amc.org.au/wp-content/uploads/accreditation_recognition/specialist_edu_and_training/report/2017_surgeons_report.pdf. Accessed March 21, 2021
- 46 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists ( RANZCOG ). 2019 Activities Report. East Melbourne, Vic.: RANZCOG; 2020. https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/About/RANZCOG-Activities-Report-2019-2020.pdf. Accessed March 21, 202
- 47McGrail M, O'Sullivan BG. Faculties to support general practitioners working rurally at broader scope: a national cross-sectional study of their value. Int J Environ Res Public Health. 2020; 17:4652.
- 48McGrail MR, O'Sullivan BG, Bendotti HR, Kondalsamy-Chennakesavan S. Importance of publishing research varies by doctors' career stage, specialty and location of work. Postgrad Med J. 2019; 95(1122): 198-204.