Outcomes Report on
“The Continuum of Medical Education”
Junior Doctor's perspectives and future implications
Frankfurt, Germany – 11.01.2014
The European Junior Doctors (EJD) once again hosted a workshop in Frankfurt, Germany to focus on the Junior Doctors’ perspectives and implications of a particular subject. This time the topic was Medical Education, focusing on postgraduate training.
The participants included representatives from 8 countries (Croatia, Finland, France, Germany, Hungary, Malta, Portugal and Turkey) and Prof. Dr. Reinhard Griebenow,- President of UEMS Section of Cardiology.
Carsten Mohrhardt - EJD President & Dr. Hrvoje Vrazic - EJD Vice-President opened the workshop.
The first presentation was by Dr. Sascha Reiff, Malta who tackled the subject of “Assessment of Clinical Skills”. He gave an overview of the aim of assessments, how postgraduate training is shifting towards competency- and work-based assessments, and the various methods of assessments with their pros and cons. This was followed by a discussion on the challenges of assessment in postgraduate training throughout the different countries. One challenge that remains is how competencies can be measured that need to be achieved during postgraduate training. In some countries there is still no formalised system of in training assessments which provides a feedback for the Junior Doctor or has any significant impact on progression In other countries there are fully developed training programs with logbooks or even eportolios which serve as a collection of trainees’ learning activities.
Next, Dr. Diana Fernandes, Portugal - EJD Medical Workforce Committee Chair delivered a presentation on “Transitions in Medical Career”. In her introduction, she showed that during medical education, trainees pass through various transitions. This includes the transition from student to worker, and different transitions during postgraduate training with increasing levels of responsibility. She focused particularly on the transition from undergraduate to postgraduate training since this has been shown to have the highest rates of suicide in junior doctors. She showed that there are various triggers that may lead to stress and burnout. This leads to consequences to Junior Doctors who might not be as efficient as they would like to be, which might also affect patient safety since with reduced confidence comes a worse doctor-patient relationship. During the discussion that followed various methods where suggested that might help doctors in transition such as structured introductory programs or shadowing periods, and effective mentorship. For hospitals or clinics which are finding it difficult to recruit new staff, offering a facilitated transition as an incentive might help to attract Junior Doctors.
A survey conducted by EJD during 2012 showed that 2/3rd of the 14 countries who participated are aware of the difficulties felt by physicians during transition periods. In 2/3rd of the countries, universities provide a curriculum that enhances medical students’ preparation for training. In order to cope with this period there are local actions in 36% of the countries, national actions in 22% and both national and local actions in 29%. It was concluded, that questions concerning the awareness on transition periods in medical education, implementation and improvement of coping strategies, still remain unanswered. Transitional programs are important for Junior Doctors but even more so for patient safety.
Prof. Dr. Griebenow presented results from a survey regarding “Patterns of use and impact on decision making of different CME modalities” using data from UEMS CME database. His first point was to remark on the fact that while 96% of all CME activities are live-events such as conferences and working groups, 17% of all points are awarded for print and online CME activities. Survey results showed that the vast majority of participants graded activities in content, understand ability, time for discussion and quality as satisfactory to highly satisfactory. About 20-30% of participants also said that their management strategies were changed or further developed after participating in a CME activity which shows that the self-reported potential for change is there. The majority of participants stated that the activities met expectations and were rewarding considering all the resources invested to participate in them. An analysis was also done which assessed at what time online CME activities were performed. It could be shown, that the majority of CME activities were done in the evening hours and weekends with no significant differences between age groups.
In conclusion, current CME activities are of high quality and have a positive influence on the intention to change physicians’ behaviour. The majority are not performed during working hours but afterhours. Live CME activities in particular also have the added benefit of bringing together professionals and stimulating discussions on best practices which helps to further raise quality of care. However, in order for CME activities to be performed these need to be enforced.
The last presentation was done by Carsten Mohrhardt- EJD President on continuous recertification. He focused on the fact that doctors have both a duty and a right to keep themselves professionally updated and that CME/CPD is a prerequisite for quality improvement. Quality control on the other hand as would happen with the introduction of recertification of specialists has many potential pitfalls like the unsolved process of revoking a license.... There are also many other unanswered questions such as which should be the competent body that decides on recertification, who would carry the costs of carrying out recertification, who is going to set standards and how? In conclusion, he reiterated the EJD’s policy which opposes a system with recertification. Legal, methodological and resource problems related to recertification systems are overwhelming compared to any advantages that might be involved. On the other hand, CME/CPD activities are a supplement to the professional growth that takes place in practical, clinical everyday work, and each clinician can adapt their CME activities to ensure that they remain competent in their field of work.