Context / probleemstelling of aanleiding

Probleemstelling (inclusief theoretische onderbouwing en onderzoeksvraag/vragen):

Staff shortages in healthcare are pressing and especially troubling for specialties such as psychiatry, considering mental health problems already affect a large proportion of the population and are expected to peak in the future. Retention issues among trainees are a potential culprit of these shortages: many psychiatry trainees leave the workforce prematurely. Some groups of trainees, such as those with a disability or lower socio-economic status, might be more prone to leave their training, which can directly affect diversity in the psychiatric workforce. This study therefore addressed the following research question: what are current trends in psychiatry trainees’ progression through training and to what extent do these trends differ for trainees with different background characteristics?

Methode:

We conducted a retrospective cohort study including all psychiatry trainees (n=2820) in the United Kingdom (UK) with data from the UK Medical Education Database. We applied discrete-time survival analysis to explore training progression for trainees that started their training between 2012-2017. The impact of several sociodemographic characteristics on trainees’ progression was examined.

Resultaten (en conclusie):

The probability that psychiatry trainees completed their training in the minimum years required for training (6 years in the UK) was 17.2%. This percentage varied from 4.8% for females that graduated medical school outside of the UK (non-UKGs) to 29% for males that graduated medical school in the UK (UKGs). The odds to complete training in 6 years was 1.49 times higher for males than for females and 2.16 times higher for UKGs than for non-UKGs. Furthermore, the odds of completing training in 6 years was 1.295 times higher for white trainees (p = 0.014), 2.766 times higher for trainees without a disability (p < 0.001), and 1.936 times higher for trainees without a history of childhood deprivation (p < 0.001; measured by entitlement to free school meals – an indicator for socio-economic status).

Discussie (beschouwing resultaten en conclusie in het kader van de theorie):

Less than one in five psychiatry trainees were able to complete their training in 6 years and this probability varied significantly for doctors from different socio-demographic backgrounds. This study implies that most trainees that start their training either drop-out of their training entirely or take much longer to complete their training than expected. This means it may be unrealistic to expect that in increase in the recruited numbers of trainees will automatically result in an increase in available workforce of psychiatry consultants.

Furthermore, the results are indicative of differential attainment occurring for different reasons amongst different groups of trainees. Considering that a more diverse group of students is applying to medical school – e.g. the number of applicants with disabilities doubled from 2001 to 2005 in the UK – we need to guarantee that the training models we use in postgraduate medical education are tailored to the needs of these upcoming trainees and inclusive to trainees with various socio-demographic backgrounds.

Referenties:

Dowell, J, Cleland, J, Fitzpatrick, S, McManus, C, Nicholson, S, Oppé, T, et al. The UK medical education database (UKMED) what is it? Why and how might you use it? BMC Med Educ 2018; 18: 6.

Lambert, TW, Turner, G, Fazel, S, Goldacre, MJ. Reasons why some UK medical graduates who initially choose psychiatry do not pursue it as a long-term career. Psychol Med 2006; 36: 679.