Case Studies

“A safe working environment is critical to safe medical practice.”

That’s the view of Associate Professor Mitra Guha, Chair of the Royal Australasian College of Physicians’ (RACP) College Education Committee. She recognises how confidential, comparative data gathered through the MTS supports the RACP to improve training environments.

The RACP has been using data from the MTS, in conjunction with results of its own Physician Training Survey, to explore and address localised and systemic issues with trainee and educator safety and wellbeing.

Focusing locally, the RACP assesses survey data against pre-defined thresholds to identify training settings that may have notable trainee or educator safety or wellbeing concerns.

Taking a collaborative, quality improvement approach, the RACP works with leaders at these training settings to evaluate the evidence base, and then asks those leaders to identify actions taken to address the concerns. Training setting leaders have shown a strong commitment to listening to the concerns signalled through this feedback, further exploring issues and investing in actions to improve safety and wellbeing.

Systemically, reports from RACP trainees and educators indicate bullying, harassment, discrimination, and uncivil behaviours are significant issues within medicine.

In 2020, one in every five RACP trainees who responded to the MTS experienced these behaviours. The data shows not all events are being reported. Concerningly, those that are reported are not always addressed.

A further concern is the data shows that doctors are the main perpetrators of bullying, harassment, and discrimination.

In response, in November 2021, the RACP convened the Safe Training Environments Summit. Education and trainee leaders and invited guests agreed on a strategic approach to tackling bullying, harassment, and discrimination in physician training environments.

Summit participants explored the root causes of bullying, harassment, and discrimination and identified high-level strategies to address these. Dr Sally Langley, President of the Royal Australasian College of Surgeons, shared RACS’ experiences in dealing with these issues in surgical training programs. The Summit culminated in development of a leadership statement and prioritisation of the RACP’s key strategic areas for action. In coming months, the RACP will use these to form a strategic action plan.

The RACP will closely monitor future MTS results, continue to collaborate with training settings on localised issues and use survey findings to guide and evaluate its strategic action plan.

Specialist medical colleges are using MTS data to research the impact of COVID-19 on the development of Australia's future medical workforce.

The Council of Presidents of Medical Colleges (CPMC) saw first-hand the disruptions to medical training during 2020. It set up a research project using MTS data, to better understand the impacts on doctors in training and evaluate changes to training developed in response to COVID.

2020 MTS data revealed COVID had a mixed impact on training, creating uncertainty and reducing training opportunities, but also triggering innovation in training.

The CPMC research will use MTS results to inform policy recommendations to Australia's National Medical Workforce Strategy. Learn more.

Queensland Health is using data from the 2020 MTS to support their work on mental health and wellbeing of QLD doctors.

Results of the 2020 MTS reflect the views of 57 per cent of doctors in training in Australia. Rich MTS feedback is informing the work of the Queensland Health Wellbeing Working Group (the Wellbeing Working Group).

During 2021, the Wellbeing Working Group will be focused on developing strategies to prioritise and promote the mental health and wellbeing of Queensland medical practitioners and students.

The Working Group have identified the MTS results as an important data source to assist in the development of strategies and will create tailored reports using the interactive data dashboard on the website to source data pertinent to trainee insights on workplace environment and culture.

As response rates to other internal survey tools limit the insights available, including the relevance of particular issues across different groups of medical practitioners, the MTS data will be utilised to complement and address gaps in other relevant datasets by providing further insight into the experience of workplace environment and culture of QLD doctors in training.

Using the MTS online data-dashboard to filter aggregated national data and create tailored reports with current state and sometimes hospital specific feedback, the Working Group plan to analyse trainee feedback expressed in MTS data, to identify what trainees think is working well and what can be done better. Based on this and building on other data sources, the Group will develop and prioritise actions that will make a difference, consistent with the five pillars of coordinated action outlined in the Every Doctor, Every Setting National Framework.

As an example, one of the pillars in the national framework relates to improving training and work environments to reduce risk, with a particular target on safe and inclusive training and work environments where bullying, harassment and discrimination are not tolerated.

Click here for further information on the Every Doctor, Every Setting National Framework.

Australia’s health system is one of the best in the world. It provides quality, safe, and affordable health care and this contributes to Australians enjoying one of the longest life expectancies in the world.

Our community has a generally high opinion of the healthcare system and research suggests this has improved since 2008, with doctors ranking highly in the cohort of health care providers.

The public’s confidence has been built by generations of highly skilled and dedicated doctors providing service in local communities and specialist centres, but now more than ever it is under assault.

Covid -19 has heightened public attention on the medical community. Numerous high-profile cases of inappropriate behaviour, misdiagnosis, inadequate staffing, overburdened hospitals, and tragic health outcomes fuel growing concerns about the quality and effectiveness of doctors.

Mainstream and social media focus on failure, amplify these concerns. A case in point is most reporting of the 2020 Medical Training Survey results. Common mainstream media headlines and stories related how junior doctors were overworked, underpaid, harassed, and bullied. This is hardly a glowing endorsement of the medical training and development regime and is a legitimate problem that needs to be addressed. But it is equally true that 80% of respondents to the Medical Training Survey recommended their training program and their current workplace and rated the quality of clinical supervision and teaching sessions highly.

The Medical Training Survey is rich in information. Although in its infancy, it is being widely used to understand and improve various facets of the medical training system and workplace. These changes should reflect in future surveys creating a virtuous cycle of improvement.

The training received by doctors is a vital part of the accreditation system, which provides the community with a highly skilled, competent, and ethical workforce delivering safe, high quality patient care. Medical training is a critical component in maintaining and enhancing community confidence in the health system

While overwork, underpayment and bullying are unacceptable and need to be redressed, the Medical Training Survey primarily highlights the excellence of the current training system and must be a prime source for strengthening community confidence. Cut through in promoting the positive and improving aspects of the training survey in the mainstream media, is a critical success factor in that endeavour.

Using the data from the 2019 Medical Training Survey (MTS), the Australian Medical Association (AMA) Councils of Doctors in Training has released its first Specialist Trainee Experience Health Check (STHC).

The STHC provides a comparison of the training experience between different specialty training pathways and identifies areas of excellent experience as well as areas for improvement.

Improving exam feedback, providing access to mental health services, improving pathways to address bullying, harassment and discrimination, providing access to study leave and supporting employment at the endo of training are areas where an ongoing commitment at all levels of training is needed to ensure Australia continues to produce highly qualified doctors.

The AMA hopes that the STHC will be of value to medical colleges, training institutions and other key stakeholders. Click here to read the AMAs STHC.

Agencies across the health sector are using 2019 MTS results to shape medical training, and individual trainees are using the results to guide their training choices.

The Australian Medical Council (AMC) says the MTS has the potential to strengthen further the voice of trainees within its accreditation assessments and monitoring activities and help shape medical training.

Over time, the Medical Training Survey will enable the AMC to build a longitudinal view of how training programs are being experienced by trainees across Australia and whether College initiatives to improve training are having a positive impact from the trainees’ perspective

The Medical Training Survey will become an important data source in AMC accreditation processes, by bringing interns and trainees together with education providers and health services to review training against the AMC’s accreditation standards.

Published MTS results already enable education providers and health services to consider the experience of their trainees, relative to sector-wide results.

In 2020, the AMC has asked Colleges to reflect on 2019 MTS results and consider how, over time, they can be used in evaluation and quality improvement of training programs.

Read more about how the AMC will be using MTS results in accreditation to help secure high quality education in supportive training environments.