Tag: psychiatry

  • Psychiatrists Australia. Good Job Prospects in Psychiatry.

    Psychiatrists Australia. Good Job Prospects in Psychiatry.

    For psychiatrists, Australia presents excellent job prospects. And it really has been this way for a long, long time. As a Fellow of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) you can literally work anywhere in Australia and pretty much in any particular field, whether that be general psychiatry or something specific like a child and adolescent psychiatry or working in public or private or even both. Having spent a fair amount of my career filling positions in psychiatry I wanted to share my experience and advice with you.

    In answer to the key question. How does one become a psychiatrist in Australia? Well, to work as a psychiatrist in Australia, you must obtain a Fellowship of the Royal Australian and New Zealand College of Psychiatrists (the RANZCP). For locally-trained doctors, this involves completing a medical degree, at least one year internship, and a minimum of 5 years of training with the RANZCP. For specialist international medical graduates (IMGs) you must apply to the RANZCP for specialist recognition of your overseas training and experience.

    Let’s look at psychiatry careers now in a bit more depth.

    There are lots of job vacancies for both local as well as overseas trained psychiatrists in Australia.

    There are lots of job vacancies for Psychiatrists in Australia (as there is in most other parts of the world). Mental health is a growth area, although arguably it’s more accurate to say that we are just now realizing how important it is relative to somatic medicine.

    This all makes the task of those recruiting to Psychiatry positions tricky. I have had personal experience with this in past roles and have been quite successful in managing to put together strategies to fill positions. In Australia, it is quite common for recruiters to have a strategy of filling positions from international medical graduates (IMGs).

    If you are an IMG Psychiatrist or even an IMG trainee in some cases. Then you will find that there are plenty of opportunities available to you in Australia. In fact, psychiatry is possibly the most accessible medical specialty for IMGs to access in this country.

    In this blog post, I wanted to share my experience with you and highlight some tips. Here’s a summary of what we will discuss about the prospects of IMG doctors working in psychiatry in Australia:

    1. There are a number of vacant psychiatry consultant positions as well as vacant psychiatry trainee posts all year round in Australia.
    2. Unlike the specialist pathway for most other specialties, if you are an IMG psychiatrist you must have a job offer first before the RANZCP will consider your application, this is a good thing.
    3. The majority of specialist psychiatrists from Competent Authority countries will likely be found to have substantial comparability and specialist psychiatrists from other countries are likely to be found partially comparability although substantially comparable is not out of the question.
    4. If you are a trainee psychiatrist from the United Kingdom, Rep Ireland, Canada or the United States you will easily find a spare training post to fill under the competent authority pathway process.
    5. Whilst the prospects are very good you do need to be sincere, prepared to do some work to make yourself an attractive candidate and be prepared to be a little bit flexible, particularly in where you might work for your first job.

    If you are excited so far then you may wish to fill out the quick survey below where we can provide you with an immediate quick appraisal of your prospects, as well as review your career profile in more depth for you.

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    With that synopsis out of the way let’s dive further into the detail.

    What does a psychiatrist do in Australia?

    According to the RANZCP a psychiatrist, you will be able to:

    listen to and provide expert care for vulnerable people and their families and work to prevent, diagnose and treat mental health conditions, lead teams of other doctors and health professionals, research to lead breakthroughs in psychiatry and mental health, foster new generations of psychiatrists, provide expert opinion to the community, government and courts.

    How do Australian doctors become psychiatrists?

    For an Australian doctor to become a psychiatrist they need to:

    • complete a medical degree
    • do on-the-job training in a hospital for at least 12 months, i.e. complete an internship
    • enrol and complete training in the medical specialty of psychiatry with RANZCP.

    Specialty training is a minimum of 5 years and leads to the Fellowship of RANZCP, the FRANZCP. Whilst the RANZCP still views the FRANZCP as a generalist qualification there are a number of Advanced Training programs or certificates that you can undertake to extend your knowledge in certain aspects of psychiatry, including child and adolescent, consultation-liaison, psychotherapy, forensics, old age to name a few.

    How do overseas training programs align with the RANZCP?

    Because being a psychiatrist is still considered to be mainly a generalist role in Australia most overseas specialty programs will align well with the RANZCP because these are also fairly generalist in their approach in the main as well.

