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10 Apr 2018


Along with approximately 1200 physician trainees around Australia and New Zealand, I recently sat one-and-a-half exams in the space of two weeks. The spectacular failure of the computer-based exam and the effect on trainees, hospitals and, by extension, patients has been well documented. The circumstances surrounding what happened that day are currently the subject of an independent inquiry by the Royal Australasian College of Physicians (RACP), however it’s not what happened on the day that interests (and concerns) me, but the lead up to it. 

The exam failure should be viewed as a symptom of a larger disease; a warning for an organisation that has lost its way. It was the culmination of a troubled relationship between a College and its trainees.

Our Colleges exist to provide a platform for life-long medical learning. They exist to maintain a standard of knowledge and practice within the profession that our patients can trust is exceptionally high. Fundamentally though, they are training providers and should, by extension, have trainees at their core. The RACP exam didn’t fail when the computers wouldn’t log in, or when the timers didn’t stop during the lunch break, or even when access was still available to the part A exam during part B. 

The exam was already cooked when the RACP failed to hear and acknowledge the concerns its trainees had in the new process.

RACP trainees have felt ostracised by their College for some time. Our trainee committees, filled with dedicated doctors in training giving of their own time, are haphazardly supported at best. With little to show for the hard work of committees over the years, the larger group has become disengaged, with most preferring to just put their heads down and get through training.

The RACP, while very publicly exposed by the exam failure, isn’t alone in its issues. The AMA Council of Doctors in Training (CDT) holds a ‘trainee soapbox’ every year to hear current issues from trainees representing each of the different specialty groups. Consistently, we hear the concerns of trainees going unheeded by their College. We hear of strained communication lines between trainees and those meant to oversee their training. Most worryingly, we hear of trainee representatives being censored by their College. Obviously, not every problem faced by trainees is of a College’s making, or indeed within their power to address, however, it should always be a place where trainees can raise their concerns without fear of jeopardising their training or career.

When trainee concerns are heard, we often see little more than lip service in response. Trainee wellbeing becomes a tick box exercise in engaging an external counselling provider, not by addressing the underlying issues. Flexible training to maintain work/life balance becomes a policy statement, rather than a review of rigid assessment processes. Emails saying ‘we hear you’ are great, but what are you actually doing about it?

It’s not all doom and gloom though. The experience of the Royal Australasian College of Surgeons (RACS) shows us that if you genuinely listen and engage with trainees, positive outcomes can arise from difficult situations. The RACS Operating with Respect program was born from highly publicised bullying and harassment faced by surgical trainees. It has become a requirement not just for trainees, but for all RACS members. Other Colleges have now partnered with RACS to use Operating with Respect to spread the word that bullying and harassment have no role in modern medicine.  A healthy and robust interaction between a College and its trainees has created tangible change within our hospitals.

In recent times we’ve watched Colleges look to expand their spheres of influence, however, they would all do well to remember where their core business lies. After events earlier this year, the RACP especially must rebuild bridges with its trainees. We must demand more than box-ticking exercises - we need to see tangible changes in the way they connect with trainees and how trainee concerns are addressed. We’ve already seen positive steps in this direction in the RACP’s willingness to listen and take on board the advice from the AMA CDT immediately after the failed exam. We intend to continue working with the RACP to help the organisation meaningfully engage with its trainees again.

Published: 10 Apr 2018