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ORIGINAL SCIENTIFIC PAPERSquantitative researchTable 1c. Pre-registration regulations for Canadian provincesTime tocompleteprovisionalregistration(equivalent)Extendedprovisionalregistrationperiodallowed (formaternityleave etc.)Additionalrestrictions toregistrationN/S = not significantAlbertaBritishColumbia2 years 2 years;core of44 weeksMaximumof 1 yearoff formaternityleaveWaiver oftrainingpossible inexceptionalcircumstancesMaximumof 1 yearoff formaternityleaveManitobaNewBrunswickNewfoundlandand LabradorNovaScotiaOntario Saskatchewan Quebec2 years 2 years 1 year 2 years 1 year 2 years N/SYes N/S YesMustcomplete anaccreditedpostgraduatetrainingprogramme.Part-timework must beequivalent tofull-time for2 yearsMustsatisfactorilycomplete anaccreditedpostgraduatetrainingprogrammeThecollege hasdiscretion tobe lenienton the totalamountcompletedMaximumof 1 yearoff formaternityleaveAll corerotations mustbe completedworking fulltime;part-timerotations must beat least 50% of afull-timeProgrammedirector’sdiscretion as towhen residencycompleteN/SMustsatisfactorilycomplete anaccreditedpostgraduatetrainingprogrammeMaximumof 1 yearoff formaternityleaveMustcomplete anaccreditedpostgraduatetrainingprogrammeand examinationsMaximumof 1 yearoff formaternityleavePart-timework generallyapproved if50–80% offull-timeN/S60%patientcontactFrenchagency (e.g. university). Table 3 shows the possibilityof part-time work, including the need forexplicit special approval.All regions required new doctors to work inpractice settings approved either by a postgraduatemedical body (Australia, Ireland, theUK), the Medical Council (NZ), or a university(Canada).Training during the first postgraduate year variedin delivery and was country-specific. Australia,NZ and the UK had intern education providedby the employing hospital, whereas Canadaand Ireland had a university-based postgraduateprogramme. All regions within Australia havetheir hospital-based training overseen by anindependent medical training institute. In NZthe hospital-based training is overseen by the NZMedical Council. In the UK, a postgraduate foundationprogramme is undertaken in the employinghospital, and is overseen by local independentmedical bodies known as postgraduate deaneries;these are unrelated to undergraduate (medicalschool) deans.DiscussionThis research project made an internationalreview of the flexibility of registration requirementsfor new medical graduates who wish toundertake paid employment and training on apart-time basis, as there is considerable internationalmovement in the junior doctor workforce.The research was limited to the provisionalregistration period, as this period may have theleast flexibility in working conditions but thegreatest consistency among the study countries,allowing comparisons to be made. The mainresult from this research was that there are manysimilarities between the study countries intheir approaches to junior doctors with regard toregistration requirements in the first postgraduateyear. We could find no previous research support-278 VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE
ORIGINAL SCIENTIFIC PAPErSquantitative researchTable 2. Common themes for registration requirement restrictions in 20 regionsTheme No. of regions % of regionsMust complete postgraduate requirements 11 55%Full-time component to training required 5 25%Minimum part-time requirement stated 3 15%Rotation length specified 5 25%ing this result but it is important because of theincreasing globalisation of the medical workforce,particularly early in doctors’ careers.Flexibility of registration requirements wasindicated by the value accorded to allowing parttimework and by having limited prior approvalrules. We looked for guidelines that clearlystated how to meet registration requirements,including minimum requirements for part-timework, maximum time allowed for an extendedprovisional registration period, and whetherany full-time component is required. Additionalsigns of a flexible registration body may includeguidance for new medical graduates on work–lifebalance, how to job-share, and how to balanceservice with training requirements when workingpart-time.While registration requirements may be flexible,the ability to work part-time also dependson the flexibility of workplaces to accommodatepart-time doctors. In the traditional hospitalestablishment, shifting from the ‘house doctor’,available 24 hours a day, to ‘part-time’ doctormay be difficult. Well-linked teams and effectivejob-sharing may ease this transition and facilitatehealthier working hours. In many countries governmentregulations are already impacting hoursof work and forcing change. 16 Few regions hadthis type of information explicitly stated. Emailsfor further information were frequently misconstruedas from an international medical graduateseeking registration or employment advice, ratherthan from a researcher seeking information.Across all study regions there are similarities inmedical registration requirements, the primaryone being that doctors must be registered to practisemedicine. A provisional registration periodapplies to all study countries except Canada,where an educational registration is applicablefor doctors engaged in vocational training. Mostregions (65%) had a provisional registration periodof one year, even if they had foundation or coretraining periods of two years. Most regions allowedextensions of this provisional registrationperiod (73%), ranging from two to four years forcompletion. Restrictions to extension had severalcommon themes; the most common was thatdoctors must complete postgraduate requirementsduring the extended period. Part-time work waspossible in at least 75% of regions. Only tworegions stated part-time or job share options werenot possible. There was unanimous agreementthat basic training must occur within approvedpractice settings.There was a strong geographical distributionof results for some questions. Canada conductsmedical registration differently from the otherstudy countries, having neither a prevocationalpostgraduate period, nor a true equivalent for theprovisional registration period. Extensions of theprovisional training period were applicable onlyfor the other regions. Canadian literature referredTable 3. Potential to work part-time during provisional registration period in 20 regionsYes Possibly No Not stated TotalPart-time option possible 15 (75%) 2 (10%) 2 (10%) 1 (5%) 20 (100%)Special approval explicitly required 7 (35%) 2 (10%) 1 (5%) 10 (50%) 20 (100%)VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE 279
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BACK TO BACKvariable, with some lef
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continuing professional development
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ETHICSObesity, autonomy and the har
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ethicsCritiqueIf this account of th
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LETTERS TO THE EDITORSustaining chl
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BOOK REVIEWSof law and morals that
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RESEARCH GEMSCommunication skills a
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