Survey shows positive signs for GPs in training

Jolyon Attwooll

3/02/2023 4:57:31 PM

The results of this year’s Medical Training Survey are broadly encouraging for general practice, but there are a few concerning trends.

GP in training
There was a positive response to the quality of teaching and supervision among GPs in training.

Better work–life balance, more flexible training, highly rated teaching and less chance of encountering bullying and harassment than other specialties: that was the good news for GPs in training from the results of the latest Medical Training Survey.

The results of the anonymous survey, which is carried out annually by the Medical Board of Australia and AHPRA and this year included a 56% response rate, were published this week. 

The RACGP’s National Director of Training, Associate Professor James Brown, noted several encouraging results, as well as a number of areas of concern.

The 86% positive rating for teaching quality given by RACGP respondents, which exceeded the overall national response (82%), particularly caught his attention. 

‘I was taken by the positive response to the quality of teaching and supervision, which is the core of training,’ Associate Professor Brown told newsGP

‘There was a positive response about the culture that the registrars experience and a high rating on the suitability of training for preparing for a career in general practice. 

‘Also, interestingly, there was quite a positive response to our assessment processes and given the challenges that they’ve had over the last few years, I thought that was excellent.’

With the responsibility for training GPs now transferred to the RACGP and the Australian College of Rural and Remote Medicine, Associate Professor Brown is keen to acknowledge the role of the Regional Training Organisations (RTOs). 

‘We need to recognise that training has been delivered by the [RTOs], and they need to be given credit for that. 

‘We are building our program based on the foundations that they have established.’

However, the survey has also attracted attention for the depressing picture it paints of the experience of Aboriginal and Torres Strait Islander medical trainees. 

It showed 55% of Aboriginal and Torres Strait Islander respondents reported experiencing or witnessing bullying, harassment, discrimination and racism. That compared to 34% of trainees overall, a situation described as ‘totally unacceptable’ by the Medical Board of Australia Chair Dr Anne Tonkin. 

As in previous years, fewer GPs in training reported experiencing and witnessing concerning behaviour in the course of their studies compared to other specialties.

While more than one in five of the medical trainees (22%) who responded to the survey said they had experienced bullying, harassment, discrimination and/or racism in the past 12 months, that number stood at 15% for GPs in training. 

Three in 10 medical trainees saying they had witnessed such behaviour, in contrast to 18% of those at the college. 

For Associate Professor Brown, however, that number remains too high even if it compares favourably to elsewhere.

‘Certainly, the issues of bullying, harassment and racism weren’t as prominent in our feedback,’ he said. 

‘However, they are present and that needs to be considered seriously because it’s completely unacceptable for registrars to be experiencing those things. 

‘While a significant amount of it related to interactions with patients, there was also bullying and harassment and racism reported within their workplace and among their colleagues. 

‘It’s key that in delivering the training program, we address this at all levels, in terms of the support that we give to registrars but also in our expectations and our training of supervisors and practices.’

Of GPs in training who said they experienced those behaviours, 47% said it was from a patient or their families – significantly more than the 40% figure reported overall. 

RACGP Aboriginal and Torres Strait Islander Health Chair Dr Karen Nicholls welcomed a positive increase in the participation rate of Aboriginal and Torres Strait Islander respondents in the overall survey, which increased from 158 in 2021 to 191 in 2022. 

However, she expressed her dismay at the results. 

‘It’s very disappointing, particularly seeing there’s been an increase in reports of bullying, harassment, racism and discrimination since the last survey,’ Dr Nicholls told newsGP

‘It’s also very worrying to note 29% of Aboriginal and Torres Strait Islander people who responded indicated that they may be looking for a future outside of medicine, which is much higher than average. 

‘If we create a safe place for our Aboriginal and Torres Strait Islander trainees, we will create a safe place for Aboriginal and Torres Strait Islander patients. 

‘If tackling racism does not become a higher priority, we will see more negative impacts on our patients, and it will further undermine a health workforce that is already under strain.’

Another worrying trend showed a dip in the percentage of respondents saying they wished to pursue a career in general practice, with only 11% of interns expressing an interest in the RACGP’s specialist training program. 

‘This is really problematic, and it’s something we intend to address by engaging strongly with medical schools and with hospital-based training,’ Associate Professor Brown said. 

‘We want to increase the presence of general practice experience and exposure to general practitioners to medical students and junior residents, so that will be a major driver for us.

‘There’s a lot of work to be done there because we know that general practice is a very satisfying career and it needs to be clearer and more obvious for prospective registrars.’

Meanwhile, the Australian Medical Students’ Association (AMSA) said it is ‘gravely concerned’ at the scale of harassment, discrimination and bullying among trainees as a whole, with AMSA Vice President Gabrielle Dewsbury calling it a ‘chronic failure of the institution of Medicine’. 

An AMSA spokesperson drew attention to the survey result that showed 70% of trainees who experienced the behaviours did not report them, with 55% of those saying they feared repercussions.

‘This horrifying statistic exposes a fundamental flaw in the healthcare profession indicating that we are still failing to protect clinicians who are most vulnerable to discrimination and racism,’ Ms Dewsbury told newsGP.

AMSA highlighted the ‘disproportionate impact’ on Aboriginal and Torres Islander healthcare professionals, and called for a culture of zero tolerance against discrimination as well as for cultural safety medical training for all health professionals. 

An AMSA spokesperson also said the organisation is ‘severely concerned’ about the decrease in medical students interested in general practice, and pointed towards 15 recommendations AMSA has released to help reverse the decline. 

Associate Professor Brown believes the responsibility the RACGP now has for GP training can help address that issue. 

‘We can make a real difference to the community and to our GPs in training,’ he said. ‘There’s lots of exciting things ahead of us.’

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