Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway

Abstract

Objective To review the selection policies and models used by speciality colleges to select candidates for entry to vocational training, exploring whether these processes are rural‐focused. Design A systematic desktop audit of college selection processes and criteria was done via college websites (Australian Medical Council (AMC) requires selection information to be publicly available). Setting and main outcomes Material was extracted into a structured template, in 2020. Information extracted related to (i) training entry and selection steps; (ii) selection criteria and elements; (iii) rural‐focused components; and (iv) rural outcomes. Findings were critically reviewed to explore their degree of rural focus. Results Of 14 specialist colleges included, rural‐focused selection mostly related to college‐led selection models rather than employer‐led. Six colleges had rural‐focused selection criteria (four college‐led), with the Australian College of Rural and Remote Medicine strongest, utilising a ‘suitability assessment’ for rural practice. Of the remaining five, childhood background or rural work experience contributed between 5% and 20% of the curriculum vitae assessment. Of eight specialist colleges without rural‐focused selection, six used employer‐led selection models. Conclusions The majority of specialty colleges have no rural‐focused selection criteria and colleges using employer‐led models are weakest. Given that the colleges are required to adhere to the AMC's accreditation standards, it follows that the best way to mobilise change is by including rural selection policies within the AMC standards and requiring reporting of selection outcomes, regardless of the selection models used. This will substantially strengthen ongoing rural pathways in medicine.

Considerations for Training and Workforce Development to Enhance Rural and Remote Ophthalmology Practise in Australia: A Scoping Review

“…Only three studies were identified in the review that specifically discussed aspects of workforce education and training for future rural and remote practise [ 3 , 85 , 86 ] ( Table 6 ). Firstly, the Australia Future Workforce Report provided insight into the potential future ophthalmology workforce by reporting on the characteristics of 325 hospital non-specialists with the intention of undertaking vocational ophthalmology training [ 3 ].…”

‘Selection into training will always be an inexact process’: A survey of Directors of Physician Education on selection into Basic Physician Training in Australia and New Zealand

“…The perception that some training sites are less desirable than others is not unique to BPT and has been implicated in rural specialist workforce shortages. 1,21 Because basic physician trainees may complete AT and work as a consultant in the same region they are trained in, BPT selection decisions may influence the distribution of the physician workforce, and more centralised policy oversight may be warranted. Finally, differing selection practices may reflect conflicting DPE opinions about what makes an 'ideal' BPT recruit.…”

“…12 Selection into BPT follows a local, employer-led model. 1 While the RACP has published selection guidelines, 5 it is not directly involved in the recruitment or appointment of candidates, which is the responsibility of training sites and DPEs. 13 There is no standardised method of selection into BPT and little publicly available data on current practices.…”

“…Selecting candidates for vocational medical training programs is challenging 1,2 and has significant implications for applicants, health services, the medical profession and society at large 3 . Selection processes are an assessment and should be subject to the same quality assurance and refinement processes of assessments that occur during training 4 .…”

Rural medical workforce pathways: exploring the importance of postgraduation rural training time

“…This study provides new evidence of the association between rural training time after leaving medical school and subsequent rural practice, after accounting for the contribution of the other key factors of childhood background and medical school rural training time across the These results suggest that the training period shortly following medical school plays a substantial role in shaping the subsequent distribution of the medical workforce, for both GPs and other specialists. This finding is concerning given that many studies have identified barriers faced by junior doctors seeking specialty college entry that may be magnified (or perceived that way) when based outside of metropolitan locations [34][35][36][37]. Examples of this include poor recognition of rural training experience in specialty college selection criteria, experiences of stigmatisation relating to rural medicine, reduced access to research opportunities in rural areas, access to smaller networks of reputable consultants within their target specialty, as well as simply having fewer visible local pathways [15,38,39].…”