Survey study of trends in adult nephrology advanced training in Australia and New Zealand

Abstract

Background There has been considerable growth in nephrology advanced trainee numbers in Australia and New Zealand, with uncertain effects on clinical experience, competence and employment outcomes. Aims To review the perceived adequacy and temporal trends of advanced training in nephrology in Australia and New Zealand by evaluating training experiences, personal views on important aspects of training and nephrology, career paths and early employment outcomes. Methods An online survey was distributed to members of the Australian and New Zealand Society of Nephrology through email in December 2020. Responses were sought from current trainees and from nephrologists qualifying since 2014. Likert scale proportions were calculated and group comparisons made using the Chi‐squared test. Results A total of 88 participants returned the survey yielding a response rate of 32%, with a representative sample of trainees and consultants from across Australia and New Zealand. Training was reported as adequate in most aspects of clinical nephrology, although 88% of respondents felt poorly prepared for entering private practice and 61% reported inadequate training in kidney histopathology. Exposure to clinical procedures was variable, with adequate training in percutaneous kidney biopsy, but mostly inadequate training in dialysis access insertion. Sixty‐nine percent of nephrologists completed their advanced training entirely in large urban centres and 85% worked in an urban area after training. Only 23% of consultants were engaged in full‐time clinical employment in their first‐year post‐training and 78% were undertaking at least one of dual specialty training or a higher degree by research. Demand for subspecialty fellowships was high. Conclusion Trainees and nephrologists in Australia and New Zealand are currently satisfied with their training in most aspects of nephrology; however, some clinical experiences are perceived as inadequate and early career paths after advanced training are increasingly diverse.

The change we seek: nephrology training in Australia and New Zealand

“…Another difference between the two studies is the reversal of gender dominance. The earlier survey showed 63% respondents were male, which decreased to 41% in the present study, suggesting a gender shift similar to the findings in the AHPRA annual reports 2,3 . There are several well established barriers to women in nephrology and women in medicine in general, including childbearing and maternity leaves, disproportional family responsibilities, and gender inequality in professional advancement 4,5 .…”

“…Beaton and colleagues published similar findings in an earlier survey study of 105 consultant nephrologists qualified through RACP between 2002 and 2014, suggesting the pattern of nephrology training has not changed significantly over the past two decades despite significant increase in the number of nephrology advance trainees 3 . A notable difference between the two survey studies is the proportion of dual training that increased from 25% (2002–2014) to 42% (2014–2020) and consisted of additional fellowship in general medicine, intensive care, obstetric medicine and palliative care 2,3 . Whether this was to achieve enhanced job security (both initial specialty training position and subsequent consultancy appointment), permit a greater confidence in rural positions or for other reasons was not explored.…”

“…3 A notable difference between the two survey studies is the proportion of dual training that increased from 25% (2002-2014) to 42% (2014-2020) and consisted of additional fellowship in general medicine, intensive care, obstetric medicine and palliative care. 2,3 Whether this was to achieve enhanced job security (both initial specialty training position and subsequent consultancy appointment), permit a greater confidence in rural positions or for other reasons was not explored. Undertaking a higher degree post-advanced training remained a common practice in early career nephrologists.…”

“…7 The study by Yaxley and colleagues highlights important gaps in current nephrology training and subsequent career choices. 2 As a survey study, there are several methodological problems that limit the generalisability of the study findings. First, although the authors attempted to capture all nephrology trainees and early career nephrologists, the response rate was low (32%).…”

“…Unfortunately, many did not continue a career in research after completion of a higher degree. As suggested by Yaxley and colleagues, an alternative career path with subspeciality fellowship may be a more appropriate option 2 …”