Being a medical trainee in Greece: Aims and key aspects of the Greek Survey of Medical Work and Education.

Q3 Medicine
Psychiatrike = Psychiatriki Pub Date : 2024-10-08 Epub Date: 2024-09-25 DOI:10.22365/jpsych.2024.016
Argyris Stringaris, Paraskeui Peiou, Ioannis Marios Rokas, Nikolaos Saridis, Lampros Orion Asimakopoulos
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Maugham's \"Human Bondage\" (he was medically trained himself), it is worth reading as a fascinating testimony to the education of our not so distant professional ancestors.1 The creation of medical specialisation training programs (starting in Paris with the US and UK following) did not change this situation much. Medical schools were slowly filled with the brightest minds of each country because of entrance examination and the prestige of the profession. From the evidence we have, medical students are often conscientious (in the sense of a personality trait) and hard working.2 Many believe that they perform more than just a profession and therefore do not see themselves as common workers who will demand changes in the way they work or challenge their employer or trainer. Additionally, asking for changes may also be perceived as a sign of weakness, which does not fit with the image of the doctor in society, which is that of the fallible and self-sacrificing hero. In other words, both social circumstances and identity issues have stood in the way of certain actions to be taken, i.e., asking, among other things, what specialty training is like for trainee doctors. A point of inflection was the processes leading up to the 2003 Working Time Directive in the European Union - the result of two famous court decisions, one in Spain and one in Germany, that had an impact on case law.3-5 It is worth noting that until then many of us were on call for 72 hours (Friday - Saturday - Sunday) and on Monday it was taken for granted that we would continue examining patients and doing other clinical work. Around the same time, in America, the well-known \"duty hour limits\" were proposed, setting, among other things, a maximum of 80 hours of work per week for medical residents. Until then, some trainee doctors were seen as residing within the hospital, offering on-call services in exchange for the training they received. Hence the term resident doctors.6 These changes in labour law have also triggered change in other areas. Gradually, trainees' views were taken into account even in the evaluation of the \"authority\", i.e., the supervisor (see British 360 evaluation including trainee feedback). The British regulatory agency of medical professions, the General Medical Council (GMC), conducts an annual evaluation of the quality and acceptability of training among residents and their trainers in the form of questionnaires.7 In Greece, and in other European countries, there is no such systematic evaluation. The regulatory agency for medical specialties in Greece, the Ministry of Health, does not conduct similar survey, nor do the Medical Associations. Previous studies concerning specialty trainees in Greece have been conducted either several years ago or were limited by their small sample size or the narrow range of specialties they examined. .8-11 To address this literature gap, our group decided to conduct its own evaluation with a survey. We called it the Greek Survey of Medical Work and Education, with the acronym EIPEs from the Greek. Our decision was prompted by the sudden decision of the Ministry to introduce admission exams for specialty training and a disagreement we had within our group about the merits of this decision. There are many important reasons why such a study should be conducted in Greece. The situation in the National Health System, ESY (where all colleagues are trained), is rather dire with chronic underfuding, long waiting lists and many doctors leaving for the private sector. The salaries of physicians are much lower than those of their colleagues in other European countries, as our country is on the lower end in terms of purchasing power of medical specialists (Figure 1). This fact, combined with the unsatisfactory building infrastructure and staffing of health care units, exacerbates the exodus of young trainees and medical specialists abroad (mainly Cyprus, Germany, and the UK), thus further worsening the sustainability of the Greek NHS (Graph 2). Our study differs from previous ones as it was designed to a great extent by trainees with lived experience of the aforementioned situation. It addressed a wide variety of questions concerning on-call hours, time off, perception of work hours conformity to the European legislation, or even trust in the Ministry of Health governance. EIPEs was designed as a nationwide cross-sectional study that addressed trainees of all medical specialties. Individuals who were attending a full or partial, general or specialised training programme or were pending to continue one having already completed some part of training were eligible to participate. In the initial phase of the study (June/2024 to August/2024), a link to an online questionnaire was sent to the personal emails of potential participants who voluntarily provided us with their emails, either through l peer networks or through social media after having been informed about the nature of the study (Snowball sampling). Then, during September, access to the questionnaire was open and the link was freely circulated. For instance, about 40% of General Psychiatry and 50% of Child and Adolescent Psychiatry trainees in Attica have responded to the questionnaire. The study was conducted without funding, in the little spare time available to the authors listed here, and was not under the auspices of any governmental agency. Regarding data processing and statistical analysis, we will use post-stratification weights to adjust each individual's response in order for the results to be as representative as possible of the target population and our estimates unbiased. In summary, there is a great need to better understand the conditions of our residents, and the EIPEs aspires to help us do just that: assess the quality of training, the working conditions in residency, and the opinion on changes initiated by the Ministry of Health. 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引用次数: 0

Abstract

