Job variation in Australian advanced training in neurology

Like training posts in other medical specialties, many of the 38 Australian core training posts in neurology have been criticized over a variety of issues relating to the quality of training provided. These issues include excessive hours of work (often related to understaffing), high inpatient workload and inadequate exposure to outpatients and/or specialist procedures. To examine these issues, we conducted an audit of Australian advanced training posts in neurology to obtain baseline data.

Two questionnaires were sent out, one to each head of department and another to the advanced trainees currently in post, requesting information about each of the training posts. The posts were compared with each other on an individual basis and by grouping them into three geographically related groups.

There was complete ascertainment and a wide variation in most of the measures examined, including inpatient and ward consult numbers, staffing levels, general neurological and specialist outpatient clinic exposure and overtime requirements. Exposure to neurophysiology clinics and training in electroencephalogram was more uniform.

Core advanced training jobs in neurology vary considerably across Australia, largely for historical reasons. This situation is suboptimal for many reasons. Training jobs ideally need to be modified to take into account the changing needs of trainees rather than just the service requirements of the various departments, but there are many resource issues involved in achieving this.