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Abstract

Flexible medical training is well established in the United Kingdom,^2-4 but relatively new in medical training in Australia. Case reports of job-sharing (ie, two people sharing the duties, responsibilities and benefits of one full-time job) in Australia have been positive;^5,6 a study by Valentine and Martin⁷ found broad support for job-sharing among medical staff in a Perth children's hospital.

All Australian medical colleges indicate that they offer part-time training.¹ The Royal Australasian College of Physicians "strongly recommends" that basic paediatric training (the first three years) be full-time, while, for advanced training (the last three years), "work sharing is acceptable" and "part-time training is available".⁸

We set out to determine what is currently available in terms of job-sharing in paediatric training in Australia and whether job-sharing is satisfactory from the trainees' perspective.

Setting

Interviews and questionnaires

We designed a trainee questionnaire (incorporating some of the statements from a UK instrument⁹), which we sent to all paediatric trainees who job-shared in Australia in 1998. Multiple-choice and open questions were included. Responses to statements regarding job-sharing were obtained using a five-point Likert scale: strongly agree, agree, neutral, disagree, or strongly disagree. Responses were subsequently collapsed down to a three-point scale (agree, neutral, or disagree). A pilot was performed on job-sharers at our hospital. Confidentiality was assured.

Trainee demographics

Job-share availability and eligibility

Five of eight hospitals indicated that trainees were not required to give a reason for wishing to job-share. Hospitals that required or preferred to be given a reason tended to regard "childcare responsibilities" as a more acceptable reason for job-sharing than "exam preparation".

Reasons for job-sharing

Job-share history

Sharing methods

• three weeks on / three off (2);
  
• two weeks on / two off (5);
  
• one week on / one off (11);
  
• splitting the week (13).

Trainees sharing for 2-3-week blocks of time commented that there were few continuity-of-care issues and that a block of time off allowed for concentrated study or holidays (none of these trainees were sharing for childcare).

All trainees who split the week were sharing for childcare reasons. Some worked the same days each week (an arrangement they felt was optimal for family routine/childcare), and some swapped days during term (allowing for equal exposure to outpatient clinics, teaching rounds, etc).

Trainees' perspective

Regarding attendance at educational sessions, six of the 13 trainees sharing for childcare reasons believed they often missed sessions, while only one of the nine trainees sharing for exam preparation believed they did.

As the total number of respondents in our survey was small, any conclusions must be somewhat tentative, but we believe some general trends are clear.

The legality of requiring trainees to provide an "acceptable" reason for wishing to work part-time is questionable; as is the practice of giving trainees wishing to share for childcare reasons precedence over trainees with other reasons for sharing.

Although most hospitals stated that all units were available for job-sharing, the majority of their trainees disagreed. Perhaps trainees are misinformed in some instances. An alternative and more likely explanation is that hospitals, wishing to appear progressive, claim that all units are available but do not appoint job-sharers to reluctant consultants.

Trainees sharing for short periods (usually exam candidates) can compensate for restricted opportunities when they return to full-time training, but those sharing for longer periods (ie, those with childcare responsibilities) can not. Trainees in the latter group are also more likely to miss educational sessions, presumably because family commitments prevent them from attending on certain days.

Demand for flexible training arrangements is likely to rise in future. Specialist medical colleges must become directly involved in the development of flexible training positions rather than simply providing reluctant permission. Hospitals must formulate clear policies regarding job-sharing and make this information available to prospective employees. Further evaluations of job-sharing are needed to ensure arrangements are satisfactory for all concerned.

1. Australian Medical Workforce Advisory Committee. Influences on participation in the Australian medical workforce. Sydney: AMWAC, 1998.
2. Goldberg I. Postgraduate medical education and flexible training. Br J Hosp Med 1996; 56: 241-242.
3. Goldberg I, Paice E. New approaches to job sharing of training posts in the North Thames region. Br J Hosp Med 1997; 58: 193-196.
4. Montgomery S. Part time work: one year's job share in Bristol. BMJ 1984; 289: 1240-1241.
5. York J. Job sharing — it works! Fellowship Affairs. RACP. 1993; 12(1): 33.
6. Preston S. Job sharing — the trainee's perspective. Fellowship Affairs. RACP. 1993; 12(1): 34.
7. Valentine J, Martin C. Job Sharing at a children's hospital. BMJ 1996; 312: 115-116.
8. The Royal Australasian College of Physicians. Requirements for physician training guidelines. Sydney: RACP, 1998.
9. Fiander A. Evaluation of flexible senior registrar training in obstetrics and gynaecology. Br J Obstet Gynaecol 1995; 102: 461-466.

Authors' details

Reprints will not be available from the authors.
Correspondence: Dr C M Whitelaw, Department of General Paediatrics, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052.

©MJA 2001
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