    There are sometimes some exceptions. For example, in the United States, it is possible to train primarily as a child and adolescent psychiatrist with little or no adult experience.

    And occasionally when IMG psychiatrists apply to the RANZCP they are found to be a bit lacking in certain experiences that are a requirement here in Australia. Again, the most notable is the requirement to do at least 6 months of child and adolescent psychiatry training. This is however rarely a deal-breaker and usually only results in an extra recommendation of some additional time in child and adolescent psychiatry as part of the supervised component of the specialist pathway.

    What are the chances of getting a job as a Psychiatrist in Australia?

    Again, according to the RANZCP:

    The likelihood of finding a job as a psychiatrist is very high. There are not enough psychiatrists to meet demand, especially in rural areas.

    ranzcp.org

    In fact you don’t really even need to look at rural areas of Australia. As you can see by this recent shot from one medical recruitment company website.

    psychiatrists australia
    courtesy of Elective Recruitment

    As you can see from above there are both consultant (Staff Specialist) roles available as well as trainee roles (Registrar) in major capital cities such as Perth and Canberra and regional coastal areas.

    What can you earn working in Psychiatry in Australia?

    The above image also gives you an indication of the salary packages, which for Consultant Psychiatrists range from $300K to the high $400K.

    Sometimes specific additional incentives are applicable for psychiatrists and I was recently successful in obtaining a package of almost $500K for a particular psychiatrist. This is one of the reasons why being open to working in regional areas may make sense as your package may be better and generally your standard of living (particularly housing costs) will be much lower.

    On top of the package for IMG Psychiatrists, employers are often also prepared to help with moving costs and may also pay for the cost of applying to the RANZCP from your professional development fund.

    Whilst the pay packets for trainee psychiatry doctors are obviously not nearly as large as for consultants, you may still earn a bit more than the annual salary through performing overtime shifts (which are generally paid at 2x the hourly rate) and it is not unheard of employers also offering to cover some moving costs for trainee doctors as well.

    What qualifications do you need to work in a Psychiatry job in Australia?

    Your qualifications will be assessed by the RANZCP. In general, you will need some form of postgraduate qualification that is preferably at least 4 years duration.

    For the UK/Ireland – MRCPsych combined with the CCT in the UK or CSCST for Ireland.

    For Canada, you will require a Certificate in Psychiatry from the Royal College of Physicians and Surgeons of Canada.

    For the USA, you will require a Certificate of the American Board of Psychiatry and Neurology.

    For India, you will need a minimum of an MD or equivalent in Psychiatry, preferably you will do more than 3 years training. The addition of the Diplomate of the National Board is generally seen as a good addition.

    For Sri Lanka, you will need a minimum of MD in Psychiatry recognised through the Postgraduate Institute of Medicine and be board certified as a psychiatrist via the Sri Lankan Medical Council.

    What is the process for obtaining specialist recognition as a Psychiatrist in Australia?

    The process is the same as for other specialist IMGs. Your educational qualifications and training as well as your specialist practice will be assessed by the RANZCP for comparability.

    If you are deemed to be within 12 months of becoming a psychiatrist, you will be offered substantial comparability, which is the best outcome as this generally requires you to work as a specialist under peer review by current Fellows of the RANZCP for 12 months.

    If you are deemed to be within 24 months of becoming a psychiatrist, you will be offered partial comparability. This is the next best outcome and generally requires you to work in an appropriate Advanced Trainee position, as well as under peer review by current RANZCP Fellows. It will also require you to undertake a range of assessments and activities as well as sit for written and clinical examinations.

    If you are not deemed to be able to become a psychiatrist within 24 months you will be found not comparable. This means that you need to consider alternative pathways for registration and working in Australia.

    RANZCP assessment requires a job offer
    from RANZCP SIMG Assessment Form

    One key difference from the process of specialist assessment for other colleges is that the RANZCP requires you to have an offer of an appropriate position first before considering your specialist pathway application.

    Whilst this may seem initially restrictive it is probably better. Because it reduces the number of specialist IMGs who are deemed comparable but are unable to gain an appropriate job offer. It also means that you are more likely to be supported by your employer to go through the RANZCP assessment process.

