The Impact of the Australian and New Zealand College of Anaesthetists’ Specialist Examinations on Trainee Learning and Wellbeing: A Qualitative Study

Abstract

Assessment is an essential component of any medical specialist training program 1-3 and the examinations serve multiple purposes. In addition to assessment of learning, assessment for learning is not only possible, but highly desirable 4 . Ideally, assessments motivate trainees to acquire the knowledge and skills essential for specialist practice, to learn in ways that promote deep understanding and retention of knowledge and skills and to develop effective approaches to learning, essential for self-directed life-long learning. Furthermore, the burden of assessment should be manageable and time spent in exam preparation should result in meaningful learning.Examinations can potentially have a negative impact on trainees 5-7 . Quality of life concerns have been explored with medical undergraduates and medical practitioners, with documented challenges to wellbeing [8][9][10][11][12][13][14][15] . Studies on quality of life in medical students and doctors reveal challenges to wellbeing, which may have a negative impact on interpersonal relationships and on the quality of patient care 13 . Sleep loss and fatigue figure highly as factors influencing quality of life 16,17 and anaesthetists appear more prone to errors if working long hours 18 . It is reasonable to expect that long hours of study, in addition to fulltime work, will exacerbate the risk of fatigue, affect perceptions of wellbeing and increase risks of error. SUMMARYAssessment is an essential component of any medical specialist training program and should motivate trainees to acquire and retain the knowledge and skills essential for specialist practice, and to develop effective approaches to learning, essential for continuous professional development. Ideally, this should be achieved without creating an unreasonable burden of assessment. In this qualitative study we sought to investigate the underlying processes involved in trainees' preparation for Australian and New Zealand College of Anaesthetists' examinations, focusing on how the examinations helped trainees to learn the Australian and New Zealand College of Anaesthetists' curriculum, and to identify any potential areas for improvement. We also explored the effect the examinations had on trainees' lives, to identify if the examinations were a potential threat to their wellbeing. Using a phenomenological approach and purposive sampling, we conducted semi-structured interviews with post-fellowship trainees (n=20) selected from three different regions, with sampling continuing to achieve data saturation. We undertook a thematic analysis of the transcribed interview data utilising a general inductive approach. Our preliminary data suggest that, while the examinations are an important extrinsic motivator to learn and important for professional development, interviewees described many test-driven learning strategies, including rote learning and memorising past examination questions. A strong theme was the considerable impact on participants' relationships and social activities for prolonged periods. Our findi...

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees; a quantitative analysis of the Satisfaction and Wellbeing in Anaesthetic Training study

“…Work‐load > 7.5 h.week −1 was associated with an almost two‐fold increase in the likelihood of high stress. The requirement for trainees to undertake examinations, workplace‐based assessments and to develop their curriculum vitae may significantly increase work‐load outside of contracted hours; these requirements are consistently reported stressors for anaesthetic trainees . This supports recent calls for UK anaesthetic departments to provide work schedules that facilitate personal and professional development, including consideration of allocating supporting professional activities time for trainees .…”

Burnout and the Learning Environment of Anaesthetic Trainees

“…They recommended these alternatives because they are known to positively impact knowledge retention and minimise undesirable test-driven learning strategies; however, they may also have an additional benefit in decreasing trainee stress. As significant examination-related stress has repeatedly been documented among anaesthetic trainees 15,33 , we think any future review of the ANZCA training program should critically examine the place of examinations and their impact on trainee welfare.…”

“…Weller et al have previously recognised the significant impact of examinations on anaesthesia trainee wellbeing and suggested alternative assessment formats be considered to fulfil part of the summative assessment role in anaesthesia training 33 . They suggested consideration of online learning with self-assessment, simulation, and progress testing.…”

A qualitative exploration of anesthesia trainees' experiences during transition to a children's hospital

“…Rather than choosing a quantitative research method, where the questions we might ask would be restricted by our preexisting knowledge, we chose a qualitative research method that would give us the best chance of gaining new knowledge (19). Qualitative methods are well suited to investigating complex human interactions in their natural setting, rather than in an experimental environment (17,18,20), and have been used to investigate aspects of anesthesia practice, including medical education (2,4,9,14,19,21), expertise (16,22), communication (2,23), workplace stress (7,24,25), performance appraisal (22,26), and patient safety (27).…”

“…The stresses of transition, and in particular the perception of being an ineffective team member, appear to impair a trainee's ability to learn . Transition may be even more stressful if the trainee is also preparing for career‐defining examinations , or if the new job entails separation from established support networks, whether by distance or by time spent at work. Work performance and learning during transition are so closely linked to the ability to adapt to the peculiarities of a new workplace and develop effective relationships with new colleagues that some have renamed transition a ‘critically intensive learning period’ .…”