A quarterly publication of AQU Catalunya

83

October 2016

During 2015 AQU Catalunya carried out a survey of the "employability and skills of internal resident doctors (interns)" and another of the "employability and skills of recent graduates in Nursing". The two surveys were the result of fieldwork in which the Department of Health collaborated in designing the sample participants. In the case of intern doctors, the survey targeted heads of hospital services and directors of primary health care teams, whereas the target group in the case of nursing was directors and supervisors of hospital and primary health care nursing.

One characteristic of the medical sector is that graduates who have just started working are often professionals training to become specialists who follow a system of learning that in practical terms is regulated. This is particularly the case with interns and increasingly so in nursing. This results in the opinions of heads of staff being influenced, in the case of intern doctors, by the fact that interns are not selected by the institutions themselves, plus they have a pace of work that includes the complement of training. In the case of nurses, their opinions are more clearly related to the assessment of professionals who have just joined the staff.

Positive aspects that stand out for the doctors are the high level of professionalism of resident interns when they start working and the way in which they readily take on the different roles of the collaborator, who of necessity forms part of a team, and the communicator; of particular note here is that heads of staff consider resident interns to be good at relating with others and dealing with patients and family members, which is something that is not often pointed out in studies on professionals; so here we consider there to be scope for research on the ways in these essential skills get lost over time in the course of professional career development.

This professionalism is also clear from their skills in problem solving and with information technologies. On the other hand, resident interns tend to be lacking in what would be expected given their situation as professionals who have just entered the health system, i.e. a knowledge and understanding of how the country's health system works and is organised, the ability to innovate, research skills and the ability to interpret the findings of research, and the management of uncertainty by way of clinical management strategies. These opinions are very important for the medical sector because, broadly speaking, these kinds of skills, which include soft skills, are given very little consideration when they are training to become future specialists. Learning activities in these subjects should therefore be designed to complement the more rigorous clinical aspects of training that resident interns receive during their formative training.

In the case of the survey of the opinions of directors and supervisors on graduate nursing skills, firstly, heads of staff in general consider nursing staff who are entering the work of work to be well trained and they are in possession of high-level skills. It is noteworthy however that there was no particularly positive assessment made of the Bachelor's programme compared to the pre-Bologna programme (diplomatura). This should give us food for thought regarding the suitability of the way in which the content has been structured over a considerably longer period of training, as well as the way in which the increase in the amount of time to achieve higher levels of professionalism was accepted as being the evident solution. It is our point of view that, in the future, the duration of regulated training in the medical professions requires a rethink. If one adds together the periods of undergraduate training and specialisation, we're talking about six years in the case of nursing and eleven years in that of doctors. At a time when it is accepted that training is a continuous lifelong process and that there is no doubt that professionals continue to learn throughout their working lives, it would seem that we are overly delaying the point at which the entry into work takes place.

Professionally-oriented Master's programmes, on the other hand, are highly rated so we should also be thinking about the directions in which specialties in the nursing profession are being developed; one would think that the skills of a specialist intern will be superior to those of a Master's graduate in Nursing although it is not enough for this to be just an idea, and this will need to be evidence-based in the near future.

So to finish off with a few recommendations, it is important to encourage a critical interpretation of research in nursing training for nurses to be able to make judgments and decisions based on the maximum amount of scientific evidence, as well as improving the problem-solving capabilities of professional practice. It will of course be open to debate whether these are skills that can be acquired by way of structuring the undergraduate Bachelor's programme in a different way or if they should be more clearly spread over a period of years during specialisation.

To summarise and round off this appraisal of the surveys, the most important things in the case of doctors is that the Department of Health needs to support the acquisition of core and soft skills (clinical management, an understanding of the system, bioethics, research, innovation, etc.) in resident intern doctors, whereas for nurses a rethink is necessary of the content structure of the Bachelor's course and its relationship with the skills that form part of today's different and constantly evolving specialities.