    Whilst it is not absolutely guaranteed. Being interviewed successfully for a position as a psychiatrist in Australia will generally mean that the RANZCP will also find you comparable.

    What types of comparability outcomes are likely for international psychiatrists in Australia?

    As can be seen in the images below taken from the most recent Medical Board of Australia report the majority of specialist IMG applications to the RANZCP are deemed substantially comparable with a significant number deemed partially comparable and only a small number seen as not comparable.

    psychiatrists australia
    Outcome of interim assessment 2019 by college.

    Does your country of training have any impact on your prospects for psychiatry jobs in Australia?

    Whilst we don’t have figures by country of IMG versus the RANZCP assessment process it’s my experience that specialist psychiatrists from the competent authority countries are generally found to be substantially comparable. Specialist psychiatrists from other countries are more likely to be found substantially comparable, however, it depends on your individual circumstances and it is not uncommon for specialist psychiatrists from India, Sri Lanka, and South Africa to be found substantially comparable at times.

    Empirical evidence for this exists when you look at the overall comparison between specialists from India and the UK in the same report.

    specialist recognition outcomes
    Outcome of Interim Assessment 2019 by country.

    What do you need to demonstrate if you want to work as a Psychiatry Trainee in Australia?

    In order to convince an employer that you are suitable to work in a trainee psychiatry role you generally need some prior psychiatry trainee experience in your own country.

    Because the process of becoming registered under the competent authority pathway is more streamlined and because the training programs in the competent authority countries are similar to that in Australia, trainee doctors with psychiatry experience in the UK, Ireland, Canada, or the US tend to be preferred by Australian employers when it comes to filling vacant trainee positions that have not been able to be filled by local graduates.

    Whilst it is not impossible for trainee psychiatry doctors from other countries to also obtain posts it is more difficult as the process of gaining registration is more complex. If you have significant experience as a trainee psychiatrist, you may be able to obtain a position for a maximum of 2 years under the short-term specialist medical training pathway.

    Is there recognition of prior learning for IMG trainees?

    Colleges have become better at assessing trainee doctors from other countries for recognition of prior learning (RPL). In fact, I recently assisted a trainee doctor from the UK to obtain 2 years and 7 months from their 5-year RANZCP psychiatry training program.

    That being said RPL generally reduces the amount of experience you may have to undertake and doesn’t normally excuse you from the key RANZCP examinations. The end effect may be to compact the number of assessment requirements you need to complete in the remaining time.

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    Some Tips For Securing A Psychiatry Post In Australia.

    Thus far it probably sounds like being able to work as a psychiatrist in Australia is a bit of a laydown misere. And whilst it is true that psychiatry is one of the top medical specialties that employers are regularly trying to fill in Australia. It is not just a matter of sending off a quick email with a CV that hasn’t been updated in a few years. There is still a bit of work ahead of you.

    Here are my recommendations for what you should do if you are keen on working in psychiatry in Australia.

    1. First off, ensure that you have an up to date and employer-friendly resume. This should be around 3 to 6 pages depending on your experience. And you should make sure wherever possible you tailor it to individual job openings. If you are needing tips on your resume (CV) we have several posts about this matter on the blog, as well as a service for helping you redo your resume if you would like some assistance with this key document.
    2. Second, if you are going to apply for a specialist role it’s worth reviewing the documentation on the RANZCP website to see if you will be eligible. And we also have a handy free short course on the specialist pathway that you can take as well.
    3. Third, whilst it is sometimes possible to score a post in a major Australian city like Sydney or Melbourne. If you are too prescriptive about where you want to work you are very likely to severely limit your chances and miss out. Bear in mind that once you complete your first year or two under supervision you will normally then be eligible for either specialist registration or general registration. At this point, you can often move jobs and locations more easily. So the key message here is to be open to all possibilities for your first position. You may even like working in regional Western Australia or the North West Coast of Tasmania!
    4. Fourthly. And following on from the above point. Whilst it is possible to directly approach employers for posts in psychiatry. This is only really about 50% of the job market. It is often unclear which publicly advertised positions are open to IMG doctors and employers are also often directly working with medical recruitment companies to fill vacant spots. For this reason, I generally recommend that you do contact a medical recruitment company if you believe you are eligible for a specialist position as an IMG or a trainee psychiatry doctor from one of the competent authority countries. If you fill in the survey below we can put you in contact with our recommended medical recruitment company.
    5. Fifth and finally. If an employer is interested in you they will invite you for an interview. This may be the first time you have sat a job interview in sometime and will almost certainly be the first job interview you have sat in Australia. You may be a little nervous and it will be important to give an impression. You may therefore want to consider getting some assistance by way of some interview coaching beforehand.

