Workshop on working and training conditions of Junior Doctors

The European Junior Doctors (EJD), Medical Chamber of Nordbaden and Marburger Bund held a joint workshop on working and training conditions of Junior doctors focusing on Family and work issues and e.portfolio.

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Combining family and work
The workshop began with a presentation of Dr Frauke Gundlach, where she highlighted, that hospitals giving the possibility of working part-time for parents, implementing Re-entry programs after maternity/paternity leave and providing flexible conditions for taking care of their children are becoming more attractive for young doctors. Data of survey conducted by German doctors showed, that only small part of doctors are working part-time and majority of them are women, which suggests, that there are some negative stereotypes in society regarding male doctors working part-time. Dr Gundlach highlighted, that there is much more expensive for hospital to recruit new staff, than integrate one, who is back from parental leave. Presentation and followed discussion was completed by emphasising the importance of demanding rights and services to be able to combine work and family life.

Maternity and parental leave in Europe
Dr Tiia Mönttinen reminded, that legal framework of maternity-, paternity- and parental leave is considered to be adequately compensated if a total of 65% of previous earnings is being obtained during the period of leave. Then, data from the survey on pregnancy, maternity, paternity and parental leave held by EJD in 2014 been presented. Thirteen countries participated in the survey and it is clear, that there is no unified strategy across the Europe – the salary is being fully paid during pregnancy in all reviewed countries, but payment after birth varies, amount of parental leave also varies from 14 weeks to 3 years in some countries, employers must ensure healthy conditions for both mother and the foetus, but there are no mandatory restrictions. Dr Mönttinen finished her speech by giving an outlook on the future projects of the working group which include conducting a further survey and the update of the country cards, which are important for selection of training countries for Junior Doctors. A short round-table-poll showed that post-graduate training is only creditable in countries such as Germany, Malta and the UK, if more than 50% of normal working hours are being worked in part-time. However, working part-time is not common in most countries such as Spain, Italy, Lithuania and Slovenia.
 
Career planning with children
Dr Julia Grauer started the presentation with insight on framework conditions in Germany - parents can stay at home a total of three years without being dismissed, preserving 67% of the former income. Furthermore, one can stay at home up to ten days taking care of sick child. Every parent has right to work part-time and every child has a right to go to kindergarten. Dr Grauer highlighted some positive examples of child care conducted by hospitals. Programs for parents include reduced on-call duties, reduced child care costs for child minders and holiday care for children organised by hospitals. At the end of presentation there was emphasised, that child care cannot replace the role of parents and every step should be evaluated regarding the children’s needs. Medical students, who attended the workshop commented, that there never be the “right” time for children, but this should not prevent physicians from receiving children.

Pregnancy related work issues
Dr Sascha Reiff gave the presentation on behalf of Dr Clara Sofie Bratholm, he started with defining pregnancy related work issues and their impact on pregnancy - workload and long working hours, night shifts, infections and question regarding progression in PGT, if sick leave is required. Dr Reiff continued with presenting sent in answers to a short poll on legal framework for pregnant health care workers. He came up with the conclusion, that many European countries automatically exclude pregnant doctors from on-calls. Other countries such as the UK individually assess working regulations for every physician. This has the benefit of a better adjustment of needs for the respective doctor, but the downside of physicians’ wishes not always being granted by authorities. Dr Reiff added, that individual answers for each country will be assessed and included in the “country cards” for better demonstrability.

Panel discussion
During the panel discussion after morning session finished, there were highlighted, that hospitals tend to save money through granting parental leaves, but in countermove not employing doctors for substitution, also hospitals have problems filling night shifts since pregnant women and physicians working part-time tend to refuse to fill these. Dr Carsten Mohrhardt emphasised, that there is a difference between working night shifts, having the right not to and being able to exceptionally refuse night shifts, although normally having to work. Studies have shown that more workers tend to refuse night shift if this is “normal” and the right to refuse night shifts is fixed in the respective contract.

How would an ePortfolio look like in Utopia?
Dr Simon Rieder started the interactive discussion by introducing e.Portfolio as a collection of electronic evidence assembled and managed by a user. Its purpose is to demonstrate user’s abilities and create a platform for self-expression. He initiated the poll afterwards asking everybody to write down three points one thinks those are characteristics for perfect e.portfolio. The results of the poll finished the presentation and showed, that most people wished for e.Portfolios to be: Flexible and therefore transferable to new employers, transparent, easy to fulfil, cheap or payed for by administration, connected to- and updated automatically by the hospital software, extended for monitoring “soft skills”, available everywhere – “mobile ePortfolio”, able to include tutoring systems and tests for self-assessment.

Examples from the United Kingdom
Dr Kitty Mohan shortly presented the UK medical education system and continued with reporting on undergraduate e.Portfolios, mentioning, that there are 20 different versions of undergraduate NHS ePortfolio with more than 320,000 users. Medical staff in foundation training has access to a different type of ePortfolio. This includes a “Personal and Professional Development Plan” (PDP), meeting reports, assessments reflective reports. Additional evidence and the “Annual Review Competence Progression” (ARCP). ePortfolios are very important for future assessment. There are also specialists’ ePortfolios which are designed to record learning in all its forms and to facilitate development. Furthermore, they are used to “give structure and evidence to support training.” The tool is mandatory for all doctors and access has to be paid for. Dr Mohan concluded, that one system “from the day one enters medical school to the day one retires” should be established and the data protection aspect needs to be re-evaluated.

The Eucardia platform – it comes from the heart…
Prof. Reinhard Griebenow presented the “Eucardia” platform, which deals with training of medical specialties on EU level. The directive defines the training site, the trainer, the trainee and the duration of PGT.  It works on the basis of the EU-Directive 2013/55. Prof. Griebenow explained that in this platform competence is being assessed in different categories. The formative knowledge can be assessed by the “European Society of Cardiology eLearning platform” (ESCel 2), whilst summative being assessed via the European Exam of General Cardiology (EEGC). All the skills are being monitored by a list of procedures in the style of a logbook. The professional attitude is being checked by a modified 360° appraisals. The advantages of Eucardia over other systems is that it is fully web-based, independent from workplace, easily adaptable and user friendly. It ensures lifelong documentation, traceable and verifiable records and is compliant with German privacy protection law. Presentation was concluded by saying, that Eucardia offers a continuous document from start to end for every cardiologist using the program.

ePortfolios used in Lithuania
Dr Aurimas Peckauskas highlighted main problems in Lithuanian medical education system, such as – excessive preparation and emigration of medical specialists, double status (student and employee) of postgraduate trainee.
Vast majority of portfolios are paper based, which brings the problems of messy and often false logbooks. Despite of that, there are some initiatives to use e.portfolio in individual departments. Dr Peckauskas was glad, that there is an ongoing project, which should bring e.Portfolio for undergraduate trainees in Lithuanian university of health sciences, with some promise for postgraduate trainees as well.

Panel discussion
Summing up the afternoon session Dr Carsten Mohrhardt, Dr Sascha Reiff and Dr Julia Grauer agreed, that there is a big problem of validating the skills by supervisor and specialists should be taught how important e.portfolios are. Prof. Reinhard Griebenow expressed concern, that there will always have two documentation systems – one for doctor’s skills evaluation and another will have to record explicit data for malpractice insurance as well as retracing procedures.