Anyone reading this text has probably been a medical trainee once. What was your training like? More importantly, did anyone during your training ask you what your training was like? For example, did anyone ask you if you were satisfied with your training or if you worked a little or a lot? Probably not. The origin of medical specialty training is that of informal apprenticeship. The apprentice was grateful to the master for accepting him; there was no room for questions or disagreements. If you haven't read Somerset. Maugham's "Human Bondage" (he was medically trained himself), it is worth reading as a fascinating testimony to the education of our not so distant professional ancestors.1 The creation of medical specialisation training programs (starting in Paris with the US and UK following) did not change this situation much. Medical schools were slowly filled with the brightest minds of each country because of entrance examination and the prestige of the profession. From the evidence we have, medical students are often conscientious (in the sense of a personality trait) and hard working.2 Many believe that they perform more than just a profession and therefore do not see themselves as common workers who will demand changes in the way they work or challenge their employer or trainer. Additionally, asking for changes may also be perceived as a sign of weakness, which does not fit with the image of the doctor in society, which is that of the fallible and self-sacrificing hero. In other words, both social circumstances and identity issues have stood in the way of certain actions to be taken, i.e., asking, among other things, what specialty training is like for trainee doctors. A point of inflection was the processes leading up to the 2003 Working Time Directive in the European Union - the result of two famous court decisions, one in Spain and one in Germany, that had an impact on case law.3-5 It is worth noting that until then many of us were on call for 72 hours (Friday - Saturday - Sunday) and on Monday it was taken for granted that we would continue examining patients and doing other clinical work. Around the same time, in America, the well-known "duty hour limits" were proposed, setting, among other things, a maximum of 80 hours of work per week for medical residents. Until then, some trainee doctors were seen as residing within the hospital, offering on-call services in exchange for the training they received. Hence the term resident doctors.6 These changes in labour law have also triggered change in other areas. Gradually, trainees' views were taken into account even in the evaluation of the "authority", i.e., the supervisor (see British 360 evaluation including trainee feedback). The British regulatory agency of medical professions, the General Medical Council (GMC), conducts an annual evaluation of the quality and acceptability of training among residents and their trainers in the form of questionnaires.7 In Greece, and in other European countries, there is no such systematic evaluation. The regulatory agency for medical specialties in Greece, the Ministry of Health, does not conduct similar survey, nor do the Medical Associations. Previous studies concerning specialty trainees in Greece have been conducted either several years ago or were limited by their small sample size or the narrow range of specialties they examined. .8-11 To address this literature gap, our group decided to conduct its own evaluation with a survey. We called it the Greek Survey of Medical Work and Education, with the acronym EIPEs from the Greek. Our decision was prompted by the sudden decision of the Ministry to introduce admission exams for specialty training and a disagreement we had within our group about the merits of this decision. There are many important reasons why such a study should be conducted in Greece. The situation in the National Health System, ESY (where all colleagues are trained), is rather dire with chronic underfuding, long waiting lists and many doctors leaving for the private sector. The salaries of physicians are much lower than those of their colleagues in other European countries, as our country is on the lower end in terms of purchasing power of medical specialists (Figure 1). This fact, combined with the unsatisfactory building infrastructure and staffing of health care units, exacerbates the exodus of young trainees and medical specialists abroad (mainly Cyprus, Germany, and the UK), thus further worsening the sustainability of the Greek NHS (Graph 2). Our study differs from previous ones as it was designed to a great extent by trainees with lived experience of the aforementioned situation. It addressed a wide variety of questions concerning on-call hours, time off, perception of work hours conformity to the European legislation, or even trust in the Ministry of Health governance. EIPEs was designed as a nationwide cross-sectional study that addressed trainees of all medical specialties. Individuals who were attending a full or partial, general or specialised training programme or were pending to continue one having already completed some part of training were eligible to participate. In the initial phase of the study (June/2024 to August/2024), a link to an online questionnaire was sent to the personal emails of potential participants who voluntarily provided us with their emails, either through l peer networks or through social media after having been informed about the nature of the study (Snowball sampling). Then, during September, access to the questionnaire was open and the link was freely circulated. For instance, about 40% of General Psychiatry and 50% of Child and Adolescent Psychiatry trainees in Attica have responded to the questionnaire. The study was conducted without funding, in the little spare time available to the authors listed here, and was not under the auspices of any governmental agency. Regarding data processing and statistical analysis, we will use post-stratification weights to adjust each individual's response in order for the results to be as representative as possible of the target population and our estimates unbiased. In summary, there is a great need to better understand the conditions of our residents, and the EIPEs aspires to help us do just that: assess the quality of training, the working conditions in residency, and the opinion on changes initiated by the Ministry of Health. It is necessary for our country to converge with international requirements for regular, systematic, and independent evaluation of medical specialty training, both by the trainees and their supervisors, so that the educational process continues to evolve and adapt to modern medical standards.