    Related Questions

    Can overseas doctors work as a psychiatrist in Australia?

    Yes. There are lots of opportunities and vacant positions for suitably qualified psychiatrists from other countries (IMGs) to work in psychiatry jobs in Australia. There are also numerous openings for appropriately experienced psychiatry trainees.

    Do psychiatrists make good money?

    Yes. consultant psychiatrists will generally earn at least $350000AUD if they work full time. And psychiatrists are 5th on the list of top salary earners in Australia.

    What qualifications do you need to become a psychiatrist in Australia?

    To become a psychiatrist you need to:
    1. complete a medical degree.
    2. do on-the-job training in a hospital for at least 12 months (internship).
    3.enrol and complete training in the medical specialty of psychiatry with RANZCP.
    Qualified psychiatrists from other countries apply to the RANZCP for assessment of their specialist recognition under the specialist pathway for medical registration.

    How much does a consultant psychiatrist earn in Australia?

    As we have highlighted in this article for a permanent full time public health service position you can be expecting to earn around $350,000AUD to $450,000AUD per annum.
    Psychiatrists also do relatively well in the private sector and you can potentially earn far more than in the public sector and up to $800,000AUD. As we have highlighted in this related blog post, psychiatrists are 5th on the list of top ten professions by earnings according to the Australian Tax Office.

    How long does it take to become a psychiatrist in Australia?

    To become a psychiatrist you: study medicine and complete a medical degree (4-6 years) do on the job training in a hospital after your degree (1 year) enrol and complete specialist training in psychiatry (5 years) with RANZCP. So all up its at least 10 years, generally longer.

    What field of psychiatry makes the most money?

    As is generally the case with other medical specialties, consultant psychiatrists will make significantly more money than other health professionals working in the mental health field, e.g. psychiatry trainees, psychologists, social workers and nurses.
    It’s hard to say which actual field of psychiatry makes the most money. There are certain subspecialties in psychiatry that are more limited to working in public hospital settings, for e.g. consultation-liaison psychiatry, so these consultants will earn a bit less than someone working in the private sector. Subspecialties that lend themselves best to private sector work, and which will therefore, have higher earning potentials, including forensic psychiatry and adult psychiatry.
  • Salary of Australian Doctors | Doctors Pay Scale

    Salary of Australian Doctors | Doctors Pay Scale

    Not surprisingly, one of the more popular topics on this blog is the subject of income or salary of Australian doctors. We have recently written about how much an Intern is paid and how much a Resident is paid. Of particular interest to many is how much a doctor earns when they have completed all their training and achieves the status of a Surgeon or a Physician or a General Practitioner or one of the many other specialties in Australia. A recent report from the Australian Tax Office has confirmed that doctors in Australia are amongst the best paid in the country.

    If we take our entry point as internship and our peak point an Australian surgeon. Then a good guide as to how much one can earn as a doctor in Australia is somewhere between $68,000 AUD and $395,000 AUD per annum.

    Of course not every doctor will earn $395,000 per annum and there are many factors that affect the earnings of a doctor. And a number of doctors also earn even more than $395,000. Let’s dive into the earnings in a bit more detail and also look at some of the cost factors for doctors.

    Surgeons, Anaesthetists, Physicians, Psychiatrists and ‘Other Medical Practitioners’ Amongst the Top Ten Earners in Australia.

    What is impressive is that 5 of the ten top occupations by earnings come from the medical profession, with Surgeons leading with an average taxable income of $394,866, followed by Anaesthetists in second with $367,343 and Internal Medicine Specialists in third with $299,378. Psychiatrists are in fifth with $216,075 and ‘Other Medical Practitioners’ in sixth with $204,387.

