A total of 13 participants were interviewed (12 JC, 1 JB) representing 10% of the cohort (13/115). The median age was 27 years (range: 24-33 years), with seven male and six female participants. The median time from graduation from initial medical training was two years (range: 2-5 years) and all but one of the participants was employed in a metropolitan health service. Of those interviewed, eight aspired to surgical training, three to radiology training and two were undecided.
From the analysis of the participant interviews, two broad themes emerged - motivations for enrolling into the course and the actual experiences of the course – with each major theme yielding a range of subthemes.
Motivations for Enrolling
Career Progression
The positive impact of participation on career progression was a key theme expressed by all participants. This was not just in terms of formal training programs, but also in a more general sense. One candidate phrased this perception very clearly, being told directly by their clinical instructors:
‘…you have to do this anatomy course if you're interested in doing pretty much anything that involves anatomy…’
Undertaking the course was perceived as offering substantial benefits in terms of successful entry into a postgraduate training program as well as making a good impression with supervisors, resulting in improved references for employment as well as training. A greater range of career options was also identified as a motivation for enrolling. One candidate also noted anatomical knowledge as important even though they had not yet chosen a career path:
‘…I don't have a very clear career goal, so it doesn't really matter as much I guess . . . if I decide to go surgical, I guess it is useful., it's something good for . . .my career, and it's something good for just progressing down the track . . . 'cause it's all relevant . . . I was thinking about doing critical care . . . I'd do a lot of central lines and things . . . and it's useful in anatomy to know things…”
Expected Benefits
Participants reported several expected benefits from completing the Diploma, with the most frequently perceived benefit an improved chance of acceptance into post-graduate training programs for their chosen specialty:
‘...doing a course vs not doing a course . . .my perception would be yes. Any sort of learning is a positive. Ah, training of any sort, particularly surgery, is long and arduous, so the more courses you do, the more training you do, the better…’
Participants also described indirect benefits including a perception that undertaking the course may make a good impression on their senior colleagues, or that the course was something that they did to keep pace in their career progression with their colleagues. Some believed that high achievement in the course would also benefit their future career aspirations. Overall, completing the diploma was regarded as almost mandatory in a highly competitive field and not doing the course was believed to be detrimental to career progression.
Another key aspect of entry to any post-graduate training program is acquiring references from supervising specialists. Applicants for post-graduate training have only a finite exposure to, and opportunity to impress, prospective referees. Paradoxically the Diploma both enhances and detracts from this; the opportunities for participants to make a good impression to senior staff during clinical rotations offset by the realization that attending the course can take them away from their rotations:
‘…I think I would've probably been able to get to theatre more and impress a bit more, and sort of. . . I think, I think a couple of times there were. . .my colleagues. . . I didn't get told this directly, but I got told this indirectly. . . that my colleagues weren't as happy that I was leaving on time,. . Well actually it was always. . . I was always leaving late from work…’
Improvements in Knowledge and Exam Performance
All participants strongly believed that their anatomical training in medical school had been inadequate and that they needed additional training to address this gap. Moreover, many felt that importance of anatomy knowledge to clinical practice was also not properly emphasised. Detailed anatomical knowledge was also seen as vital in examination performance, particularly for the highly competitive speciality selection processes. Other participants viewed the anatomy knowledge gained through the course as relevant to a range of other examinations they may encounter in their future careers.
Participants often referred to the recommendations of previous graduates of the course in describing the knowledge that they had gained in completing this additional anatomy training:
‘…seeing what my previous colleagues had done, and the amount of knowledge they had gained from it. The fact that they were then able to teach me a lot of. . so, a lot of what I previously hadn't known, and just seeing how ready they were for the surgical science exam…’
Experiences of The Course
Barriers to Attendance: Cost, Time, Leave & Rostering and Travel
The financial burden (in 2017, course fees were set at AUS$18,000) of the program was a significant barrier identified by participants and most felt that it be cost-prohibitive were it not necessary for their career development.
To enable them to undertake the course in the context of other commitments, several participants took unpaid leave from their hospital positions to attend the course, with some undertaking locum positions to support themselves during this time. Others overcame this barrier by assisting surgeons in their private work; a source of funding available only to those in a surgical stream.
Financial costs associated with the course were regarded as a barrier to a greater degree for older students with more significant financial commitments who had to plan whether they could afford the cost of the course in the context of other living expenses. Others accepted the short-term financial hardship because they saw it is an important part of a longer-term career plan:
‘...I'm happy to make sacrifices because I have my eyes on the prize…money is a big thing. . ., you know, working as a junior doctor we work long, long hours and it's not extremely well paid…’
In addition to financial costs, the significant time requirement of the course was also perceived as a barrier:
‘…for the amount of money you're paying, you want to be able to be present for all the sessions. And if you can't, then it's arguably not worth your time….’
Time commitments also placed a strain upon participants’ personal lives. Some recognised that these difficulties were short-term and persevered despite the strain. Others were more concerned about the impact on relationships, missing out on events outside of work and study and a lack of work-life balance.
‘…I missed a lot of family things, things with the girlfriend, things with the family, cousins, you know uncles and aunts and stuff. .We had family things. . .my sisters came back from overseas. . . the rest. So there are a few things that I gave up, but again, I'm happy to do that. . . but it was trying to juggle the time. It was trying to get in here after work, get through the traffic, you know and sort of get back at night, study in addition to trying to exercise, sleep, eat, the rest. . . it's been tricky…’
Some participants also struggled with time committed to the course and managing their employment. Juggling leave allocations and rostering presented challenges, but in addition several participants noted that their performance in their rotations was comprised. These participants were not seen as fully committed to their teams, and they perceived that this may have resulted in less than optimal references in a highly competitive field:
‘…I think that the time that I put into it detracted somewhat from my ability to stand out from other people, during that rotation…’
The practicalities of hospital rostering posed a further barrier to course attendance for some participants. Some described limited support from their employers to ensure that they had opportunities to attend the course through more flexible rostering from their employer. However, most participants described a lack of support from their employer in terms of rostering and time off as a barrier to course attendance.
Travel to attend the course also proved to be unexpectedly challenging and difficult for participants. They had not considered that there would be significant unscheduled overtime, making it difficult to arrive at their classes on time.
Course Structure
Participants’ overall responses to the course were uniformly positive and the high quality of teaching was valued. There was also a strong appreciation of the instructors' enthusiasm for teaching anatomy.
Participants also held strong views about the structure of the course and the ways that it could be improved. Participants held a strong preference for having the course lectures available online in advance, so that they could be watched beforehand, thus allowing more time for dissection. Others requested either more teaching time or the opportunity to do more than one stream (in other words, to undertake detailed study and dissection of more than one region of the body). Participants did acknowledge that the limitations inherent in a single semester course (limited by specialty training scheme application deadlines, so that each year's participants can have it on their CV in time), with limited time to accommodate these suggestions.
Unexpected Benefits
Course participants were interviewed towards the end of the course. As such, they had noted some benefits from participating that they had not anticipated, but still appreciated. Although not a key motivator for any of the participants, many reported that they valued the peer support and networking opportunities. Although many of the participants knew each other from medical school or from subsequent employment, this course allowed them to work together and reinforce relationships with their future colleagues.
Somewhat surprisingly, more than half of those interviewed reported that their professional confidence had significantly benefitted from attending the course. There are several possible explanations for this improvement, ranging from familiarity (many of the course instructors are senior specialists in prominent hospitals) through to a greater confidence in their own back-ground knowledge.