在希腊接受医学培训:希腊医学工作和教育调查的目标和主要方面。
读过这篇文章的人都可能曾经是一名医学实习生。你的培训是什么样的?更重要的是,在你受训期间,有没有人问过你受训的感受?例如,有没有人问过你对自己的培训是否满意,有没有人问过你工作少还是工作多?可能没有。医学专业培训的起源是非正式学徒制。学徒对师傅的收留心存感激,没有质疑和异议的余地。如果您没有读过萨默塞特。毛姆的《人类的束缚》(他本人也接受过医学培训),这本书值得一读,因为它是我们并不遥远的职业先辈们接受教育的精彩见证1。1 医学专业培训计划的设立(从巴黎开始,美国和英国紧随其后)并没有改变这种状况。由于入学考试和医学专业的声望,各国医学院慢慢招满了最聪明的学生。从我们掌握的证据来看,医科学生通常都很认真(从人格特质的意义上说)和勤奋。2 许多人认为,他们从事的不仅仅是一种职业,因此不认为自己是会要求改变工作方式或挑战雇主或培训师的普通工人。此外,要求改变也可能被视为软弱的表现,这与医生在社会中的形象不符,即容易犯错和自我牺牲的英雄形象。换句话说,社会环境和身份问题阻碍了某些行动的开展,例如,除其他事项外,询问实习医生的专业培训是什么样的。3-5 值得注意的是,在此之前,我们中的许多人都是 72 小时(周五-周六-周日)随叫随到,而在周一,我们会理所当然地继续检查病人和从事其他临床工作。大约在同一时间,美国提出了著名的 "值班时间限制",规定住院医生每周最多工作 80 小时。在此之前,一些见习医生被视为居住在医院内,提供随叫随到的服务,以换取所接受的培训。6 劳动法的这些变化也引发了其他领域的变革。逐渐地,甚至在对 "权威"(即主管)进行评估时,也会考虑受训者的意见(见英国 360 度评估,包括受训者反馈)。英国医学专业管理机构--医学总理事会(GMC)每年都会以调查问卷的形式对住院医师及 其培训师的培训质量和可接受性进行评估。希腊的医学专业监管机构--卫生部和医学协会都没有进行类似的调查。以往有关希腊专科受训人员的研究要么是几年前进行的,要么因样本量小或研究的专科范围狭窄而受到限制。.8-11 为了填补这一文献空白,我们小组决定通过调查进行自己的评估。我们将其命名为 "希腊医疗工作与教育调查"(希腊语缩写为 EIPEs)。促使我们做出这一决定的原因是,希腊卫生部突然决定在专科培训中引入入学考试,而我们小组内部对这一决定的利弊也存在分歧。在希腊开展这项研究有许多重要原因。国家卫生系统 ESY(所有同事都在这里接受培训)的情况相当糟糕,长期供不应求,等待名单很长,许多医生都去了私营部门。由于我国在医疗专家购买力方面处于较低水平,因此医生的工资远低于其他欧洲国家的同行(图 1)。这一事实,再加上医疗机构的基础设施建设和人员配备不尽人意,加剧了年轻受训人员和医学专家向国外(主要是塞浦路斯、德国和英国)的外流,从而进一步恶化了希腊国家医疗服务体系的可持续性(图 2)。我们的研究不同于以往的研究,因为它在很大程度上是由对上述情况有切身体会的受训人员设计的。它涉及的问题多种多样,包括值班时间、休息时间、对工作时间是否符合欧洲立法的看法,甚至是对卫生部管理的信任度。EIPEs 是一项全国范围的横断面研究,针对所有医学专业的受训人员。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Psychiatrike = Psychiatriki
Psychiatrike = Psychiatriki Medicine-Medicine (all)
CiteScore
2.60
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37
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