    OccupationAverage Taxable Income
    Surgeons$398,866
    Anaesthetists$367,343
    Internal Medicine Specialists$299,378
    Financial Dealer$261,008
    Psychiatrist$216,075
    Other Medical Practitioner$204,387
    Judicial / Legal Professionals$195,703
    Mining Engineer$167,345
    CEO or Managing Director$157,643
    Engineering Manager$147,451

    This is even more impressive when one considers that the ATO lists around 1,100 occupations to select from when one compiles their tax return.

    You have probably already spotted one potential problem with these figures, which is that they rely on the person completing the tax return to select the appropriate occupation.

    The other possible occupations for doctors to choose under the ATO categories are: General Medical Practitioner and Doctor specialist – type not identified. Both of which earned about $140,000 AUD per annum in 2016/17.

    Presumably most surgeons select surgeon for an occupation and anaesthetists select anaesthetics etcetera. However, its not clear what occupations trainee doctors select. Most will likely select “Other Medical Practitioner”. Some may select the specialty that they are training in and this will reduce the overall average as trainee doctors earn less than specialists.

    There were 28,307 doctors who selected “Other Medical Practitioners” in 2016/17, versus for e.g. 3,951 for Surgeons, so this number would incorporate most of the trainee doctors in Australia. But it might also be joined by for e.g. Emergency Physicians and Obstetricians and Gynaecologists, who don’t have another obvious occupation to select. Not many doctors selected Doctor specialist -type not identified (only 37).

    In any regard its fairly plausible to say that trainee doctors are also in the top ten earners in Australia.  And this certainly stacks up when one considers the publicly available information about trainee doctor salaries in Australia and one factors in overtime.

    The average of these salaries will also be influenced by doctors working part-time and doctors working in the public sector (although as we show below by not too much).

    Some interesting information is discerned when one digs into the detail provided by the ATO.

    The ATO provides more detailed breakdowns on a State or Territory level so let’s look at Surgeons, Anaesthetists, Physicians and Psychiatrists in NSW:

    OccupationAverage taxable incomeAverage salary or wage incomeAverage total income
    Surgeons$324,965$65,881$340,511
    Anaesthetists$335,301$68,794$348,323
    Physicians$283,577$63,489$296,034
    Psychiatrists$213,160$58,305$224,159

    So what we notice here is that there is a very low level of average salary or wage income compared to the actual salary. This likely reflects the fact that many specialists do not earn the majority of their income as a paid wage but rather through contractual work and Medicare and private billings.

    Is There a Difference Between Public and Private Earnings in the Salary of Australian Doctors?

    In short. Yes. But what we see when we compare the above average taxable income with some of the rates that Specialists are paid in Australia for working in the public hospital system is something quite comparable.

    Let’s take NSW again.

    Salaried Staff Specialists.

    First, let us look at Staff Specialists. These are Consultants who are employed on a salary basis in NSW hospitals. Generally, they work full time in the hospital system and don’t work in the private sector.

    They may, however, see some private patients within the hospital system for which there is sometimes the capacity to share in part of the revenue.

    A first-year Staff Specialist working full time will earn a minimum of $234,556 if they do not see private patients. So we are already above the average taxable income of a Psychiatrist.

    This income can go up to $342,060 if the doctors sees a large number of private patients and splits this revenue with the hospital. Going past the average taxable income of Physicians.

    The staff specialist rates increment every year until year 5.  Once you have worked as a Staff Specialist for 7 years you are eligible to apply for Senior Staff Specialist status.

    At this point, you will earn a minimum salary of $316,891 and a maximum salary of $462,133.

    At this point, the Specialist is on par with the average taxable income of a Surgeon.

    Add to this a generous professional development allowance of up to $35,000 and the possibility of a managerial allowance of an extra $9,000 to $23,000 for being the head of department or such. Being publicly employed is a well-remunerated experience for specialist doctors.

    Visiting Medical Officers.

    Visiting Medical Officer is the term given to a Specialist that contracts their services to a hospital. There are various ways that this occurs but lets stick with the most common one which is a sessional rate which is paid on an hourly basis.

    Again sticking with NSW, a senior surgeon on a sessional VMO contract will earn $234.75 per hour plus $46.55 for background practice costs. That’s $281.30 per hour.

    Were that surgeon to work 40 hours per week, just for the hospital for 48 weeks a year. That amounts to $540,096 AUD per annum. So about $80,000 more than what one could possibly earn as a Staff Specialist.

    Of course, VMOs don’t generally just work for the public hospital system. They often consult from rooms and work in private hospital settings where they can generate greater revenue.

    But to bring it back to reality a little bit. Working as a contractor means that you are not paid for your leave. You do not receive a professional development fund. And you have to carry your own Indemnity Insurance.

    How Much Do Specialists Make Working in the Private Sector?

    This question is a little bit more difficult to answer. Because there are no real reliable sources of information other than the broad information provided by the Australian Tax Office.

    In addition, different specialists do different things. Some solely or primarily work in rooms, for example many Psychiatrists, General Practitioners and Physicians. Others work between rooms and hospitals, including most Surgeons and Anaesthetists.

    Even the costs of running rooms can be considerable. Psychiatrists tend to have the lowest costs as they generally just need a comfortable office, reception and waiting room and a small amount of equipment. Versus, for example, Obstetricians and Gynaecologists who need a large amount of equipment to perform their job in rooms.

    As we have also mentioned once you are in the private sector you are not just earning you are paying out expenses, which includes your own wage as well as the staff you employ, rent, various insurances, your own costs of professional development.

    Also, when you go on leave you don’t get paid. But your staff generally do.

    That being put aside we can do some rough estimations.

    I’m going to use my own background specialty of Psychiatry for a simple example.

    Lets say I work as a Psychiatrist solely in private rooms and charge patients for either half hour or 1 hour sessions. If I apply Australian Medical Association rates (which most specialists in private do). And I saw 4 patients for an hour and 8 patients for a half hour every day for 5 days a week for 47 weeks of the year (4 weeks leave and some adjustment for public holidays).

    I would generate around $3,100 AUD in fees per day OR about $730,000 AUD per annum. This could go up somewhat if I charged for different items OR engaged in writing medico-legal reports.

    This seems a lot and its and it is. And it doesn’t take into account all the costs I mentioned above. 

    For Specialists who are able to charge for procedures. Earnings scale up even more significantly. It is certainly not inconceivable therefore to see how some Surgeons in particular are making more than $1million per annum

    Related Questions.

    Question: How long does it take to become a Specialist in Australia?

    Answer. A long time. 

    First, you need to go to medical school which is generally a minimum of 5 years for an undergraduate program. After graduating you then complete one or two provisional years which are called intern and resident years. You then apply for specialty training which in some cases is quite competitive (for example surgery) and therefore may take several years to get in. Most specialty training is a minimum of 5 years. Although General Practice training can take as little as 3 years.

    So from entering into medical school to becoming a specialist may take you a minimum of 9 years but is more likely to take you about 12 or more.

    For part of this time you are at medical school, incurring debt and with limited scope to work. But as we have pointed out above once you enter the hospital system you start to earn a decent wage helping you to pay off those debts. As a trainee you are probably already in the top ten of earners in the country. But you will have significant costs in terms of paying for your training. Exam fees and College fees tend to be in the several thousands of dollars. And you will be making this money partly due to working long hours.

    Question: How much tax do Specialists pay?

    Answer. This obviously depends on the Specialist and how much they earn. In Australia there are quite a few deductible expenses. So doctors are generally able to deduct things like equipment, insurance, college and exam fees, medical board fees even sometimes travel and accomodation. This will reduce the taxable income somewhat. Also many doctors who work privately will establish companies or trusts through which they collect some of their earnings. They may leave some of this money in these entities paying a lower corporate tax on the profits than if they were to pay themselves.

    If we create an example of a full time Senior Staff Specialist in NSW who is not earning additional from their private billings. And has $20,000 in deductible expenses. They will have a taxable income of $296,891. Assuming that they have already cleared their university debts and have private health insurance, so don’t need to pay a medicare levy. Such a doctor would pay $106,860 in tax.

    Question: How many doctors pay tax?

    Answer. A fun fact is that if you count up all the doctors who filed a tax return according to the ATO figures there were 80,482 tax returns filed by doctors in 2016/17.

    This post was compiled with acknowledgement to the Australian Taxation Office for some of the information in this post.

  • The Relevance of Personal Learning Environments in #MedEd

    The Relevance of Personal Learning Environments in #MedEd

    Sir William Osler

    Sir William Osler was said to be the “Father of Modern Medicine” and the first to bring medical students from the lecture hall to the clinical bedside.

    Source – Prof Oliver Wong, Wellcome Images Library *

    Part 1 – The Medical Educator

    Credit where it’s due, Mike D’Alessandro appears to be the first doctor to write about the potential of Personal Learning Environments in Medical Education, writing here about the development of a course using the concept in the Journal of Pediatric Radiology in 2011.

    A personal learning environment helps learners take control of and manage their own learning. By entering cases into a learning portfolio you store your experience, reflection, knowledge, and wisdom and create your own knowledge management and E-memory system. Furthermore, by participating in a community of practice where you contribute content, engage in conversations, and make connections you are enabling peer-to-peer and master-to apprentice teaching. In the future, it is hoped that tying your learning to your practice and being awarded continuing medical education credit for it will fulfill a larger role in the process of Maintenance of Certification and Continuing Professional Development.

    Recently I presented the concept at a meeting of Clinician Educators at the 2015 International Conference on Residency in Vancouver. For want of a better definition, this was a group of medical educationalists, those that have a role (or several roles) in teaching medicine to other doctors. The participants appeared to find the concept helpful to their own practice. Many had already thought about their personal learning networks in a technology sense, see here recent ICE blog by Felix Ankel and Anand Swaminathan but only perhaps in the sense of how they might share information about medical education. The PLE concept can be seen as extending the Personal Learning Network (PLN) further into additional areas such as storing, remembering, and retrieving. Many of those who attended could also see that both the technological and the non-technological were valid in constructing their own personal learning networks with many reflecting on how, for example, the concept of peer review is drawn into a PLE.

    The Clinician Educators present could see some of the opportunities as wells as challenges presented by the PLE concept. We looked at some of the questions posed by Hicks and Sinkinson in their 2014 open-source article:

    1. What capacities and practices will learners and teachers need to develop?
    2. How will the learner and teacher role be defined within these approaches?
    3. What barriers will inhibit the exploration of these approaches?
    4. What components of the traditional approach should be protected and maintained?
    If we focus on each of these questions in turn:

    For question one – if we do accept the PLE concept then the medical educator of today and tomorrow will need to develop capacities and practices to be informed of the types and kinds of learning environments his/her medical learner is involved with. It obviously will be important to attempt to ascertain what sorts of sources of information learners are using and sharing, for e.g. blogs and podcasts, and consider the credibility of some of the more common sources at least. However, it is likely to quickly challenge the time and resources of the medical educator if they endeavour to map each of their learner’s PLE (not to mention that perhaps the learner may not wish to give access to certain aspects of their PLE.

    This then turns us to question two and the potential importance of the medical educator focusing on their role as both a facilitator of learning but also a facilitator of critical analysis and thinking, so as to encourage the medical learner not to believe everything that is written on the internet and perhaps also consider the risks of “group-think” in the construction of knowledge.

    For question three, many barriers may inhibit the medical educator, some of which may not be in their own control to address, for example working within institutions that close off their learning management systems and e-portfolio systems and even worse parts of the internet itself.

    Finally for question four, if the medical educator manages to successfully address some of the issues raised by the previous questions there opens up a possible opportunity for them to focus on those aspects of learning that truly have an impact on their particular training endeavour by, for example, removing the need to teach and provide information sources for a large swathe of the curriculum and then focusing more on issues such as practical skills development, work-place based assessment or developing reflective-practice skills in the medical learner.

    The above is by no means a comprehensive assessment of the impact of these questions on medical education but hopefully might guide the reader to why I think this is an area worthy of further investigation.

    Next blog I will attempt to touch on a definition of PLEs as well as speak to the potential relevance to medical learners.

  • The Impostor Syndrome in Medical Education

    The Impostor Syndrome in Medical Education

    Recently I hosted an inaugural Medical Education event in my local area. One of the key repeated claims from many of our speakers was of Impostor Syndrome (IS).  It became quite a theme through the Conference.  The typical argument went something along the line of “well really I don’t consider myself to be a medical educationalist first and foremost so I was a bit surprised to be asked to give a talk on the medical education topic of …”

    Given that the participant feedback indicated a high quality of presentation and content from our speakers, the claim of Impostor Syndrome seemed to be most justified.

    The Impostor Syndrome was first hypothesized by a pair of female Clinical Psychologists Pauline Clance and Suzanne Imes in 1978 to describe a phenomenon they had observed in their practices amongst high-achieving individuals (predominantly women) who struggled to accept their accomplishments despite contrary external evidence and constantly feared being placed in an expert role as they might be discovered to be a fraud.

    Is it surprising that medical educationalists feel like imposters or is it a broader phenomenon in medicine itself?  Well, in a 2008 article in the Journal of General Internal Medicine, of the 48 participating Internal Medicine residents 44% were found on the survey to exhibit signs of “impostorisim”.  It’s probably not surprising that, particularly at times of transition in our medical careers, we as doctors might feel a bit more fraudulent, for example when transitioning from an undergraduate to a postgraduate as the JGIM article shows or when someone gets asked to talk at a medical education conference for the first time not many of us appear to deliberately set out to become medical educators.

    I’ve recently been undergoing a transition back into some clinical practice and feeling the IS myself a bit.  I felt that my first day in outpatient practice was possibly my worst workday in a long time.  I was particularly troubled by the amount of time it took me to document my patient encounters.  To deal with this I found it reassuring to discuss my experience and cases within a peer review group and get some of my documentation confidentially checked by a peer.  I soon discovered that my experience was quite normal.

    By the way, Impostor Syndrome is not a mental disorder it didn’t make it into the latest DSM5. But there are still reasons, in my opinion, to take this issue on seriously.

    One worrying possible consequence of Impostor Syndrome is its potential impact on patient care.  I observed this issue at play some time ago in my psychiatry training program.  A colleague and I noticed a pattern in the psychiatry trainees and their behavior when on-call after hours.  We noticed that there was an inverse relationship between the seniority of the trainees and the number of times that they would call the Consultant to review a patient.

    We had some reasonable data on the numbers of patients presenting and were aware of how many patients were being admitted overnight and so we could compare this with the actual frequency of calls.  This would often get to a point of comedic-tragedic proportions where I can recall having meetings with trainees around wanting to write detailed policies about when trainees should call the Consultant.  I pointed out at the time that this didn’t seem to be the real problem as the Consultants were always happy to be called and if we wrote a policy and a trainee didn’t follow it (which I assessed was a high probability) this would create even more problems for the trainee.

    When I talked to the trainees about why it was they called more as a senior trainee versus a junior trainee the responses indicated that junior trainees felt they were not experienced enough and didn’t know enough to call the Consultant (were worried about embarrassing themselves) whereas senior trainees highly valued the opportunity to discuss with a Consultant because they felt it was more of a peer relationship and they even confessed that perhaps they were calling a little more than they felt they really needed to because they had already made a good assessment and plan ”bounce things off the Consultant”.

    I’ve talked to other colleagues from other disciplines about this observation and they have observed it as well.  By definition, its not true Impostor Syndrome but it’s something quite close; doctors close in experience and/or capability and/or seniority to other doctors are less anxious about revealing a weakness than those further apart.

    I haven’t been an on-call Consultant for a little while but when I was I tried a simple experiment in countering this problem.  Each morning after my on-call I would send the trainee doctor a quick email thanking them for being on-call and giving them some feedback on the presentations from the night before.  If I hadn’t been called at all I would remind them that I was on-call and still hoped the night went well for them.  My experiment didn’t last long enough for me to know whether it had an effect on the Trainee Impostor Syndrome but as I am shortly returning to on-call again I think I might give it another go.

    What about you?  Have you encountered Impostor Syndrome in your work?  Have you developed any methods of addressing the seniority gap in patient handover?

    Footnote:  We were very fortunate indeed to have Jason Frank as our international speaker for our Conference. There were many points as to why we decided to hold a local #MedEd event but the primary reason was that we wanted an event where we could bring all the key players in the medical training pipeline together in one room for two days.  On that measure our event was a great success as it spawned a lot of collaborative conversations from organizations that attended including after the event.  It’s often stated that the real learning at a Conference happens at the sidelines.